title: Do informed consent documents for chiropractic clinical research studies meet readability level recommendations and contain required elements: a descriptive study.
abstract: BACKGROUND
  Informed consent documents (ICD) in research are designed to educate research participants about the nature of the research project in which he or she may participate. United States (US) law requires the documents to contain specific elements present and be written in a way that is understandable to research participants. The purpose of this research is to determine if ICDs from randomized controlled trials conducted at chiropractic colleges meet recommended readability standards and contain the 13 content items required by US law.
  
  
  METHODS
  This study was approved by Palmer College of Chiropractic's IRB #2012-12-3-T and was conducted between December 3, 2012 and February 14, 2013. We contacted the research directors of five chiropractic colleges that have received federal funding supporting their clinical research. A total of 13 informed consent documents from four chiropractic colleges were analyzed using the Flesch-Kincaid measurement. We assigned a grade-level readability score to the document based on the average of three separate grade level scores conducted on the three largest uninterrupted blocks of text. Content of the 13 ICDs was assessed using a 13-element checklist. A point was given for every element present in the document, giving a score range of "0, no elements are present", to "13, all elements are present."
  
  
  RESULTS
  The mean Flesch-Kincaid grade level readability was 10.8 (range 7.2 -14.0). Our sample had a mean readability score 2.8 grade levels above the generally-accepted US average reading level. Content varied among the 13 informed consent forms, ranging from only nine elements present in one document to all 13 required in five documents. Additionally, we collated the risks presented in each document.
  
  
  CONCLUSIONS
  These results strongly suggest that chiropractic clinical researchers are not developing ICDs at a readability level congruent with the national average acceptable level. The low number of elements in some of the informed consent documents raises concern that not all research participants were fully informed when given the informed consent, and it may suggest that some documents may not be in compliance with federal requirements. Risk varies among institutions and even within institutions for the same intervention.
authors.affiliation: Palmer Center for Chiropractic Research, 741 Brady Street, Davenport, IA 52803 USA.
authors.forename: Elissa
authors.initials: E
authors.lastname: Twist
authors.affiliation: Palmer College of Chiropractic, 1000 Brady St., Davenport, IA 52803 USA.
authors.forename: Dana J
authors.initials: DJ
authors.lastname: Lawrence
authors.affiliation: Palmer Center for Chiropractic Research, 741 Brady Street, Davenport, IA 52803 USA.
authors.forename: Stacie A
authors.initials: SA
authors.lastname: Salsbury
authors.affiliation: Logan University, 1851 Schoettler Rd., Chesterfield, MO 63017 USA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Hawk
keywords: Bioethics; Chiropractic; Clinical trials; Ethical review; Informed consent; Manual therapies