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Assessing Online Patient Education Readability for Spine Surgery Procedures

Long, William W. BA; Modi, Krishna D. BS; Haws, Brittany E. BS; Khechen, Benjamin BA; Massel, Dustin H. MD; Mayo, Benjamin C. MD; Singh, Kern MD

doi: 10.1097/BSD.0000000000000575

Background Context: Increased patient reliance on Internet-based health information has amplified the need for comprehensible online patient education articles. As suggested by the American Medical Association and National Institute of Health, spine fusion articles should be written for a 4th–6th-grade reading level to increase patient comprehension, which may improve postoperative outcomes.

Purpose: The purpose of this study is to determine the readability of online health care education information relating to anterior cervical discectomy and fusion (ACDF) and lumbar fusion procedures.

Study Design: Online health-education resource qualitative analysis.

Methods: Three search engines were utilized to access patient education articles for common cervical and lumbar spine procedures. Relevant articles were analyzed for readability using Readability Studio Professional Edition software (Oleander Software Ltd). Articles were stratified by organization type as follows: General Medical Websites (GMW), Healthcare Network/Academic Institutions (HNAI), and Private Practices (PP). Thirteen common readability tests were performed with the mean readability of each compared between subgroups using analysis of variance.

Results: ACDF and lumbar fusion articles were determined to have a mean readability of 10.7±1.5 and 11.3±1.6, respectively. GMW, HNAI, and PP subgroups had a mean readability of 10.9±2.9, 10.7±2.8, and 10.7±2.5 for ACDF and 10.9±3.0, 10.8±2.9, and 11.6±2.7 for lumbar fusion articles. Of 310 total articles, only 6 (3 ACDF and 3 lumbar fusion) were written for comprehension below a 7th-grade reading level.

Conclusions: Current online literature from medical websites containing information regarding ACDF and lumbar fusion procedures are written at a grade level higher than the suggested guidelines. Therefore, current patient education articles should be revised to accommodate the average reading level in the United States and may result in improved patient comprehension and postoperative outcomes.

Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL

No FDA device/drug status to report (ORA#14051301).

The authors declare no conflict of interest.

Reprints: Kern Singh, MD, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, Chicago, IL 60612 (e-mail:

Received May 22, 2017

Accepted July 24, 2017

© 2018 by Lippincott Williams & Wilkins, Inc.