Cross sectional analysis of scoliosis-specific information on the internet: potential for patient confusion and misinformation


Background context

Patients and their families are increasingly turning to the internet for medical information. Most of these patients believe the information to be accurate and reliable. However, the quality and accuracy of that information on the internet is variable and unregulated. Accurate and applicable information may align patients’ expectations and improve satisfaction and overall outcomes.


This study aimed to evaluate the quality and accuracy of scoliosis-related information available on the internet.

Study design

Cross-sectional analysis.


Independent searches were conducted on the three most commonly accessed search engines (Google, Yahoo and Bing) using the keyword “scoliosis”. The top 30 sites from each search engine were reviewed. Each website was categorized as per its authorship and sourcing. Each site was then evaluated for accuracy, readability and with quality-assurance markers such as Health on the Net code (HONcode), DISCERN, Journal of American Medical Association (JAMA) systems. The accuracy of the website was assessed by two fellowship-trained spine specialists. Website accuracy was rated on a scale of 1–4 based on the level of agreement with the information presented. Websites with greater than 75% agreement were rated 4. Finally, the sites were evaluated with a validated website distraction index and assessed for mobile friendliness.


42 unique websites were analyzed. 31% of the sites were categorized as academic (13 academic, 9 healthcare system, 12 health news outlets and 8 unspecified) and had the highest rate of physician authorship (54%). Accuracy ranged from less than 25% to more than 75% were recorded with a mean accuracy of 3 signifying 50–75% agreement. Academic sites had the highest scoliosis specific accuracy score (P < 0.05). Overall, average readability was at a 12th grade reading level. More than 90% of the sites were mobile friendly. Approximately 71% of the websites did not have HONcode certification, although health news outlets had the highest rate of certification (67%). There was a significant effect of HONcode certification on DISCERN, JAMA, grade level and reading ease. On average, HONcode certified websites had lower grade level readability with greater reading ease and higher DISCERN and JAMA scores than un-certified sites (p < 0.05). On average, health news outlets had the highest DISCERN, JAMA, and reading ease scores and were written at the lowest grade reading level but had the highest level of distraction (p < 0.05).


For the iGeneration and their care-givers, the internet remains the most popular source of health-related and medical information. Despite the wide number of sources available, the quality, accuracy, pertinence and intelligibility of the information remains highly variable. As clinicians, we should direct patients to verifiable sites with regulated information and, where possible, contribute high quality information to those sites.

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No funding was received for this work.

Author information




David Truumees: Data collection, manuscript preparation, review and approval. Ashley Duncan, RN: Data collection, study design, manuscript preparation, review and approval. Eric Kano Mayer, MD: Study design, manuscript preparation, review and approval. Devender Singh, PhD: Study design, data collection, manuscript preparation, review and approval. Matthew J. Geck MD: Manuscript preparation, review and final approval. Eeric Truumees MD: Study design, manuscript preparation, review, approval and overall study management.

Corresponding author

Correspondence to Eeric Truumees.

Ethics declarations

Conflict of interest

David Truumees, Ashley Duncan, Devender Singh: None; Eeric Truumees: Stryker spine (royalty); Doctoral research group (stock); Relievant Medsystems, Stryker, Medtronic, KUROS, Seikagau Corporation (research support); North American Spine Society (board member); Eric Kano Mayer: Indiago, Lanai Health Solutions, IOPI (stocks); Matthew J Geck: Difusion (stock), SpineHope (Board member:unpaid).

Ethical approval (IRB)

Approved by Institutional review board.

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Not applicable.

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Truumees, D., Duncan, A., Mayer, E.K. et al. Cross sectional analysis of scoliosis-specific information on the internet: potential for patient confusion and misinformation. Spine Deform (2020).

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  • Scoliosis
  • Internet
  • Information