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Readability, Suitability, and Complexity of Online Resources for Lower Extremity Reconstruction

Hughes, Christopher D., MD, MPH*; Tran, Bao Ngoc N., MD*; Rinkinen, Jacob, MD*; Lee, Bernard T., MD, MBA, MPH*; Iorio, Matthew L., MD

doi: 10.1097/SAP.0000000000001636
Circumspectus Medicinae: Texts and Contexts

Background Surgical options for lower extremity reconstruction frequently include a decision between autologous free flap reconstruction and amputation. Patients rely on health education materials for information before making treatment decisions. This study evaluates the quality of online health information for lower extremity reconstruction.

Methods We identified the top 10 Web sites for “leg amputation” and “leg free flap reconstruction.” Three validated tools were used to evaluate literacy demand of materials, including (1) the Simple Measure of Gobbledygook for readability; (2) the Peter Mosenthal and Irwin Kirsch readability formula for complexity of nonprose materials such as list, graphs, charts; and (3) the Centers for Disease Control and Prevention's Clear Communication Index (Index). Differences in mean between the 2 groups were compared using Student t test.

Results Average Simple Measure of Gobbledygook reading grades approximated 12th-grade level and were similar between the 2 groups. This is above the recommended level of sixth-grade health literature. Complexity scores for nonprose materials of these groups were within recommended range and corresponded to very low complexity at a fourth- to seventh-grade level. The Centers for Disease Control and Prevention index was higher for amputation literature compared with free flap reconstruction (70% vs 54%), but the difference was not statistically significant.

Conclusions Overall, online health resources for lower extremity amputation and free flap reconstruction do not meet the standard for quality and accessible health information. Free flap reconstruction resources are scarce and complex. Patients facing decisions about extremity reconstruction may not have appropriate online health resources available to them to make informed decisions.

From the *Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and

Division of Plastic and Reconstructive Surgery, University of Colorado Hospital, Denver, CO.

Received November 29, 2017, and accepted for publication, after revision August 6, 2018.

Conflicts of interest and sources of funding: none declared.

Reprints: Matthew L. Iorio, MD, University of Colorado, Anschutz Medical Center Division of Plastic and Reconstructive Surgery, 12631 East 17th Ave, C309 Aurora, CO 80045. E-mail:

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