New research has found that patient education materials are written at too high of a reading level for patients.
Patient Education Materials Generally Un-Readable

The study, “Readability of Patient Education Materials From the Web Sites of Orthopedic Implant Manufacturers,” appears in the December 2017 edition of The Journal of Arthroplasty.
Paul H. Yi, a radiology resident at the Johns Hopkins University, was a co-author on the study. Other authors include Craig Della Valle, M.D., Michael B. Cross, M.D., Khalil I. Hussein, M.D. and Meghan M. Yi, B.A.
Dr. Yi commented to OTW, “We have noticed that communicating healthcare information to our patients is difficult and that much of what we wish to convey is ‘lost in translation.’ One proposed solution to this issue of education our patients is written materials.”
“These materials, however, have unfortunately been shown to be written at a level too high for the average patient, particularly those endorsed by the major orthopaedic societies.”
“We noticed that most of the major orthopaedic implant companies produced patient educational materials and were curious if these too were written at a level too high for most patients or if they were perhaps a better source of education.”
In the study article, the authors wrote, “All patient education article available in 2013 from the web sites of the 5 largest orthopedic implant manufacturers were identified. Each article was evaluated the Flesch-Kincaid (FK) readability test. The number of articles with readability ≤ the eight-grade level (average reading ability of US adults) and the sixth-grade level (recommended level for patient education materials) was determined.”
Dr. Yi told OTW, “The FK readability test is a formula which estimates the grade level in school required to adequately read and comprehend a piece of written text. It takes into account total numbers of words, sentences, and syllables in a text and has been validated throughout the orthopaedic and general medical literature for assessment of text readability.”
“The readability of materials across all companies were written at a level too high for the average patient; few were written at or below the NIH-recommended [National Institutes of Health] sixth-grade reading level or the eighth-grade reading level (average reading level of a US adult). While there was significant variation between the companies, all were still written at too high of a level for most patients.”
“Much work remains to improve patient educational material readability!
Our study shows that this is a problem not just amongst the orthopaedic societies, but amongst the orthopaedic implant companies, as well. While recent studies have shown improvements in orthopaedic patient educational material readability, we are still a ways off from reaching the NIH-recommended sixth-grade reading levels.”
“Patient education is important to inform our patients and ally their concerns, as well as to build the physician-patient relationship. We are making progress in our efforts to write readable patient educational materials, but have room to improve. We hope that we continue to pursue this worthwhile effort for the benefit of our patients.”

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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