Assessment of the effectiveness of SFCR patient information sheets before scheduled spinal surgery

Digital Health for Patients Undergoing Spine Surgery: A Systematic Review

OBJECTIVE

Digital health tools, including smartphone applications (apps), websites, and online search engines, are increasingly being utilized for health data collection and patient education. Studies have shown that these tools can help disseminate information widely and even help guide patients through acute surgical episodes. We aimed to search the literature to summarize available studies on using digital health tools for patients undergoing spine surgery.

METHODS

We conducted a systematic review of PubMed MEDLINE, Elsevier EMBASE, and Elsevier Scopus databases, as well as ClinicalTrials.gov up to March 11, 2022.

RESULTS

Forty-four full-text articles were included and qualitatively analyzed. Studies were broadly grouped into those that analyzed the quality of web-based materials for patients, the quality of YouTube videos for spine surgery, the development, feasibility, and implementation of mobile apps for patients, and randomized controlled trials for integrating mobile apps into perioperative care.

CONCLUSIONS

We presented a systematic review analyzing the current landscape of digital health for patients undergoing spine surgery. Internet patient education materials in searchable websites and YouTube videos are of poor quality, lacking in readability to the average patient and robustness of information needed for patients to make informed decisions about pursuing spine surgery. However, there lies promise in digital apps developed to guide patients through surgery and collect postoperative outcomes.

Modern internet search analytics and spine: what are patients asking and reading online?

Background

Google's People Also Ask feature uses various machine learning algorithms to distill the most frequently asked questions and link users to potential answers. The aim of this study is to investigate the most frequently asked questions related to commonly performed spine surgeries.

Methods

This is an observational study utilizing Google's People Also Ask feature. A variety of search terms were entered into Google for anterior cervical discectomy and fusion (ACDF), discectomy, and lumbar fusion. Frequently asked questions and linked websites were extracted. Questions were categorized by topic based on Rothwell's Classification system, and websites were categorized by type. Pearson's chi-squared and Student t tests were performed as appropriate.

Results

A total of 576 unique questions (181 ACDF, 148 discectomy, 309 lumbar fusion) were extracted with 372 unique websites and 177 domains. The most common website types were medical practice (41%), social media (22%), and academic (15%). The most popular question topics were specific activities & restrictions (22%), technical details (23%), and evaluation of surgery (17%). Questions related to technical details were more common in discectomy vs lumbar fusion (33% vs 24%, p=.03) and lumbar fusion vs ACDF (24% vs 14%, p=.01). Questions related to specific activities & restrictions were more common in ACDF vs discectomy (17% vs 8%, p=.02) and ACDF vs lumbar fusion (28% vs 19%, p=.016). Questions related to risks & complications were more common in ACDF vs lumbar fusion (10% vs 4%, p=.01).

Conclusions

The most frequently asked questions on Google regarding spine surgery are related to technical details and activity restrictions. Surgeons may emphasize these domains in consultations and direct patients to reputable sources of further information. Much of the linked information provided originates from nonacademic and nongovernment sources (72%), with 22% from social media websites.

Management of symptomatic postoperative epidural hematoma in spine surgery: Medicolegal implications

INTRODUCTION

Spine surgery is one of the specialties with the highest medicolegal risk, with a legal action initiated every 17 months per practitioner. One of the most dreaded complications is an epidural hematoma with postoperative deficit. The treatment of this complication is still being debated. We therefore conducted a retrospective study of the database of a medical liability insurer to assess perioperative factors determining the liability of the surgeon or paramedical team during an expert review in the event of a postoperative symptomatic epidural hematoma.

HYPOTHESIS

To identify the factors determining the liability of the medical team in the event of a postoperative symptomatic epidural hematoma.

MATERIALS AND METHODS

We retrospectively analyzed the largest French register of medicolegal expert reviews between 2011 and 2018. We identified 68 cases by entering the following keywords in this database: "spine surgery," "complications," and "epidural hematoma." After a thorough review of each case, only 14 were deemed to be truly relevant to our study. We collected for each patient the perioperative data, complications (including neurologic deficits) and their clinical course.

RESULTS

Only one surgeon was accused and found liable for failing to perform a surgical revision within a reasonable timeframe (time to revision of 11 days). In 2 cases, the liability of a nurse working in the surgical department was called into question for failing to contact the surgeon upon the onset of symptoms. In the other cases (11 patients, 79%), the occurrence of a symptomatic epidural hematoma was considered a no-fault medical accident that was not caused by the surgeon. The presence of a drain did not have any medicolegal impact in the cases reviewed.

CONCLUSION

The key element in medicolegal decisions is the reaction time of the healthcare teams, in particular the time between the onset of symptoms and surgical revision. According to these expert reviews, the placement of a drain was not taken into consideration during the medicolegal assessment of a postoperative symptomatic epidural hematoma.

LEVEL OF EVIDENCE

II; retrospective prognostic study, investigation of patient characteristics and their impact on functional outcome.

Preoperative information: Written first?

Patient information is now an ethical and legal obligation in France; it is the physician who is required to provide proof. The Law of March 4, 2002 and the code of ethics and main legal and regulatory texts are, however, imprecise on some points. Written documents, although not stipulated in law, are in practice essential, supplementing the indispensable oral information given by the surgeon in individual personalized interview. Patients remember only some of this information, and overestimate their own understanding of it. Written documents are therefore essential to compensate for this. Their contents need validation by scientific societies. In case of disagreement, the medical file is the essential means of assessing information quality, and should be kept up to date as rigorously as possible. A key document is the letter summarizing the preoperative consultation, validating surgery, which should be drawn up in a manner that meets the obligation to inform. Signed consent is not mandatory in law, but is necessary in practice and should be archived. For judges, proof of information is based on several elements: the complete structured letter to the patient and community physician plus the signed information sheet and consent form constitute solid evidence and all three should be included in the medical file. Information has now become a part of health-care in itself. In a context of increasing litigation, "defensive medicine" is still to be avoided but physicians should have their own check-lists so as to be in a position to prove delivery of structured information if called upon to do so. In the absence of proven information, patients can plead loss of chance and/or prejudice for lack of preparation and/or infringement of dignity, and claim damages from the courts.

Readability of Sports Injury and Prevention Patient Education Materials From the American Academy of Orthopaedic Surgeons Website

Introduction:

The purpose of this study is to evaluate the readability of 114 Sports Injury and Prevention patient education materials provided by the American Academy of Orthopaedic Surgeons (AAOS).

Methods:

We evaluated all articles written in English posted under the Sports Injury and Prevention section of the AAOS website using readability software to compute six readability scores, which we compared with the eighth-grade level using a two-tailed one-sample Student t-test.

Results:

The mean reading grade level calculated by each readability test was markedly higher than the eighth-grade level. We reported mean ± SD for each test: Flesch-Kincaid grade level (8.95 ± 1.51; P < 0.001), Simple Measure of Gobbledygook (11.53 ± 1.18; P < 0.001), Coleman-Liau index (11.16 ± 1.33; P < 0.001), Gunning Fog index (11.06 ± 1.63; P < 0.001), New Dale-Chall (9.49 ± 1.66; P < 0.001), and FORCAST formulas (10.96 ± 0.60; P < 0.001).

Discussion:

This study shows that patient education materials provided by the AAOS concerning sports injury and prevention are written at a readability level too high for patients to understand. On average, patient materials are written at least 2.5 grade levels higher than national recommendations. Only 7% of the 114 articles had readability scores in line with national recommendations. These findings indicate a need for revised patient education materials geared toward bringing the readability level down to the recommended eighth-grade level.

Readability assessment of American Shoulder and Elbow Surgeons patient brochures with suggestions for improvement

Background

Many Americans have limited literacy skills, and the National Institutes of Health (NIH) suggests patient educational material be written below the 8th grade level. Many orthopedic organizations provide print material for patients, but whether these documents are written at an appropriate reading level is not clear. This study assessed the readability of patient education brochures provided by the American Shoulder and Elbow Surgeons (ASES).

Materials and Methods

In May 2017, 6 ASES patient education brochures were analyzed using readability software. The reading level was calculated for each brochure using 9 different tests. The mean reading level for each article was compared with the NIH-recommended 8th grade level using 2-tailed, 1-sample t tests assuming unequal variances.

Results

For each of the 9 tests, the mean reading level was higher than the NIH-recommended 8th grade (test, grade level): Automated Readability Index, 14.1 (P < .05); Coleman-Liau, 14.2 (P < .05); New Dale-Chall, 13.2 (P < .05); Flesch-Kincaid, 13.7 (P < .05); FORCAST, 11.8 (P < .05); Fry, 15.8 (P < .05); Gunning Fog, 16.5 (P < .05); Raygor Estimate, 15.4 (P < .05); and Simple Measure of Gobbledygook (SMOG), 15.1 (P < .05).

Conclusions

The ASES patient education brochures are written well above the NIH-recommended 8th grade reading level. These findings are similar to other investigations concerning orthopedic patient education material. Supplementary brochures and websites could be a useful source of information, particularly for patients who are deterred from asking questions in the office. Printed material designed for patient education should be edited to a more reasonable reading level. Further review of patient education materials is warranted.