Readability of Online Hand Surgery Patient Educational Materials: Evaluating the Trend Since 2008.

PURPOSE: Online patient educational materials have historically been written at a higher-than-recommended sixth grade reading level. The objectives of this study were to assess the readability of online hand surgery patient educational materials from the official online patient resource website of the American Society for Surgery of the Hand (ASSH) and to compare changes in the readability of the current ASSH online patient educational materials with those in 2008 and 2015. METHODS: An internet-based study of all 88 English language patient educational materials on HandCare.org, the official online patient resource website of the ASSH, was performed. The readability of each article was assessed using the Flesch reading ease formula, Flesch-Kincaid grade level, Coleman-Liau index, Gunning-Fog index, and Simple Measure of Gobbledygook grade level. To evaluate the trend in the readability of ASSH online hand surgery patient educational materials, the Flesch-Kincaid grade levels of articles published in 2020 were compared with those of data published in 2008 and 2015. RESULTS: The average Flesch reading ease score of the patient educational materials was 57.6, which is at the high-school reading level. The average reading grade level of patient educational materials ranged from 9.0 to 12.3 depending on the readability metric used. The average Flesch-Kincaid grade level of all the ASSH patient educational materials was 9.8 in 2020, which is significantly better than 10.4 in 2008 but significantly worse than 8.5 in 2015. CONCLUSIONS: Online hand surgery patient educational materials continue to be written for the general public at a higher-than-recommended reading grade level. There has been no substantial improvement in the readability of online hand surgery patient educational materials since 2008. CLINICAL RELEVANCE: Improvements are needed in the readability of online patient educational materials to ensure that patients with all health literacy levels are able to comprehend and benefit from health information.

Impact of Conventional and Open Access Publications in Orthopaedic Surgery.

INTRODUCTION: The academic impact of open access publications compared with conventional publications in orthopaedic surgery is not well described. The primary objective of this study was to compare the number of academic citations and social media posts between recent conventional and open access publications in orthopaedic surgery. Secondary objectives of this study were (1) to determine the correlation between academic citations and social media posts and (2) to study the trend of academic citations and social media posts over time. METHODS: An internet-based study was performed on 3,720 articles from five high-impact orthopaedic journals and their associated open access journals from March 2017 to February 2019, including 2,929 conventional and 791 open access journal publications. Academic citations were quantified using Google Scholar and Web of Science, and social media mentions using Twitter. The Mann-Whitney U test was used for comparisons of nonparametric data, and the Spearman rank correlation coefficient was calculated for correlations. RESULTS: The average number of academic citations per article was 10.1 on Google Scholar and 6.0 on Web of Science. The average number of Twitter posts per article was 1.6. Conventional publications had markedly more citations than open access publications on Google Scholar and Web of Science. Open access publications had markedly more Twitter posts, but the effect size was small and unimportant. Academic citations were weakly correlated with social media posts. On average, orthopaedic publications accrue 7.4 citations per year on Google Scholar and 4.6 citations per year on Web of Science. DISCUSSION: Our findings support a citation advantage to conventional publication. Publications in open access journals are cited less frequently and less rapidly compared with those in conventional journals. The use of social media for orthopaedic research is effectively equivalent between conventional and open access journals and continues to grow. LEVEL OF EVIDENCE: N/A.