Anaesthesia for total hip and knee replacement: A review of patient education materials available online

Abstract

Background: Patients frequently consult the internet for health information. Our aim was to perform an Internet-based readability and quality control study using recognised quality scoring systems to assess the patient information available online relating to anaesthesia for total hip and knee replacement surgery. Methods: Online patient information relating to anaesthesia for total hip and knee replacement was identified using Google, Bing and Yahoo with search terms ‘hip replacement anaesthetic’, ‘knee replacement anaesthetic.’ Readability was assessed using Flesch Reading Ease (FRE), Flesch-Kincaid grade level (FKGL) and Gunning Fog Index (GFI). Quality was assessed using DISCERN instrument, Health On the Net Foundation seal, and Information Standard mark. Results: 32 websites were analysed. 25% were HONcode certified, 15.6% had the Information Standard. Mean FRE was 55.2±12.8. Mean FKGL was 8.6±1.9. Six websites (18.8%) had the recommended 6th-grade readability level. Mean of 10.4±2.6 years of formal education was required to read the websites. Websites with Information Standard were easier to read: FKGL (6.2 vs. 9, P < 0.001), GFI (8.8 vs. 10.7, P = 0.04), FRE score (64.2 vs. 9, P = 0.02). Mean DISCERN score was low: 40.3 ± 13. Conclusions: Overall, most websites were poor quality with reading levels too high for the target audience. Information Standard NHS quality mark was associated with improved readability, however along with HONcode were not found to have a statistically significant correlation with quality. Based on this study, we would encourage healthcare professionals to be judicious in the websites they recommend to patients, and to consider both the readability and quality of the information provided.

Description of the Content and Quality of Publicly Available Information on the Internet About Inhaled Volatile Anesthesia and Total Intravenous Anesthesia: Descriptive Study

“…Up to 80% of US adults have used the internet to search for health information [64], and many surgical patients have looked for information on general anesthesia on their own using web-based information [2]. Consistent with previous studies on websites on anesthesia-related topics [8][9][10][11][12][13][14][15], this study identified limitations in the availability of web-based information about general anesthesia. Although majority of the included websites provided a basic definition and description of general anesthesia, most failed to explain the benefits and drawbacks of general anesthesia compared with other potentially relevant choices (eg, sedation, regional anesthesia, and local anesthesia).…”

“…Unfortunately, the majority of the websites on anesthesia-related topics are not comprehensive, updated, and fully accurate [8][9][10][11][12][13][14][15]. In addition, although some high-quality and accurate websites about anesthesia exist, they do not always rise to the top of the search engine results [14].…”

“…In addition, although some high-quality and accurate websites about anesthesia exist, they do not always rise to the top of the search engine results [14]. Moreover, most websites on anesthesia-related topics are written at a reading level above the American Medical Association (AMA) recommended level of sixth grade [8,10,11,15,16]. In fact, the median readability level is around a 13.5 (IQR 12.0-14.6) grade level, at which only about 62% of US adults can easily understand [11,17].…”

“…In fact, the median readability level is around a 13.5 (IQR 12.0-14.6) grade level, at which only about 62% of US adults can easily understand [11,17]. There are some available website quality certifications developed by national organizations or independent foundations, but these are not always indicative of content quality [10]. In addition, patients have expressed concerns with the process of searching for web-based information about general anesthesia.…”

The Effect of Education Planned According to Health Literacy Level on Functionality, Problems Experienced, and Quality of Life in Patients Undergoing Total Knee Replacement

“…For optimum understanding and harmony, patient education materials should contain elements like paintings and drawings aimed at health literacy levels corresponding to the sixth or seventh grade or lower levels (Edwards et al, 2017). However, most instructional material prepared in orthopaedics has an advanced level of readability that patients cannot understand, indicating that little attention was paid to health literacy levels (Eltorai et al, 2016; Marshall et al, 2019; Mehta et al, 2018; Rosenbaum et al, 2015).…”