Quality of Carpal Tunnel Syndrome Patient Education Handouts Available on the Internet: A Systematic Analysis of Content and Design

Published:September 18, 2021DOI:



      To evaluate the quality of carpal tunnel syndrome (CTS) patient education handouts and identify the best resources for patients and clinicians.


      A document content analysis of handouts identified through a systematic internet search using 8 search terms on Google and Bing and a hand search of professional association websites.


      Not applicable.


      Documents (N=56) were identified from the top 50 search results across 16 individual searches. Included documents provided general patient education for CTS; descriptive websites, videos, and research studies were excluded.


      Not applicable.

      Main Outcome Measures

      Content analysis was conducted using the Information Score (IS) tool to evaluate completeness of information (0%-100%) and misleading treatment recommendations were identified. Design analysis was conducted using the Patient Material Assessment Tool for Printable Materials (PEMAT-P) (0%-100%) and 2 widely used readability formulas, Flesch Reading Ease and Flesch Kincaid Grade Level. Using these results, all handouts were rated with a summative 12-point scale.


      Of 805 unique search results, we included 56 CTS handouts. The average IS was 74.6%±17.9%, and 78.6% of the handouts mentioned non–evidence-based treatment recommendations. The average PEMAT-P score was 70.2%±10.9%, and the average readability grade level was 7.7±1.7. Only 3 handouts were identified as high quality based on the 12-point summative scores, 22 handouts had mixed quality, and 17 handouts had low quality on both content and design.


      Findings of this study suggest a lack of high-quality and easily understandable CTS patient education handouts. Most handouts contained unreliable treatment information. Improvements are needed to ensure patients’ ability to understand and manage this condition.


      List of abbreviations:

      CTS (carpal tunnel syndrome), FRE (Flesch Reading Ease), FKGL (Flesch Kincaid grade level), IS (Information Score), PDF (Portable Document Format), PEMAT-P (Patient Material Assessment Tool for Printable Materials), URL (Uniform Resource Locator)
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