Quality Analysis of Online Resources for Patients with Peripheral Artery Disease

Background: The burden of peripheral artery disease is significant for public health but the readily available on-line information on the disease is poorly studied. This study seeks to evaluate the quality and readability of patient resources and identify gaps that appear in the top search results for peripheral artery disease. Methods: Internet searches were performed for "PAD" and "Peripheral Artery Disease" and "PVD" on three search engines and two metasearch engines. The top 30 websites from each search engine were compiled, screened, and evaluated across four categories of information to assess overall quality: accountability, interactivity, structure, and content. Four indices were used to evaluate readability of the text for the viewer. Statistical analyses was performed using Rstudio with ANOVA. Results: Sixty-three websites met inclusion criteria, of which 25 were open access (34.9%), 30 were from hospital/healthcare organization (48%), 5 were from a governmental agency (8%), 4 were industry sponsored (6%), and 2 were from professional medical societies (3%). Median total quality score was 19 out of 47 (IQR, 15-30): of the components of this score, accountability was 5 out of 17 (2-10), interactivity was 2 out of 5 (2.0-2.0), site structure was 3 out of 4 (2.5-3.0), and site content was 11 out of 21 (7-14). Total score varied significantly by organization type (P = 0.007). Open access (30, 17-34, median, IQR) and governmental agency (30, 29-31) websites scored the highest while hospital/healthcare organization (16, 14v21) websites scored the lowest. Overall readability was low with a median Flesch-Kincaid Grade Level Score of 10.7 (IQR, 10-12). Using this index, only one website (1.6%) was written below the recommended 6th grade reading level. Conclusion: Freely available online patient education materials for peripheral artery disease are poor, have varying quality, and are largely written at a level higher than that of an average US adult thus depriving the patient from understanding the existing information. We recommend that the vascular surgery community re-examine the current offering and provide improved readable websites to patients to facilitate patient education and shared decision making.