{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T19:44:57Z","timestamp":1782675897442,"version":"3.54.5"},"reference-count":31,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T00:00:00Z","timestamp":1782604800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T00:00:00Z","timestamp":1782604800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["arthroscopyjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"abstract":"\n Purpose<\/jats:title>\n To evaluate the readability, understandability, and actionability of current orthopaedic discharge instructions and assess the effectiveness of generative artificial intelligence (AI) in addressing these areas of improvement.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Orthopaedic discharge instruction documents were collected from a large academic hospital from March to May 2025. Subcategories frequently associated with postoperative inquiries\u2014activities, complications and follow\u2010up, medications, narcotics, pain management, physical therapy, and wound care\u2014were extracted for analysis. ChatGPT\u20104 was used to generate improved discharge instructions using structured prompting strategies. Readability and text complexity measures were assessed using 5 validated readability tests whereas understandability and actionability were assessed using a modified Patient Education Materials Assessment Tool (PEMAT). Paired t\u2010tests were used to compare scores between original and ChatGPT\u2010rewritten content whereas comparisons across subcategories were achieved with independent samples t\u2010tests (\n P<\/jats:italic>\n \u2009<\u2009.05).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Fifty\u2010two subcategory excerpts were identified across twelve distinct discharge instructions. ChatGPT significantly reduced the average reading grade level of discharge instructions from 9.8 to 7.5 across all content categories (\n P<\/jats:italic>\n \u2009<\u2009.001). The wound care subcategory showed the lowest reading grade level before and after ChatGPT. The narcotics subcategory showed the highest reading grade level before ChatGPT, whereas the medications and physical therapy subcategories showed the highest reading grade level after ChatGPT. Understandability and actionability scores improved from 63.6% to 87.9% (\n P<\/jats:italic>\n \u2009<\u2009.001) and from 44.4% to 73.6%, respectively (\n P<\/jats:italic>\n \u2009<\u2009.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Generative AI significantly improves the readability, understandability, and actionability of orthopaedic discharge instructions; however, not all documents achieved the desired sixth\u2010grade reading level. Subcategory analysis revealed opportunities for targeted interventions to improve patient education in specific topics, such as narcotics, medication, or physical therapy\u2010related instructions.<\/jats:p>\n <\/jats:sec>\n \n Clinical Relevance<\/jats:title>\n This study describes a cost\u2010effective, scalable AI intervention for improving orthopaedic discharge instructions which may improve clinical outcomes, reduce healthcare burden, and support patients\u2019 management of postoperative recovery.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/arj.70400","type":"journal-article","created":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T19:19:04Z","timestamp":1782674344000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Natural Language Processing Improves Postoperative Discharge Instructions"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0912-3472","authenticated-orcid":false,"given":"Carrie N.","family":"Reaver","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Washington University in St. Louis St. Louis Missouri U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohit","family":"Siddabattula","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Washington University in St. Louis St. Louis Missouri U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6356-9830","authenticated-orcid":false,"given":"Daniel E.","family":"Pereira","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Washington University in St. Louis St. Louis Missouri U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,28]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"S235","DOI":"10.1097\/PHH.0000000000001424","article-title":"Healthy people 2030 leading health indicators and overall health and well\u2010being measures: Opportunities to assess and improve the health and well\u2010being of the nation","volume":"27","author":"Ochiai E","year":"2021","journal-title":"J Public Health Manag Pract."},{"key":"e_1_2_9_3_1","volume-title":"AHRQ Health Literacy Universal Precautions Toolkit, 2nd Edition"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"e70","DOI":"10.2106\/JBJS.15.00658","article-title":"The readability of AAOS patient education materials: Evaluating the progress since 2008","volume":"98","author":"Roberts H","year":"2016","journal-title":"J Bone Joint Surg Am."},{"key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"e591","DOI":"10.1097\/BPO.0000000000002402","article-title":"Readability of online patient educational materials in pediatric orthopaedics: A systematic review","volume":"43","author":"Hecht CJ","year":"2023","journal-title":"J Pediatr Orthop."},{"key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1016\/j.arth.2023.01.032","article-title":"Readability of online patient education materials for total joint arthroplasty: A systematic review","volume":"38","author":"Karimi AH","year":"2023","journal-title":"J Arthroplasty."},{"key":"e_1_2_9_7_1","first-page":"96","article-title":"Readability level of English and Spanish orthopaedic patient education materials English and Spanish patient education","volume":"30","author":"Patetta MJ","year":"2021","journal-title":"J Surg Orthop Adv."},{"key":"e_1_2_9_8_1","first-page":"232596711880538","article-title":"Poor readability of AOSSM patient education resources and opportunities for improvement","volume":"6","author":"Kakazu R","year":"2018","journal-title":"Orthop J Sports Med."},{"key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.jss.2020.12.047","article-title":"Prospective evaluation of health literacy and its impact on outcomes in emergency general surgery","volume":"261","author":"Calabrese EC","year":"2021","journal-title":"J Surg Res."},{"key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1016\/j.amjsurg.2021.10.024","article-title":"The association of health literacy and postoperative complications after colorectal surgery: A cohort study","volume":"223","author":"Theiss LM","year":"2022","journal-title":"Am J Surg."},{"key":"e_1_2_9_11_1","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1016\/j.hpb.2022.07.006","article-title":"Low health literacy is associated with worse postoperative outcomes following hepato\u2010pancreato\u2010biliary cancer surgery","volume":"24","author":"Driessens H","year":"2022","journal-title":"HPB (Oxford)."},{"key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"e96","DOI":"10.1097\/BOT.0000000000000746","article-title":"Factors associated with patient\u2010initiated telephone calls after orthopaedic trauma surgery","volume":"31","author":"Hadeed MM","year":"2017","journal-title":"J Orthop Trauma."},{"key":"e_1_2_9_13_1","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1016\/j.surg.2018.10.014","article-title":"Enhanced readability of discharge summaries decreases provider telephone calls and patient readmissions in the posthospital setting","volume":"165","author":"Choudhry AJ","year":"2019","journal-title":"Surgery."},{"key":"e_1_2_9_14_1","first-page":"e237334","article-title":"Enhancing readability of online patient\u2010facing content: The role of AI chatbots in improving cancer information accessibility","volume":"22","author":"Abreu AA","year":"2024","journal-title":"J Natl Compr Canc Netw."},{"key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"2260","DOI":"10.1097\/CORR.0000000000002668","article-title":"Can artificial intelligence improve the readability of patient education materials?","volume":"481","author":"Kirchner GJ","year":"2023","journal-title":"Clin Orthop Relat Res."},{"key":"e_1_2_9_16_1","doi-asserted-by":"crossref","first-page":"e240357","DOI":"10.1001\/jamanetworkopen.2024.0357","article-title":"Generative artificial intelligence to transform inpatient discharge summaries to patient\u2010friendly language and format","volume":"7","author":"Zaretsky J","year":"2024","journal-title":"JAMA Netw Open."},{"key":"e_1_2_9_17_1","doi-asserted-by":"crossref","first-page":"e36","DOI":"10.2106\/JBJS.24.01078","article-title":"Evaluating the performance of artificial intelligence for improving readability of online English\u2010 and Spanish\u2010language orthopaedic patient educational material: Challenges in bridging the digital divide","volume":"107","author":"Reaver CN","year":"2025","journal-title":"J Bone Joint Surg Am."},{"key":"e_1_2_9_18_1","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.bjps.2024.08.065","article-title":"ChatGPT for improving postoperative instructions in multiple fields of plastic surgery","volume":"99","author":"Zhang A","year":"2024","journal-title":"J Plast Reconstr Aesthet Surg."},{"key":"e_1_2_9_19_1","unstructured":"Prompt Engineering. OpenAI.https:\/\/platform.openai.com\/docs\/guides\/prompt\u2010engineering. Accessed March 2025."},{"key":"e_1_2_9_20_1","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.pec.2014.05.027","article-title":"Development of the Patient Education Materials Assessment Tool (PEMAT): A new measure of understandability and actionability for print and audiovisual patient information","volume":"96","author":"Shoemaker SJ","year":"2014","journal-title":"Patient Educ Couns."},{"key":"e_1_2_9_21_1","unstructured":"OpenAI.https:\/\/chat.openai.com\/. Accessed February\u2010May 2025."},{"key":"e_1_2_9_22_1","doi-asserted-by":"crossref","unstructured":"KincaidPJ FishburneRP RogersRL ChissomBS. Derivation of new readability formulas (automated readability index fog count and Flesch reading ease formula) for Navy enlisted personnel.Research Branch Report8\u201075.1975.https:\/\/stars.library.ucf.edu\/istlibrary\/56.","DOI":"10.21236\/ADA006655"},{"key":"e_1_2_9_23_1","first-page":"513","article-title":"A readability formula that saves time","volume":"11","author":"Fry E","year":"1968","journal-title":"J Reading."},{"key":"e_1_2_9_24_1","first-page":"639","article-title":"SMOG Grading: A new readability formula","volume":"12","author":"McLaughlin GH","year":"1969","journal-title":"J Reading."},{"key":"e_1_2_9_25_1","first-page":"490","article-title":"Lix and Rix: Variations on a little\u2010known readability index","volume":"26","author":"Anderson J","year":"1983","journal-title":"J Reading."},{"key":"e_1_2_9_26_1","volume-title":"The technique of clear writing","author":"Gunning R","year":"1952"},{"key":"e_1_2_9_27_1","first-page":"e1","article-title":"Reducing the use of complex words and reducing sentence length to <15 words improves readability of patient education materials regarding sports medicine knee injuries","volume":"5","author":"Hanish SJ","year":"2022","journal-title":"Arthrosc Sports Med Rehabil."},{"key":"e_1_2_9_28_1","first-page":"e60318","article-title":"Does the information quality of ChatGPT meet the requirements of orthopedics and trauma surgery?","volume":"16","author":"Kasapovic A","year":"2024","journal-title":"Cureus."},{"key":"e_1_2_9_29_1","doi-asserted-by":"crossref","first-page":"123755","DOI":"10.1016\/j.wneu.2025.123755","article-title":"Comparing ChatGPT 3.5 and 4.0 in low back pain patient education: Addressing strengths, limitations, and psychosocial challenges","volume":"196","author":"Tabanli A","year":"2025","journal-title":"World Neurosurg."},{"key":"e_1_2_9_30_1","doi-asserted-by":"crossref","first-page":"e60336","DOI":"10.2196\/60336","article-title":"Patient\u2010representing population's perceptions of GPT\u2010generated versus standard emergency department discharge instructions: Randomized blind survey assessment","volume":"26","author":"Huang T","year":"2024","journal-title":"J Med Internet Res."},{"key":"e_1_2_9_31_1","doi-asserted-by":"crossref","first-page":"e52597","DOI":"10.2196\/52597","article-title":"Large language models and empathy: Systematic review","volume":"26","author":"Sorin V","year":"2024","journal-title":"J Med Internet Res."},{"key":"e_1_2_9_32_1","doi-asserted-by":"crossref","first-page":"e58831","DOI":"10.2196\/58831","article-title":"\u201cDoctor ChatGPT, Can You Help Me?\u201d The patient's perspective: Cross\u2010sectional study","volume":"26","author":"Armbruster J","year":"2024","journal-title":"J Med Internet Res."}],"container-title":["Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/arj.70400","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/arj.70400","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/arj.70400","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T19:19:11Z","timestamp":1782674351000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1002\/arj.70400"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,28]]},"references-count":31,"alternative-id":["10.1002\/arj.70400"],"URL":"https:\/\/doi.org\/10.1002\/arj.70400","archive":["Portico"],"relation":{},"ISSN":["0749-8063","1526-3231"],"issn-type":[{"value":"0749-8063","type":"print"},{"value":"1526-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,28]]},"assertion":[{"value":"2025-08-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"arj.70400"}}