A cross-sectional quantitative analysis of the readability and quality of online resources regarding thumb carpometacarpal joint replacement surgery

Background: Thumb carpometacarpal (CMC) joint osteoarthritis is a common degenerative condition that affects up to 15 % of the population older than 30 years. Poor readability of online health resources has been associated with misinformation, inappropriate care, incorrect self-treatment, worse health outcomes, and increased healthcare resource waste. This study aims to assess the readability and quality of online information regarding thumb carpometacarpal (CMC) joint replacement surgery.<br /> Methods: The terms "thumb joint replacement surgery", "thumb carpometacarpal joint replacement surgery", "thumb cmc joint replacement surgery", "thumb arthroplasty", "thumb carpometacarpal arthroplasty", and "thumb cmc arthroplasty" were searched in Google and Bing. Readability was determined using the Flesch Reading Ease Score (FRES) and the Flesch-Kincaid Reading Grade Level (FKGL). FRES >65 or a grade level score of sixth grade and under was considered acceptable. Quality was assessed using the Patient Education Materials Assessment Tool (PEMAT) and a modified DISCERN tool. PEMAT scores below 70 were considered poorly understandable and poorly actionable.<br /> Results: A total of 34 websites underwent qualitative analysis. The average FRES was 54.60 f 7.91 (range 30.30-67.80). Only 3 (8.82 %) websites had a FRES score >65. The average FKGL score was 8.19 f 1.80 (range 5.60-12.90). Only 3 (8.82 %) websites were written at or below a sixth-grade level. The average PEMAT percentage score for understandability and actionability was 76.82 f 9.43 (range 61.54-93.75) and 36.18 f 24.12 (range 0.00-60.00) respectively. Although 22 (64.71 %) of websites met the acceptable standard of 70 % for understandability, none of the websites met the acceptable standard of 70 % for actionability. The average total DISCERN score was 32.00 f 4.29 (range 24.00-42.00). Conclusions: Most websites reviewed were written above recommended reading levels. Most showed acceptable understandability but none showed acceptable actionability. To avoid the negative outcomes of poor patient understanding of online resources, providers of these resources should optimise accessibility to the average reader by using simple words, avoiding jargon, and analysing texts with readability software before publishing the materials online. Websites should also utilise visual aids and provide clearer pre-operative and post-operative instructions.