Evaluating the Readability of Patient Education Materials for Anterior Vertebral Body Tethering, Distraction- Based Methods, and Posterior Spinal Fusion for the Treatment of Pediatric Spinal Deformity

Background: The Internet is an important source of information for patients, but its effectiveness relies on the readability of its content. Patient education materials (PEMs) should be written at or below a sixthgrade reading level as outlined by agencies such as the American Medical Association. This study assessed PEMs' readability for the novel anterior vertebral body tethering (AVBT), distraction - based methods, and posterior spinal fusion (PSF) in treating pediatric spinal deformity. Methods: An online search identified PEMs using the terms "anterior vertebral body tethering," "growing rods scoliosis," and "posterior spinal fusion pediatric scoliosis." We selected the first 20 general medical websites (GMWs) and 10 academic health institution websites (AHIWs) discussing each treatment (90 websites total). Readability tests for each webpage were conducted using Readability Studio software. Reading grade levels (RGLs), which correspond to the US grade at which one is expected to comprehend the text, were calculated for sources and independent t tests compared with RGLs between treatment types. Results: The mean RGL was 12.1 +/- 2.0. No articles were below a sixthgrade reading level, with only 2.2% at the sixthgrade reading level. AVBT articles had a higher RGL than distraction - based methods (12.7 +/- 1.6 vs 11.9 +/- 1.9, P = 0.082) and PSF (12.7 +/- 1.6 vs 11.6 +/- 2.3, P = 0.032). Materials for distraction - based methods and PSF were comparable (11.9 +/- 1.9 vs 11.6 +/- 2.3, P = 0.566). Among GMWs, AVBT materials had a higher RGL than distraction - based methods (12.9 +/- 1.4 vs 12.1 +/- 1.8, P = 0.133) and PSF (12.9 +/- 1.4 vs 11.4 +/- 2.4, P = 0.016). Clinical Relevance: Patients' health literacy is important for shared decision- making. Assessing the readability of scoliosis treatment PEMs guides physicians when sharing resources and discussing treatment with patients. Conclusion: Both GMWs and AHIWs exceed recommended RGLs, which may limit patient and parent understanding. Within GMWs, AVBT materials are written at a higher RGL than other treatments, which may hinder informed decision- making and patient outcomes. Efforts should be made to create online resources at the appropriate RGL. At the very least, patients and parents may be directed toward AHIWs; RGLs are more consistent. Level of Evidence: 3.