Most patient education materials on shoulder conditions from the American Academy of Orthopaedic Surgeons exceed recommended readability levels

Background: A growing number of patients use the internet to learn about their conditions and management options, but there may exist a disconnect between the readability of online education materials and a patient's health literacy. This issue is of particular relevance for shoulder conditions, where even with traumatic injuries (eg, clavicle fracture, shoulder dislocation), treatment is discretionary, directed primarily at quality of life, and therefore highly preference-sensitive.The purpose of this study was to utilize multiple readability algorithms to calculate the readability of the American Academy of Orthopaedic Surgeons (AAOS) patient education materials pertaining to diseases and conditions of the shoulder. Methods: Online patient education articles from the AAOS pertaining to diseases and conditions of the shoulder were reviewed. The articles were modified for analysis using Readability Pro and readability scores were computed using the following 9 algorithms: Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning Fog Index, Coleman-Liau Index, Simple Measure of the Gobbledygook Index (SMOG), Automated Readability Index, FORCAST, and New Dale and Chall Index. A list of suggested word changes to improve the readability of included articles was compiled from Readable Pro. The average number of illustrations (images and/or videos) included per article was documented. Results: Twenty-eight articles were included for analysis. For each of the algorithms studied, the average scores were as follows: Flesch Kincaid Grade Level was 8.8 ± .8 range, 7.2-10.2; recommended score: ≤ 8.0, Flesch Reading Ease 54.3 ± 5.3 range, 45.3-64.1; recommended score: ≥ 60, Gunning Fog 10.8 ± 1.2 range, 8.3-13.1; recommended score: ≤ 8.0, Coleman-Liau 11.2 ± .9 range, 9.2-12.9; recommended score: ≤8.0, SMOG index 11.4 ± .8 range, 9.2-12.9; recommended score: ≤ 8.0 , Automated Readability Index 8.4 ± .8 range, 6.9-10.0; recommended score: ≤ 8.0, FORCAST 11.2 ± .4 range, 10.2-12.0; recommended score: ≤ 9.0, and New Dale and Chall Index 5.8 ± .5 range, 4.9-7.2 recommended score: ≤ 6.0-6.9. The average number of illustrations per article was 4.5 ± 3.1 range, 1-14. Conclusion: The readability of most patient education materials from the AAOS pertaining to diseases and conditions of the shoulder is higher than recommended across a variety of algorithms. Efforts to revise the readability of online education materials are important to facilitate shared decision-making, particularly in practice settings where most decisions are preference-sensitive.