An Evaluation of Readability of Information on the Internet regarding Total Ankle Replacement

Background: Health literacy is the ability to understand basic health information and use this information to enhance health. To ensure accessibility, it's suggested that health literature has a reading grade level equivalent to the American sixth grade. However, previous studies show that this rarely occurs. Total Ankle Replacement (TAR) technology is a complex procedure that may be challenging to explain to the patient. Thus, many patients will turn to the internet for more information and as a ‘quasi-second opinion’. The study aims to evaluate the readability of information on the internet with regards to Total Ankle Replacement. Material and Methods: 110 websites from the two main search engines (Google and Bing) were assessed using the terms ‘total ankle replacement’ and ‘total ankle arthroplasty. Once exclusion criteria were applied, 36 unique websites were categorized and underwent analysis using readability software (WEB FX readability tool). The websites were assessed for readability using the Fleisch Reading Ease Score (FRES) and the Reading Grade Level (RGL). A score of greater than 65 for FRES and an RGL of six or less were considered acceptable. Results: The mean FRES score was 54.95 (SD: ± 13.2); this was significantly below the recognized acceptable standard score of 65 (P<.0001). An ANOVA conducted showed a significant difference between FRES scores based on categories(P=.041) with post-hoc testing showing that the difference between commercial and non-physician scores was the most significant (P=.016; CI:3.84-61.66). The mean RGL was 8.31 (SD: ± 1.95). One-way t-tests showed that these scores were significantly higher than the acceptable standard (P<.0001; CI:1.64-2.97). ANOVA testing showed a significant difference based on category (P=.028) with post hoc testing showing a significant difference between nonphysician and commercial scores (P=.012, CI:0.71-9.33). Conclusion: The majority of the websites are beyond the comprehension levels of the general public. This may lead to serious ramifications for consent as well as post-operative compliance