{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:47:05Z","timestamp":1787755625874,"version":"build-2784847793"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n National guidelines recommend that patient education materials are written at or below a 6th-grade reading level. Poor understanding of their care plan after orthopaedic surgery has been associated with worse outcomes, including lower surgical satisfaction and higher postoperative complications. This study evaluates the language availability and readability of orthopaedic patient education materials published by Elsevier and distributed via Epic, the most widely used electronic health record system in the United States.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n In March 2025, orthopaedic patient education documents, as well as their easy-to-read versions when available, were extracted from Epic in English and Spanish. Documents were summarized by type, subspecialty, and revision date. Readability was assessed using 5 validated English scoring systems and 2 Spanish systems. Comparisons with recommended grade levels and with their easy-to-read versions were analyzed using\n t<\/jats:italic>\n -test, whereas trends over time were assessed using linear regression.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Among 806 patient education documents, English and Spanish versions were available for all documents, but other languages were available for less than 30% of the documents. The mean readability grade level was 8.6 for English and 5.8 for Spanish documents, with 100% and 27% exceeding the recommended 6th-grade level, respectively. Preoperative documents consistently demonstrated the highest grade levels, whereas rehabilitation documents demonstrated lower grade levels across both English and Spanish documents (p < 0.05). Furthermore, musculoskeletal oncology documents consistently had the highest grade levels across document subspecialties (p < 0.05). Easy-to-read versions were only available for 11% of documents and reduced grade level to 7.4 for English and 5.5 for Spanish documents, although 94% and 4% still exceeded the recommended 6th-grade level, respectively. No significant changes in readability were observed over time.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Elsevier's orthopaedic patient education materials, specifically related to preoperative information, are frequently written above recommended reading levels. The scarcity of easy-to-read versions further restricts their availability accessibility. To improve patient comprehension and adherence, efforts should focus on increasing the availability of simplified materials and expanding translation efforts. Artificial intelligence driven solutions may offer a scalable approach to addressing these deficiencies.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Level III<\/jats:underline>\n . See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.oa.25.00143","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T19:00:09Z","timestamp":1754593209000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Lost in Translation: Preoperative Orthopaedic Education Materials Significantly Exceed Recommended Reading Levels"],"prefix":"10.2106","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7192-2575","authenticated-orcid":false,"given":"Maxwell","family":"Sahhar","sequence":"first","affiliation":[{"name":"Warren Alpert Medical School, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4524-6226","authenticated-orcid":false,"given":"Manjot","family":"Singh","sequence":"additional","affiliation":[{"name":"Warren Alpert Medical School, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8728-6682","authenticated-orcid":false,"given":"Tanmay","family":"Mehta","sequence":"additional","affiliation":[{"name":"Warren Alpert Medical School, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3826-7797","authenticated-orcid":false,"given":"Arjun","family":"Laud","sequence":"additional","affiliation":[{"name":"Warren Alpert Medical School, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2475-4996","authenticated-orcid":false,"given":"Joseph E.","family":"Nassar","sequence":"additional","affiliation":[{"name":"Warren Alpert Medical School, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9705-1351","authenticated-orcid":false,"given":"Michael J.","family":"Farias","sequence":"additional","affiliation":[{"name":"Warren Alpert Medical School, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7835-2263","authenticated-orcid":false,"given":"Bassel G.","family":"Diebo","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9597-4139","authenticated-orcid":false,"given":"Alan H.","family":"Daniels","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,7]]},"reference":[{"issue":"4","key":"R2-20250807","doi-asserted-by":"crossref","first-page":"367","DOI":"10.2105\/AJPH.70.4.367","article-title":"Methodological issues in health care surveys of the Spanish heritage population","volume":"70","author":"Aday","year":"1980","journal-title":"Am J Public Health"},{"key":"R4-20250807","doi-asserted-by":"crossref","first-page":"2377960819900707","DOI":"10.1177\/2377960819900707","article-title":"The discharge process\u2014from a patient's perspective","volume":"6","author":"Krook","year":"2020","journal-title":"SAGE Open Nurs"},{"key":"R5-20250807","doi-asserted-by":"crossref","DOI":"10.1016\/j.amjmed.2025.03.015","article-title":"Language and readability barriers in discharge instructions: a call to improve patient aftercare","author":"Sahhar","year":"2025","journal-title":"Am J Med"},{"key":"R8-20250807","article-title":"The principles of readability","author":"Dubay","year":"2004","journal-title":"Impact Inf"},{"issue":"10","key":"R9-20250807","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1542\/hpeds.2019-0055","article-title":"Translating discharge instructions for limited English-proficient families: strategies and barriers","volume":"9","author":"Davis","year":"2019","journal-title":"Hosp Pediatr"},{"issue":"4","key":"R10-20250807","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1097\/MLR.0b013e318249c949","article-title":"Language barriers and understanding of hospital discharge instructions","volume":"50","author":"Karliner","year":"2012","journal-title":"Med Care"},{"issue":"2","key":"R11-20250807","first-page":"e18161","article-title":"Readability of patient education materials on the American Association for Surgery of Trauma website","volume":"3","author":"Eltorai","year":"2014","journal-title":"Arch Trauma Res"},{"issue":"1","key":"R12-20250807","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1177\/19386400221116463","article-title":"Readability of online foot and ankle surgery patient education materials","volume":"18","author":"Hartnett","year":"2025","journal-title":"Foot Ankle Spec"},{"issue":"4","key":"R13-20250807","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1007\/s11999-015-4151-y","article-title":"Editor's spotlight\/take 5: most American Academy of Orthopaedic Surgeons' online patient education material exceeds average patient reading level","volume":"473","author":"Leopold","year":"2015","journal-title":"Clin Orthop"},{"issue":"12","key":"R14-20250807","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1097\/BRS.0000000000001446","article-title":"Is the readability of spine-related patient education material improving? An assessment of subspecialty websites","volume":"41","author":"Eltorai","year":"2016","journal-title":"Spine"},{"issue":"4","key":"R15-20250807","first-page":"31","article-title":"Quality of internet health information on thumb carpometacarpal joint arthritis","volume":"97","author":"Kamal","year":"2014","journal-title":"R Med J (2013)"},{"issue":"4","key":"R16-20250807","doi-asserted-by":"crossref","first-page":"125","DOI":"10.3810\/psm.2014.11.2099","article-title":"Readability of patient education materials on the American Orthopaedic Society for Sports Medicine website","volume":"42","author":"Eltorai","year":"2014","journal-title":"Phys Sportsmed"},{"key":"R17-20250807","first-page":"101985","article-title":"Readability and quality of online information on total ankle arthroplasty","volume":"54","author":"Hartnett","year":"2023","journal-title":"Foot Edinb Scotl"},{"issue":"7 Suppl","key":"R18-20250807","doi-asserted-by":"crossref","first-page":"S192","DOI":"10.1016\/j.arth.2021.02.075","article-title":"Musculoskeletal health literacy is associated with outcome and satisfaction of total knee arthroplasty","volume":"36","author":"Narayanan","year":"2021","journal-title":"J Arthroplasty"},{"issue":"2","key":"R19-20250807","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.spinee.2023.09.016","article-title":"Limited health literacy results in lower health-related quality of life in spine patients","volume":"24","author":"Koole","year":"2024","journal-title":"Spine J"},{"issue":"1","key":"R20-20250807","doi-asserted-by":"crossref","first-page":"103605","DOI":"10.1016\/j.otsr.2023.103605","article-title":"Health literacy in orthopaedic lower limb trauma patients: a cross-sectional survey study","volume":"110","author":"Sar\u0131ca \u00c7evik","year":"2024","journal-title":"Orthop Traumatol Surg Res"},{"issue":"2","key":"R21-20250807","doi-asserted-by":"crossref","first-page":"110","DOI":"10.12788\/jhm.2692","article-title":"Impact of patient-centered discharge tools: a systematic review","volume":"12","author":"Okrainec","year":"2017","journal-title":"J Hosp Med"},{"issue":"4","key":"R22-20250807","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1111\/scs.12407","article-title":"Patient involvement in own rehabilitation after early discharge","volume":"31","author":"H\u00f8rdam","year":"2017","journal-title":"Scand J Caring Sci"},{"key":"R23-20250807","doi-asserted-by":"crossref","first-page":"23743735231171564","DOI":"10.1177\/23743735231171564","article-title":"Patient perspectives of the hospital discharge process: a qualitative study","volume":"10","author":"Jones","year":"2023","journal-title":"J Patient Exp"},{"key":"R24-20250807","doi-asserted-by":"crossref","first-page":"1284015","DOI":"10.3389\/fsurg.2023.1284015","article-title":"ChatGPT in orthopedics: a narrative review exploring the potential of artificial intelligence in orthopedic practice","volume":"10","author":"Giorgino","year":"2023","journal-title":"Front Surg"},{"issue":"11","key":"R25-20250807","doi-asserted-by":"crossref","first-page":"5190","DOI":"10.1007\/s00167-023-07529-2","article-title":"Exploring the potential of ChatGPT as a supplementary tool for providing orthopaedic information","volume":"31","author":"Kaarre","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"2","key":"R26-20250807","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1093\/eurjcn\/zvad087","article-title":"Using ChatGPT and Google Bard to improve the readability of written patient information: a proof of concept","volume":"23","author":"Moons","year":"2024","journal-title":"Eur J Cardiovasc Nurs"},{"issue":"2","key":"R27-20250807","doi-asserted-by":"crossref","first-page":"e23.00129","DOI":"10.2106\/JBJS.OA.23.00129","article-title":"ChatGPT is moderately accurate in providing a general overview of orthopaedic conditions","volume":"9","author":"Sparks","year":"2024","journal-title":"JBJS Open Access"},{"issue":"3","key":"R29-20250807","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1177\/1090198105277329","article-title":"A systematic review of readability and comprehension instruments used for print and web-based cancer information","volume":"33","author":"Friedman","year":"2006","journal-title":"Health Educ Behav"},{"issue":"12","key":"R31-20250807","doi-asserted-by":"crossref","first-page":"3568","DOI":"10.1016\/j.arth.2017.07.003","article-title":"Readability of patient education materials from the web sites of orthopedic implant manufacturers","volume":"32","author":"Yi","year":"2017","journal-title":"J Arthroplasty"},{"issue":"8","key":"R32-20250807","doi-asserted-by":"crossref","first-page":"e307","DOI":"10.1097\/BOT.0000000000002593","article-title":"Readability of the orthopaedic trauma association patient education tool","volume":"37","author":"Ghanem","year":"2023","journal-title":"J Orthop Trauma"},{"issue":"5","key":"R33-20250807","doi-asserted-by":"crossref","first-page":"23259671221092356","DOI":"10.1177\/23259671221092356","article-title":"Readability of patient educational materials in sports medicine","volume":"10","author":"\u00d3 Doinn","year":"2022","journal-title":"Orthop J Sports Med"},{"issue":"17","key":"R34-20250807","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","year":"2016","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"R35-20250807","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1038\/s41746-024-01039-2","article-title":"Bridging the literacy gap for surgical consents: an AI-human expert collaborative approach","volume":"7","author":"Ali","year":"2024","journal-title":"NPJ Digit Med"},{"key":"R36-20250807","doi-asserted-by":"crossref","first-page":"1477898","DOI":"10.3389\/fmed.2024.1477898","article-title":"Large language models in patient education: a scoping review of applications in medicine","volume":"11","author":"Aydin","year":"2024","journal-title":"Front Med"},{"issue":"2","key":"R37-20250807","doi-asserted-by":"crossref","first-page":"2266751","DOI":"10.1080\/24740527.2023.2266751","article-title":"The impact of preoperative patient education on postoperative pain, opioid use, and psychological outcomes: a narrative review","volume":"7","author":"Darville-Beneby","year":"2023","journal-title":"Can J Pain"},{"issue":"1","key":"R38-20250807","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1177\/15563316221110536","article-title":"Health literacy in orthopedic surgery: a systematic review","volume":"19","author":"Lans","year":"2023","journal-title":"HSS J"},{"issue":"4","key":"R39-20250807","doi-asserted-by":"crossref","first-page":"472","DOI":"10.55275\/JPOSNA-2022-472","article-title":"Spanish language resources for patients with developmental dysplasia of the hip: original research","volume":"4","author":"Mendoza","year":"2022","journal-title":"J Pediatr Orthop Soc N Am"},{"issue":"11","key":"R40-20250807","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","year":"2023","journal-title":"Clin Orthop"},{"issue":"2","key":"R41-20250807","first-page":"148","article-title":"ChatGPT is a promising tool to increase readability of orthopedic research consents","volume":"31","author":"Gill","year":"2024","journal-title":"J Orthop Trauma Rehabil"},{"issue":"7","key":"R42-20250807","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1097\/CORR.0000000000003413","article-title":"Artificial intelligence shows limited success in improving readability levels of spanish-language orthopaedic patient education materials","volume":"483","author":"Busig\u00f3 Torres","year":"2025","journal-title":"Clin Orthop"},{"issue":"5","key":"R43-20250807","first-page":"e39238","article-title":"High rates of fabricated and inaccurate references in ChatGPT-generated medical content","volume":"15","author":"Bhattacharyya","year":"2023","journal-title":"Cureus"}],"container-title":["JBJS Open Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.25.00143","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:45:31Z","timestamp":1787751931000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.25.00143"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":37,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.oa.25.00143","relation":{},"ISSN":["2472-7245"],"issn-type":[{"value":"2472-7245","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}