Readability and Content of Online Materials for Dupuytren's Contracture

Background: Dupuytren’s contracture is a common disorder involving fibrosis of the palmar fascia. Online content describing the disease and its treatment have not been well-characterized. As patients are predominantly using online materials to gather health care information, it is imperative to assess the readability and appropriateness of this content. The recommended grade level for patient educational materials is sixth grade according to the National Institutes of Health (NIH) and the American Medical Association (AMA).¹ It is also critical that online content address both surgical and nonsurgical treatment options for Dupuytren’s contracture to ensure an adequate foundation for patient education. This study aims to assess the readability and content of online patient resources for Dupuytren’s contracture.        

Methods: The largest public search engine, Google, was queried using the term “dupuytren’s contracture surgery” on February 26, 2016. Location filters were disabled and sponsored results excluded to avoid any inadvertent search bias. The 10 most popular websites were identified and all relevant, patient-directed information within one click from the original site was downloaded and saved as plain text. Readability was analyzed using five established analyses (Readability-score.com).

Results: Analysis of ten websites demonstrates an average grade level of at least 11th grade. No material was at the recommended sixth to seventh grade reading level (Flesch-Kincaid, 10.2; Gunning-Fog, 13.1; Coleman-Liau, 14.4; SMOG 10.0; Automated Readability, 9.7; Average Grade Level, 11.5). Overall Flesch Reading Ease Index was 46.4, indicating reading ease above seventh grade level, which is a score of at least 70. None of the websites explained all of the following treatments: steroid injections, collagenase injections, needle fasciotomy, fat grafting, open fasciotomy, fasciectomy, and dermatofasciectomy. 

Conclusions: Online materials available for treatment of Dupuytren’s contracture are above recommended reading levels and do not include a comprehensive explanation of treatment options, which may prevent appropriate decision-making in patients considering treatment for this condition. Surgeons should be cognizant of available online patient materials and make efforts to develop and provide more appropriate materials.