A standardised method for improving patient education material readability for orthopaedic trauma patients.

PURPOSE: While the National Institutes of Health and American Medical Association recommend patient education materials (PEMs) should be written at the sixth-grade reading level or below, many patient education materials related to traumatic orthopaedic injuries do not meet these recommendations. The purpose of this study is to create a standardised method for enhancing the readability of trauma-related orthopaedic PEMs by reducing the use of ≥ three syllable words and reducing the use of sentences >15 words in length. We hypothesise that applying this standardized method will significantly improve the objective readability of orthopaedic trauma PEMs. METHODS: A patient education website was queried for PEMs relevant to traumatic orthopaedic injuries. Orthopaedic trauma PEMs included (N = 40) were unique, written in a prose format, and <3500 words. PEM statistics, including scores for seven independent readability formulae, were determined for each PEM before and after applying this standard method. RESULTS: All PEMs had significantly different readability scores when comparing original and edited PEMs (p < 0.01). The mean Flesch Kincaid Grade Level of the original PEMs (10.0 ± 1.0) was significantly higher than that of edited PEMs (5.8 ± 1.1) (p < 0.01). None of the original PEMs met recommendations of a sixth-grade reading level compared with 31 (77.5%) of edited PEMs. CONCLUSIONS: This standard method that reduces the use of ≥ three syllable words and <15 word sentences has been shown to significantly reduce the reading-grade level of PEMs for traumatic orthopaedic injuries. Improving the readability of PEMs may lead to enhanced health literacy and improved health outcomes.

Readability of spine-related patient education materials: a standard method for improvement.

PURPOSE: Orthopaedic patient education materials (PEMs) have repeatedly been shown to be well above the recommended reading level by the National Institute of Health and American Medical Association. The purpose of this study is to create a standardized method to improve the readability of PEMs describing spine-related conditions and injuries. It is hypothesized that reducing the usage of complex words (≥ 3 syllables) and reducing sentence length to < 15 words per sentence improves readability of PEMs as measured by all seven readability formulas used. METHODS: OrthoInfo.org was queried for spine-related PEMs. The objective readability of PEMs was evaluated using seven unique readability formulas before and after applying a standardized method to improve readability while preserving critical content. This method involved reducing the use of > 3 syllable words and ensuring sentence length is < 15 words. Paired samples t-tests were conducted to assess relationships with the cut-off for statistical significance set at p < 0.05. RESULTS: A total of 20 spine-related PEM articles were used in this study. When comparing original PEMs to edited PEMs, significant differences were seen among all seven readability scores and all six numerical descriptive statistics used. Per the Flesch Kincaid Grade level readability formula, one original PEM (5%) versus 15 edited PEMs (75%) met recommendations of a sixth-grade reading level. CONCLUSION: The current study shows that using this standardized method significantly improves the readability of spine-related PEMs and significantly increased the likelihood that PEMs will meet recommendations for being at or below the sixth-grade reading level.

Reducing the Use of Complex Words and Reducing Sentence Length to <15 Words Improves Readability of Patient Education Materials Regarding Sports Medicine Knee Injuries.

Purpose: To develop a standardized method to improve readability of orthopaedic patient education materials (PEMs) without diluting their critical content by reducing the use of complex words (≥3 syllables) and shortening sentence length to ≤15 words. Methods: OrthoInfo, a patient education website developed by the Academy of American Orthopedic Surgeons, was queried for PEMs relevant to the care of athletic injuries of the knee. Inclusion criteria were PEMs that were unique, pertained to topics of knee pathology in sports medicine, and written in a prose format. Exclusion criteria were information presented in video or slideshow format, or topics not pertaining to knee pathology in sports medicine. Readability of PEMs was evaluated using 7 unique readability formulas before and after applying a standardized method to improve readability while preserving critical content (reducing the use of ≥3 syllable words and ensuring sentence length is ≤15 words). Paired samples t-tests were conducted to assess the relationship between reading levels of the original PEMs and reading level of edited PEMs. Results: Reading levels differed significantly between the 22 original PEMs and edited PEMs across all 7 readability formulas (P < .01). Mean Flesch Kincaid Grade Level of original PEMs (9.8 ± 1.4) was significantly increased compared to that of edited PEMs (6.4 ± 1.1) (P = 1.9 × 10-13). 4.0% of original PEMs met National Institutes of Health recommendations of a sixth-grade reading level compared with 48.0% of modified PEMs. Conclusions: A standardized method that reduces the use of ≥3 syllable words and ensures sentence length is ≤15 words significantly reduces the reading-grade level of PEMs for sports-related knee injuries. Orthopaedic organizations and institutions should apply this simple standardized method when creating PEMs to enhance health literacy. Clinical Relevance: The readability of PEMs is important when communicating technical material to patients. While many studies have suggested strategies to improve the readability of PEMs, literature describing the benefit of these proposed changes is scarce. The information from this study details a simple standardized method to use when creating PEMs that may enhance health literacy and improve patient outcomes.

Predictive Factors for Failure of Intraarticular Injection in Management of Adhesive Capsulitis of the Shoulder.

Intraarticular (IA) corticosteroid injections have been demonstrated to be an effective management for adhesive capsulitis in both the short- and mid-term. Yet, certain patients fail to improve both subjectively and clinically. This study aims to identify predictive factors for treatment failure of IA injections in management of adhesive capsulitis. A retrospective review found 533 patients undergoing IA corticosteroid or IA NSAID injection for adhesive capsulitis between June 2015 and May 2020 at a single healthcare institution. Patient demographics characteristics, comorbidities, pain scores, and range of motion were compared. Treatment failure was defined as need for subsequent IA injection within 6 months or progression to surgical management within 12 months. 152 patients (28.52%) experienced treatment failure of IA corticosteroid injection. Pre-injection pain scores were greater for those who experienced treatment failure (5.40 vs. 4.21, p < 0.05). Post-injection pain scores were greater for those who experienced treatment failure (3.77 vs. 2.17, p < 0.01). Reduced post-injection external rotation in abduction also predicted treatment failure (56.88° vs. 70.22°, p < 0.01). IA corticosteroid injections are associated with increased rates of failure and progression to surgical management when patients present with increased pain levels as well as with less improvement in pain levels and ROM following injection.

Blood Transfusion can be Avoided in Single-Anesthetic Bilateral Total Knee Arthroplasty.

BACKGROUND: Female gender and surgical drain use have been associated with an increased transfusion risk following single-anesthetic bilateral total knee arthroplasty (SBTKA). This study evaluated allogenic blood transfusion rates among female and male patients undergoing SBTKA with intraoperative tourniquet, tranexamic acid and contemporary blood transfusion thresholds but without surgical drain use. METHODS: We performed a retrospective electronic medical record review for 125 consecutive patients undergoing SBTKA (250 knees) between May 1, 2015 and July 10, 2021. Patient demographic characteristics (age, gender, body mass index, American Society of Anesthesiologists), preoperative and postoperative hemoglobin levels, perioperative transfusions, operative time, and hospital length of stay were compared between 76 female (60.8%) and 49 male (39.2%) patient cohorts using paired Student's t-test or Fisher's exact test with a P value <.05 for significance. RESULTS: No patient in either gender-based cohort received a perioperative allogeneic or autologous blood transfusion (P = 1). There were no significant differences in patient demographic features or medical comorbidities. Male patients had significantly higher mean preoperative (14.7 versus 13.7 g/dL, P < .01) and postoperative (12.7 versus 11.8 g/dL, P < .01) hemoglobin levels and a shorter mean hospital length of stay (2.5 versus 3.0 days, P < .01). There was no difference in the mean operative time (154.7 versus 150.7 minutes, P = .34) or change in the hemoglobin level (2.1 versus 1.9 g/dL, P = .27). CONCLUSION: SBTKA can be performed with a limited risk of perioperative transfusion with a combination of intraoperative tourniquet, tranexamic acid, conservative blood transfusion criteria, and avoidance of postoperative drain use. Study results were not influenced by patient gender. LEVEL OF EVIDENCE: This is a level III, retrospective cohort study.