Lost in Translation: Preoperative Orthopaedic Education Materials Significantly Exceed Recommended Reading Levels

Area of Science:

• Orthopaedic Surgery
• Patient Education
• Health Literacy

Background:

• National guidelines advocate for patient education materials at or below a 6th-grade reading level.
• Poor understanding of care plans post-orthopaedic surgery is linked to adverse outcomes like lower satisfaction and increased complications.
• This study assesses the language and readability of orthopaedic patient education materials from Elsevier, distributed via the Epic electronic health record system.

Purpose of the Study:

• To evaluate the language availability and readability of orthopaedic patient education materials.
• To compare the readability of these materials against national guidelines and their easy-to-read versions.
• To identify trends in readability over time.

Main Methods:

• 806 orthopaedic patient education documents were extracted from Epic in English and Spanish.
• Readability was assessed using validated English and Spanish scoring systems.
• Statistical analyses, including t-tests and linear regression, were used for comparisons and trend analysis.

Main Results:

• English materials averaged an 8.6-grade reading level, Spanish 5.8; 100% of English and 27% of Spanish exceeded the 6th-grade recommendation.
• Preoperative and musculoskeletal oncology materials showed the highest reading levels.
• Easy-to-read versions, available for only 11% of documents, reduced the grade level but often still exceeded recommendations.

Conclusions:

• Elsevier's orthopaedic patient education materials, particularly preoperative ones, frequently exceed recommended reading levels.
• Limited availability of simplified and translated materials impedes patient comprehension and adherence.
• AI-driven solutions could enhance the creation and accessibility of simplified patient education materials.