Assessing online patient education materials for major lower extremity amputation

The aim of the study was to assess the readability, quality, transparency, and clinical content of online patient education materials related to major lower extremity amputation (LEA) due to vascular disease.

We conducted a descriptive audit of online patient education materials on major LEA due to vascular disease. Using Google Chrome Incognito mode, we searched eight search terms ("leg amputation," "below-knee amputation," "above-knee amputation," "amputation for poor circulation," "amputation for peripheral artery disease," "vascular surgery leg amputation," "diabetic leg amputation," "foot amputation surgery") and reviewed the first 30 results per term to identify relevant websites and patient education. Readability was assessed using five validated tools (Flesch-Kincaid, Gunning Fog, SMOG, Coleman-Liau, Automated Readability index). Quality was assessed using JAMA and DISCERN criteria. Content was analyzed for key clinical elements.

Of 240 websites screened, 58 were included. Mean readability scores exceeded the recommended sixth-grade level: Flesch-Kincaid (10.47), Gunning Fog (12.55), SMOG (12.95), Coleman Liau (10.83), Automated readability index (9.86). The average JAMA Benchmark score was 1.54/4, with 59% reporting currency, 36% disclosure, 33% reporting authorship, and 26% attribution. DISCERN scores averaged 46.8/80 ("fair" quality). Content coverage of key clinical concepts was low: 26% reported alternative procedures, 33% reported surgical risks, 41% operation description, 50% quality of life, 67% prosthetics/mobility aids, 74% postoperative care, and 74% indications. DISCERN and content scores were moderately correlated (r = 0.5), Flesch-Kincaid and SMOG were highly correlated (r = 1.0). Quality and readability scores were uncorrelated, suggesting reliable sources may remain hard to understand.

Despite the burden of major LEA, online patient education resources often have low readability and quality and lack critical content. There is an urgent need to develop high-quality, accessible materials to support education and shared decision-making.