Health literacy and patient-reported outcomes in preoperative patients undergoing lumbar spine surgery: a cross-sectional study

BACKGROUND CONTEXT: Health literacy (HL) plays an important role in health outcomes (eg, Activities of Daily Living and Quality of Life) among patients with chronic diseases and elderly persons. The association between functional HL and health outcomes in patients with lumbar degenerative disease has also been revealed. Comprehensive HL includes 3 levels of functional, communicative, and critical HL that may affect the health outcomes of patients undergoing lumbar spine surgery. However, the association between comprehensive HL and health outcomes in patients undergoing lumbar spine surgery has not yet been investigated. PURPOSE: To examine the impact of comprehensive HL on patient-reported outcomes (PROs) of pain-related disabilities and health-related quality of life in patients undergoing lumbar spine surgery. STUDY DESIGN/SETTING: Cross-sectional study. PATIENT SAMPLE: Patients aged 18 years or older who presented to a general hospital-based spine center for the surgical treatment of lumbar degenerative disease. OUTCOME MEASURES: Oswestry Disability Index 2.0 (ODI), EuroQol-5D-5L (EQ-5D-5L). METHODS: Between June 2023 and May 2024, consecutive patients aged 18 years or older presenting to the spine center were approached for participation in this cross-sectional study. Patients completed a questionnaire concerning sociodemographic characteristics; Functional, Communicative, and Critical Health Literacy (FCCHL); and PROs, including ODI and EQ-5D-5L. A multivariable linear regression analysis with potential confounders was performed to examine the relationship between FCCHL and PROs. RESULTS: Of 128 eligible patients, 124 (97%) were included in the statistical analysis. Higher total FCCHL score was significantly associated with better PROs (ODI (regression coefficient, -10.6; [95% confidence interval, -17.6, -3.6]), EQ-5D-5L (0.093 [0.022, 0.165])) in a linear dose-response manner. Functional HL was not associated with PROs; however, communicative and critical HL were both associated with PROs. CONCLUSIONS: Higher comprehensive HL, including functional, communicative, and critical HL, was associated with better PROs, characterized by lower ODI and higher EQ-5D-5L scores, in a linear dose-response manner in patients undergoing lumbar spine surgery. Our study suggests that comprehensive HL is important to prevent disabilities in daily life due to lumbar degenerative disease.