Patient education for carpal tunnel syndrome: analysis of readability

Abstract

Background: The National Institutes of Health and American Medical Association recommend a sixth grade reading level for patient-directed content. This study aims to quantitatively evaluate the readability of the most commonly used resources for surgical treatment of carpal tunnel syndrome.

Methods: A web search for "carpal tunnel surgery" was performed using an Internet search engine, and the 13 most popular sites were identified. Relevant, patient-directed articles immediately accessible from the main site were downloaded and formatted into plain text. A total of 102 articles were assessed for readability using ten established analyses: first overall, then by website for comparison.

Results: Patient information about carpal tunnel surgery had an overall average reading level of 13.1. Secondary analysis by website revealed a range of mean readability from 10.8 (high school sophomore level) to 15.3 (university junior level). All sites exceeded the recommended sixth grade reading level.

Conclusions: Online patient resources for carpal tunnel surgery uniformly exceed the recommended reading level. These are too difficult to be understood by a large portion of American adults. A better understanding of readability may be useful in tailoring more appropriate resources for average patient literacy.

Keywords: Carpal tunnel syndrome; Health literacy; Online resources; Patient education; Readability.

Fig. 1

Fry readability graph. For each article, the average number of syllables and average number of sentences per hundred words are plotted on the X- and Y-axes, respectively. The majority of articles fall well above the recommended sixth grade level

Fig. 2

Raygor readability estimate. Each mark indicates an article’s readability as a function of the average number of sentences and number of long words per hundred words. Raygor analysis reveals that all 102 articles were found to have a higher required reading level than that recommended by the AMA and NIH

Fig. 3

Mean reading level by website. All 13 sites exceed the recommended sixth grade reading level

Fig. 4

Mean Flesch Reading Ease score by website. FRE Index scores are shown. These are reported on a scale from 0 to 100 (Y-axis), where 100 indicates the easiest to read information. Average documents in “plain English” should score between 60 and 70; websites about carpal tunnel surgery ranged from 29 to 58