Readability assessment of patient education materials on autonomic dysreflexia

Context: Autonomic dysreflexia (AD), a lethal condition of which patients with spinal cord injury (SCI) are at risk, is under-identified in these patient populations. Research literature is limited on AD-related educational resources provided to patients with SCI. Objective: The American Medical Association and National Institutes of Health recommend healthcare material be written in a sixth- to eighth-grade reading level for patients. In this study, the authors compared the readability of AD-related materials provided to patients with SCI through Commission on Accreditation of Rehabilitation Facilities (CARF)-accredited websites versus those obtained via Google search. Methods: Online, free materials were obtained from CARF-accredited institutions. These data were compared with top Google search results for the term “autonomic dysreflexia.” Materials were assessed using 4 different validated readability scales. The average reading grade level was recorded for each readability index between the two groups. Results: For CARF-accredited institutions (n = 21), the mean readability score was at a 10th grade level. For Google search (n = 84), the mean readability score was at a 13th grade level. Further analysis demonstrated a statistically significant difference between the readability of the CARF-accredited and non-accredited websites (P < 0.01). One-way ANOVA demonstrated no significant differences among the four readability calculators for CARF-accredited sites and, separately, for Google websites. Conclusion: Online information provided to patients with SCI on AD through CARF-accredited institutions is two- to four-reading grade levels higher than recommended. Efforts should be made to modify the readability of CARF-accredited and non-academic website materials to improve patient education.