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Readability of Spine-Related Patient Education Materials From Leading Orthopedic Academic Centers

Ryu, Justine H., BA; Yi, Paul H., MD

doi: 10.1097/BRS.0000000000001321

Study Design. Cross-sectional analysis of online spine-related patient education materials from leading academic centers.

Objective. To assess the readability levels of spine surgery–related patient education materials available on the websites of academic orthopedic surgery departments.

Summary of Background Data. The Internet is becoming an increasingly popular resource for patient education. Yet many previous studies have found that Internet-based orthopedic-related patient education materials from subspecialty societies are written at a level too difficult for the average American; however, no prior study has assessed the readability of spine surgery–related patient educational materials from leading academic centers.

Methods. All spine surgery–related articles from the online patient education libraries of the top five US News & World Report–ranked orthopedic institutions were assessed for readability using the Flesch-Kincaid (FK) readability test. Mean readability levels of articles amongst the five academic institutions and articles were compared. We also determined the number of articles with readability levels at or below the recommended sixth- or eight-grade levels. Intraobserver and interobserver reliability of readability assessment were assessed.

Results. A total of 122 articles were reviewed. The mean overall FK grade level was 11.4; the difference in mean FK grade level between each department varied significantly (range, 9.3–13.4; P < 0.0001). Twenty-three articles (18.9%) had a readability level at or below the eighth grade level, and only one (0.8%) was at or below the sixth grade level. Intraobserver and interobserver reliability were both excellent (intraclass correlation coefficient of 1 for both).

Conclusion. Online patient education materials related to spine from academic orthopedic centers are written at a level too high for the average patient, consistent with spine surgery-related patient education materials provided by the American Academy of Orthopaedic Surgeons and spine subspecialty societies. This study highlights the potential difficulties patients might have in reading and comprehending the information in publicly available education materials related to spine.

Level of Evidence: N/A

*Medical Student, Boston University School of Medicine, MA

Orthopaedic Resident, Department of Orthopaedic Surgery, University of California, San Francisco.

Address correspondence and reprint requests to Paul H. Yi, MD, 500 Parnassus Avenue, MU 320 West, San Francisco, CA 94143; E-mail:

Received 6 August, 2015

Revised 28 September, 2015

Accepted 9 October, 2015

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.