Evaluating the Quality, Content, and Readability of Online Resources for Failed Back Spinal Surgery

Study Design. An Internet-based assessment of websites using recognized score systems. Objective. To assess the quality, content, and readability of online information for failed back spinal surgery (FBSS). Summary of Background Data. A significant amount of patients still suffer from chronic or recurrent back pain with or without radicular symptoms after spinal surgery. More and more patients use the Internet to find health-related information. Lowquality or inaccurate information may not only misleading patients but also have a negative impact on the trust between patients and physicians. Methods. The terms "chronic pain after spinal surgery,'' "chronic pain after back surgery,'' "failed back surgery syndrome,'' "post spinal surgery syndrome,'' and "post laminectomy syndrome'' were entered into three search engines (Google, Yahoo!, and Bing). The first 25 websites from each search were reviewed. The quality, content, and readability of each website were evaluated using DISCERN score, FBSS-specific content score, and the Journal of the American Medical Association (JAMA) benchmark criteria, the first two score systems were assessed by three reviewers independently. The Flesch-Kincaid grade level (FKGL) was used to assess the readability. Each website with or without the Health on the Net Code (HONcode) was also recorded. Results. Seventy-two websites were analyzed in our study. The average DISCERN score for all websites was 35.26 11.45, indicating the quality of the websites was poor. The DISCERN score of physician websites was 31.25 9.08, lower than that of media (36.50 0.71, P 1/4 0.017) and commercial websites (42.55 10.93, P 1/4 0.045). The mean FBSS-specific content score was 9.58 3.90 out of maximum 25. We failed to find any difference of FBSS-specific content score among different type of website. Websites with HONcode certification were associated with higher DISCERN score, FBSS-specific content score, and JAMA benchmark criteria score than non-certified websites. The mean FKGL was 12.19 2.20, and none of the websites' FKGL was lower than the six grade level. Conclusion. The quality and content of available online information for FBSS were poor. The readability of online information in our results showed a significantly higher reading level than the sixth-grade level recommended by the AMA and NIH.