The American Medical Association (AMA) and National Institutes of Health (NIH) currently suggest that health care materials be written at a sixth-grade reading level. Our study investigates the readability of online information on Achilles rupture and reconstruction. Achilles tendon rupture, Achilles tendon repair, and Achilles tendon reconstruction were queried using advanced search functions of Google, Bing, and Yahoo!. Individual websites and text from the first 3 pages of results for each search engine were recorded and categorized as physician based, academic, commercial, government and nongovernmental organization, or unspecified. Individual readability scores were calculated via 6 different indices: Flesch-Kincaid grade level, Flesch Reading Ease, Gunning Fog, SMOG, Coleman-Liau index, and Automated Readability Index along with a readability classification score and average grade level. A total of 56 websites were assessed. Academic webpages composed the majority (51.8%), followed by physician-based sources (32.1%). The average overall grade level was 10.7 ± 2.54. Academic websites were written at the highest-grade level (11.5 ± 2.77), significantly higher than physician-based websites (P = .040), and only 2 were written at, or below, a sixth-grade reading level. Currently, online information on Achilles tendon rupture and reconstruction is written at an inappropriately high reading level compared with recommendations from the AMA and NIH.
YangXMengHQuanQPengJLuSWangA. Management of acute Achilles tendon ruptures: a review. Bone Joint Res. 2018;7:561-569. doi:10.1302/2046-3758.710.BJR-2018-0004.R2
2.
LanttoIHeikkinenJFlinkkiläTOhtonenPLeppilahtiJ. Epidemiology of Achilles tendon ruptures: increasing incidence over a 33-year period. Scand J Med Sci Sports. 2015;25:e133-e138. doi:10.1111/sms.12253
3.
GanestamAKallemoseTTroelsenABarfodKW. Increasing incidence of acute Achilles tendon rupture and a noticeable decline in surgical treatment from 1994 to 2013: a nationwide registry study of 33 160 patients. Knee Surg Sports Traumatol Arthrosc. 2016;24:3730-3737. doi:10.1007/s00167-015-3544-5
4.
HoGTantigateDKirschenbaumJGreisbergJKVossellerJT. Increasing age in Achilles rupture patients over time. Injury. 2017;48:1701-1709. doi:10.1016/j.injury.2017.04.007
5.
WillitsKAmendolaABryantD, et al. Operative versus nonoperative treatment of acute Achilles tendon ruptures. J Bone Joint Surg Am. 2010;92:2767-2775. doi:10.2106/JBJS.I.01401
6.
SoroceanuASidhwaFAarabiSKaufmanAGlazebrookM. Surgical versus nonsurgical treatment of acute Achilles tendon rupture. J Bone Joint Surg Am. 2012;94:2136-2143. doi:10.2106/JBJS.K.00917
7.
MattilaVMHuttunenTTHaapasaloHSillanpääPMalmivaaraAPihlajamäkiH. Declining incidence of surgery for Achilles tendon rupture follows publication of major RCTs: evidence-influenced change evident using the Finnish registry study. Br J Sports Med. 2015;49:1084-1086. doi:10.1136/bjsports-2013-092756
SheppardEDHydeZFlorenceMNMcGwinGKirchnerJSPonceBA. Improving the readability of online foot and ankle patient education materials. Foot Ankle Int. 2014;35:1282-1286. doi:10.1177/1071100714550650
11.
HaddenKPrinceLYSchnaekelACouchCGStephensonJMWyrickTO. Readability of patient education materials in hand surgery and health literacy best practices for improvement. J Hand Surg Am. 2016;41:825-832. doi:10.1016/j.jhsa.2016.05.006
12.
National Cancer Institute. Clear & Simple. Developing Effective Print Materials for Low—Literate Readers. Bethesda, MD: National Cancer Institute; 1994.
BadarudeenSSabharwalS. Assessing readability of patient education materials: current role in orthopaedics. Clin Orthop Relat Res. 2010;468:2572-2580. doi:10.1007/s11999-010-1380-y
US National Library of Medicine. How to write easy-to-read health materials. https://medlineplus.gov/etr.html. Accessed March 5, 2019.
17.
KüçükdurmazFGomezMMSecristEParviziJ. Reliability, readability and quality of online information about femoracetabular impingement. Arch Bone Jt Surg. 2015;3:163-168.
18.
RobertsHZhangDDyerGSM. The readability of AAOS patient education materials: evaluating the progress since 2008. J Bone Joint Surg Am. 2016;98:e70. doi:10.2106/JBJS.15.00658
EllsworthBPatelHKamathAF. Assessment of quality and content of online information about hip arthroscopy. Arthroscopy. 2016;32:2082-2089. doi:10.1016/j.arthro.2016.03.019
21.
Bruce-BrandRABakerJFByrneDPHoganNAMcCarthyT. Assessment of the quality and content of information on anterior cruciate ligament reconstruction on the Internet. Arthroscopy. 2013;29:1095-1100. doi:10.1016/j.arthro.2013.02.007
22.
StarmanJSGettysFKCapoJAFleischliJENortonHJKarunakarMA. Quality and content of Internet-based information for ten common orthopaedic sports medicine diagnoses. J Bone Joint Surg Am. 2010;92:1612-1618. doi:10.2106/JBJS.I.00821
23.
MehtaMPSwindellHWWestermannRWRosneckJTLynchTS. Assessing the readability of online information about hip arthroscopy. Arthroscopy. 2018;34:2142-2149. doi:10.1016/j.arthro.2018.02.039
24.
DaltonDMKellyEGMolonyDC. Availability of accessible and high-quality information on the Internet for patients regarding the diagnosis and management of rotator cuff tears. J Shoulder Elbow Surg. 2015;24:e135-e140. doi:10.1016/j.jse.2014.09.036
25.
FleschR. A new readability yardstick. J Appl Psychol. 1948;32:221-233.
26.
ColemanMLiauTL. A computer readability formula designed for machine scoring. J Appl Psychol. 1975;60:283-284. doi:10.1037/h0076540
PolishchukDLHashemJSabharwalS. Readability of online patient education materials on adult reconstruction web sites. J Arthroplasty. 2012;27:716-719. doi:10.1016/j.arth.2011.08.020
31.
BozicKJChanVValoneFHIIIFeeleyBTVailTP. Trends in hip arthroscopy utilization in the United States. J Arthroplasty. 2013;28(8, suppl):140-143. doi:10.1016/j.arth.2013.02.039
32.
BrophyRHGefenAMMatavaMJWrightRWSmithM V. Understanding of meniscus injury and expectations of meniscus surgery in patients presenting for orthopaedic care. Arthroscopy. 2015;31:2295-2300. doi:10.1016/j.arthro.2015.05.003
33.
RossiMJBrandJCProvencherMTLubowitzJH. The expectation game: patient comprehension is a determinant of outcome. Arthroscopy. 2015;31:2283-2284. doi:10.1016/j.arthro.2015.09.005
34.
WuJRMoserDKDeWaltDARayensMKDracupK. Health literacy mediates the relationship between age and health outcomes in patients with heart failure. Circ Heart Fail. 2016;9:e002250. doi:10.1161/CIRCHEARTFAILURE.115.002250
MurphyPWChessonALWalkerLArnoldCLChessonLM. Comparing the effectiveness of video and written material for improving knowledge among sleep disorders clinic patients with limited literacy skills. South Med J. 2000;93:297-304.
37.
AgarwalNHansberryDRSabourinVTomeiKLPrestigiacomoCJ. A comparative analysis of the quality of patient education materials from medical specialties. JAMA Intern Med. 2013;173:1257-1259. doi:10.1001/jamainternmed.2013.6060
