Patients With Femoroacetabular Impingement Obtain Information From Low-Quality Sources Online and Are Most Interested in Conservative Treatment and Expected Recovery

Arthroscopic Management of Femoroacetabular Impingement: Current Concepts

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain and dysfunction, especially in young and active individuals, and it may require surgical management for associated labral tears and cartilage damage. The management of FAI has advanced radically over the last few years, and hip arthroscopy has gained a leading role. However, despite the increasing number of published research and technological advancements, a comprehensive systematic review summarising current evidence is still missing. Methods: All the clinical studies investigating the arthroscopic management of FAI were accessed. Only studies with a minimum of six months of follow-up were considered. The 2020 PRISMA guidelines were followed. In December 2024, PubMed, Web of Science, and Embase were accessed without time constraints. Results: The present systematic review included 258 clinical investigations (57,803 patients). The mean length of follow-up was 34.2 ± 22.7 months. The mean age was 34.7 ± 5.3, and the mean BMI was 25.1 ± 2.0 kg/m2. Conclusions: The present systematic review updates current evidence on patients who have undergone arthroscopic surgery for FAI, updating and discussing current progress in managing labral injuries and patient selection, emphasising outcomes and pitfalls. Progress in surgery and improvement in eligibility criteria, as well as current controversies and prospects, were also discussed.

ChatGPT-3.5 and -4 provide mostly accurate information when answering patients' questions relating to femoroacetabular impingement syndrome and arthroscopic hip surgery

OBJECTIVES

This study aimed to evaluate the accuracy of ChatGPT in answering patient questions about femoroacetabular impingement (FAI) and arthroscopic hip surgery, comparing the performance of versions ChatGPT-3.5 (free) and ChatGPT-4 (paid).

METHODS

Twelve frequently asked questions (FAQs) relating to FAI were selected and posed to ChatGPT-3.5 and ChatGPT-4. The responses were assessed for accuracy by three hip arthroscopy surgeons using a four-tier grading system. Statistical analyses included Wilcoxon signed-rank tests and Gwet's AC2 coefficient for interrater agreement corrected for chance and employing quadratic weights.

RESULTS

The median ratings for responses ranged from "excellent not requiring clarification" to "satisfactory requiring moderate clarification." No responses were rated as "unsatisfactory requiring substantial clarification." The median accuracy scores were 2 (range 1-3) for ChatGPT-3.5 and 1.5 (range 1-3) for ChatGPT-4, with 25 ​% of ChatGPT-3.5's responses and 50 ​% of ChatGPT-4's responses rated as "excellent." There was no statistical difference in performance between the two versions (p ​= ​0.279) although ChatGPT-4 showed a tendency towards higher accuracy in some areas. Interrater agreement was substantial for ChatGPT-3.5 (Gwet's AC2 ​= ​0.79 [95% confidence interval (CI) ​= ​0.6-0.94]) and moderate to substantial for ChatGPT-4 (Gwet's AC2 ​= ​0.65 [95% CI ​= ​0.43-0.87]).

CONCLUSION

Both versions of ChatGPT provided mostly accurate responses to FAQs on FAI and arthroscopic surgery, with no significant difference between the versions. The findings suggest potential utility of ChatGPT in patient education, though cautious implementation and further evaluation are recommended due to variability in response accuracy and low power of the study.

LEVEL OF EVIDENCE

IV.

Online patients questions regarding reverse total shoulder arthroplasty pertain to timeline of recovery, specific activities, and limitations

Background

Reverse total shoulder arthroplasty (rTSA) demonstrates favorable long-term data and has outpaced anatomic total shoulder arthroplasty and hemiarthroplasty as the most-performed shoulder arthroplasty procedure. As indications and outcomes continue to favor rTSA, patients may turn to the internet as an efficient modality to answer various questions or concerns. This study investigates online patient questions pertaining to rTSA and the quality of the websites providing information.

Hypotheses

(1) Questions will pertain to surgical indications, timeline of recovery, and postoperative restrictions; (2) the quality and transparency of online information is largely heterogenous.

Methods

Three rTSA searches were entered into the Google Web Search. Questions under the "People also ask" tab were expanded sequentially and 100 consecutive results for each query were included for analysis (300 in total). Questions were categorized based on Rothwell's Classification and subcategorized by topic. Websites were categorized by source. Website quality was evaluated by the Journal of the American Medical Association (JAMA) Benchmark Criteria.

Results

Most questions fell into the Rothwell Fact category (49.7%). The most common question topics were Timeline of Recovery (17.3%), Specific Activities (14.7%), and Restrictions (11.3%). The least common question topics were Anatomy/Function (0.0%), Cost (0.3%), and Diagnoses/Evaluation (0.3%). The most common websites were Medical Practice (45.0%), Academic (22.3%), and Single Surgeon (12.3%). PubMed articles consisted of 41.2% of Government websites. The average JAMA score for all websites was 1.48 ± 1.27. Government websites had the highest JAMA score (3.11 ± 1.01) and constituted 55.9% of all websites with a score of 4/4. Medical Practice websites had the lowest JAMA score (0.99 ± 0.91).

Conclusion

Patients are interested in the timeline of recovery, ability to perform specific activities after surgery, and short-term and long-term restrictions following rTSA. Although all patients will benefit from education on ways to perform activities of daily living while abiding by postoperative restrictions, physicians should set preoperative expectations regarding return-to-activity following rTSA in younger, more active patients. Finally, surgeons should provide patients with physical booklets and online information available on their websites to avoid reliance on low-quality online sources.

Evaluating the Quality and Readability of Online Health Information on Snapping Hip Syndrome: A Cross-Sectional Analysis

AIM

This study aims to evaluate the quality and readability of online health information related to snapping hip syndrome (SHS).

METHODS

A cross-sectional analysis was conducted by searching the term "Snapping Hip Syndrome" on Google, Bing, and Yahoo. The first 30 results from each search engine were assessed, and duplicate or irrelevant websites were excluded. The remaining 90 unique web pages were categorized into academic, physician, commercial, medical professional, and non-identified groups. Quality was assessed using the DISCERN instrument, Journal of the American Medical Association (JAMA) Benchmark Criteria, and HONcode certification, while readability was evaluated with the Flesch-Kincaid Grade Level (FKGL) and Flesch-Kincaid Reading Score (FKRS). The SHS Content Score (SHS-CS) was also developed for a comprehensive content-specific evaluation.

RESULTS

Academic websites had the highest quality scores, with DISCERN (52.10 ± 6.85), JAMA (3.48 ± 0.50), and SHS-CS (27.85 ± 2.15), but demonstrated lower readability (FKGL: 11.76 ± 0.40, FKRS: 21.45 ± 7.12). Commercial and non-identified websites scored lowest across all quality measures. Significant correlations were found between DISCERN and JAMA (r = 0.932, p = 0.000*), SHS-CS and DISCERN (r = 0.918, p = 0.000*), and a negative correlation with readability metrics (DISCERN vs. FKRS, r = -0.668, p = 0.000*).

CONCLUSION

The quality of SHS-related online information varies significantly across website types. While academic websites provide the highest quality content, they often lack readability. HONcode-certified websites exhibited superior quality but did not differ significantly in readability compared to non-certified sites. Future efforts should focus on improving the readability of high-quality health information.

ChatGPT as a Source of Patient Information for Lumbar Spinal Fusion and Laminectomy: A Comparative Analysis Against Google Web Search

STUDY DESIGN

Retrospective Observational Study.

OBJECTIVE

The objective of this study was to assess the utility of ChatGPT, an artificial intelligence chatbot, in providing patient information for lumbar spinal fusion and lumbar laminectomy in comparison with the Google search engine.

SUMMARY OF BACKGROUND DATA

ChatGPT, an artificial intelligence chatbot with seemingly unlimited functionality, may present an alternative to a Google web search for patients seeking information about medical questions. With widespread misinformation and suboptimal quality of online health information, it is imperative to assess ChatGPT as a resource for this purpose.

METHODS

The first 10 frequently asked questions (FAQs) related to the search terms "lumbar spinal fusion" and "lumbar laminectomy" were extracted from Google and ChatGPT. Responses to shared questions were compared regarding length and readability, using the Flesch Reading Ease score and Flesch-Kincaid Grade Level. Numerical FAQs from Google were replicated in ChatGPT.

RESULTS

Two of 10 (20%) questions for both lumbar spinal fusion and lumbar laminectomy were asked similarly between ChatGPT and Google. Compared with Google, ChatGPT's responses were lengthier (340.0 vs. 159.3 words) and of lower readability (Flesch Reading Ease score: 34.0 vs. 58.2; Flesch-Kincaid grade level: 11.6 vs. 8.8). Subjectively, we evaluated these responses to be accurate and adequately nonspecific. Each response concluded with a recommendation to discuss further with a health care provider. Over half of the numerical questions from Google produced a varying or nonnumerical response in ChatGPT.

CONCLUSIONS

FAQs and responses regarding lumbar spinal fusion and lumbar laminectomy were highly variable between Google and ChatGPT. While ChatGPT may be able to produce relatively accurate responses in select questions, its role remains as a supplement or starting point to a consultation with a physician, not as a replacement, and should be taken with caution until its functionality can be validated.

Patients With Posterior Cruciate Ligament Injuries Obtain Information Regarding Diagnosis, Management, and Recovery from Low-Quality Online Resources

OBJECTIVES

This study investigates the most common online patient questions pertaining to posterior cruciate ligament (PCL) injuries and the quality of the websites providing information.

METHODS

Four PCL search queries were entered into the Google Web Search. Questions under the 'People also ask' tab were expanded in order and 100 results for each query were included (400 total). Questions were categorized based on Rothwell's Classification of Questions (Fact, Policy, Value). Websites were categorized by source (Academic, Commercial, Government, Medical Practice, Single Surgeon Personal, Social Media). Website quality was evaluated based on the Journal of the American Medical Association (JAMA) Benchmark Criteria. Pearson's chi-squared was used to assess categorical data. Cohen's kappa was used to assess inter-rater reliability.

RESULTS

Most questions fell into the Rothwell Fact category (54.3%). The most common question topics were Diagnosis/Evaluation (18.0%), Indications/Management (15.5%), and Timeline of Recovery (15.3%). The least common question topics were Technical Details of Procedure (1.5%), Cost (0.5%), and Longevity (0.5%). The most common websites were Medical Practice (31.8%) and Commercial (24.3%), while the least common were Government (8.5%) and Social Media (1.5%). The average JAMA score for websites was 1.49 ± 1.36. Government websites had the highest JAMA score (3.00 ± 1.26) and constituted 42.5% of all websites with a score of 4/4. Comparatively, Single Surgeon Personal websites had the lowest JAMA score (0.76 ± 0.87, range [0-2]). PubMed articles constituted 70.6% (24/34) of Government websites, 70.8% (17/24) had a JAMA score of 4 and 20.8% (5/24) had a score of 3.

CONCLUSION

Patients search the internet for information regarding diagnosis, treatment, and recovery of PCL injuries and are less interested in the details of the procedure, cost, and longevity of treatment. The low JAMA score reflects the heterogenous quality and transparency of online information. Physicians can use this information to help guide patient expectations pre- and post-operatively.

Best practices on patient education materials in hip surgery based on learnings from major hip centers and societies

Patient education is important as it gives patients a better understanding of the risks and benefits of medical and surgical interventions. Developing communication technologies have completely changed and enhanced patient access to medical information. The aim of this study was to evaluate available patient education materials (PEMs) regarding hip surgery on the websites of major hip societies and centers. The PEM from 11 selected leading hip centers and societies were evaluated with the following assessment tools: Flesch-Kincaid (FK) readability test, Flesch Reading Ease formula, Literature-Intelligence-Data-Analysis (LIDA) instrument and Discernibility Interpretability Sources Comprehensive Evidence Relevance Noticeable (DISCERN) tool. Videos were assessed using Patient Educational Video Assessment Tool (PEVAT). A total of 69 educational items, including 52 text articles (75.4%) and 17 videos (24.6%) were retrieved and evaluated. The median Interquartile Range (IQR) FK level of 52 text articles was 10.8 (2.2). The median (IQR) LIDA score of text articles by center was 45. According to the LIDA score, 60% of all website articles demonstrated high accessibility (LIDA score > 44). The median DISCERN score of text articles by center was 69. Overall, 52 (100%) of the text articles were deemed to be at 'good' quality rating or higher, and 23.2% (16 out of 69) of the articles had excellent quality. The mean PEVAT score for the 17 videos was 25 ± 1.9. Analysis of text and video articles from the 11 leading orthopedic surgery centers and societies demonstrated that by selecting a reliable source of information from main scientific societies and major centers in hip surgery, patients can find more accurate information regarding their hip conditions.

What are our patients asking Google about acromioclavicular joint injuries?-frequently asked online questions and the quality of online resources

Background

Management of acromioclavicular (AC) joint injuries has been an ongoing source of debate, with over 150 variations of surgery described in the literature. Without a consensus on surgical technique, patients are seeking answers to common questions through internet resources. This study investigates the most common online patient questions pertaining to AC joint injuries and the quality of the websites providing information.

Hypothesis

1) Question topics will pertain to surgical indications, pain management, and success of surgery and 2) the quality and transparency of online information are largely heterogenous.

Methods

Three AC joint search queries were entered into the Google Web Search. Questions under the "People also ask" tab were expanded in order and 100 results for each query were included (300 total). Questions were categorized based on Rothwell's classification. Websites were categorized by source. Website quality was evaluated by the Journal of the American Medical Association (JAMA) Benchmark Criteria.

Results

Most questions fell into the Rothwell Fact category (48.0%). The most common question topics were surgical indications (28.0%), timeline of recovery (13.0%), and diagnosis/evaluation (12.0%). The least common question topics were anatomy/function (3.3%), evaluation of surgery (3.3%), injury comparison (1.0%), and cost (1.0%). The most common websites were medical practice (44.0%), academic (22.3%), and single surgeon personal (12.3%). The average JAMA score for all websites was 1.0 ± 1.3. Government websites had the highest JAMA score (4.0 ± 0.0) and constituted 45.8% of all websites with a score of 4/4. PubMed articles constituted 63.6% (7/11) of government website. Comparatively, medical practice websites had the lowest JAMA score (0.3 ± 0.7, range [0-3]).

Conclusion

Online patient AC joint injury questions pertain to surgical indications, timeline of recovery, and diagnosis/evaluation. Government websites and PubMed articles provide the highest-quality sources of reliable, up-to-date information but constitute the smallest proportion of resources. In contrast, medical practice represents the most visited websites, however, recorded the lowest quality score. Physicians should utilize this information to answer frequently asked questions, guide patient expectations, and help provide and identify reliable online resources.

Evaluation High-Quality of Information from ChatGPT (Artificial Intelligence-Large Language Model) Artificial Intelligence on Shoulder Stabilization Surgery

PURPOSE

To analyze the quality and readability of information regarding shoulder stabilization surgery available using an online AI software (ChatGPT), using standardized scoring systems, as well as to report on the given answers by the AI.

METHODS

An open AI model (ChatGPT) was used to answer 23 commonly asked questions from patients on shoulder stabilization surgery. These answers were evaluated for medical accuracy, quality, and readability using The JAMA Benchmark criteria, DISCERN score, Flesch-Kincaid Reading Ease Score (FRES) & Grade Level (FKGL).

RESULTS

The JAMA Benchmark criteria score was 0, which is the lowest score, indicating no reliable resources cited. The DISCERN score was 60, which is considered a good score. The areas that open AI model did not achieve full marks were also related to the lack of available source material used to compile the answers, and finally some shortcomings with information not fully supported by the literature. The FRES was 26.2, and the FKGL was considered to be that of a college graduate.

CONCLUSIONS

There was generally high quality in the answers given on questions relating to shoulder stabilization surgery, but there was a high reading level required to comprehend the information presented. However, it is unclear where the answers came from with no source material cited. It is important to note that the ChatGPT software repeatedly references the need to discuss these questions with an orthopaedic surgeon and the importance of shared discussion making, as well as compliance with surgeon treatment recommendations.

CLINICAL RELEVANCE

As shoulder instability is an injury that predominantly affects younger individuals who may use the Internet for information, this study shows what information patients may be getting online.

Digital Patient Education on Xanthelasma Palpebrarum: A Content Analysis

Patient education has been transformed using digital media and online repositories which disseminate information with greater efficiency. In dermatology, this transformation has allowed for patients to gain education on common cutaneous conditions and improve health literacy. Xanthelasma palpebrarum is one of the most common cutaneous conditions, yet there is a poor understanding of how digital materials affect health literacy on this condition. Our study aimed to address this paucity of literature utilizing Brief DISCERN, Rothwell's Classification of Questions, and six readability calculations. The findings of this study indicate a poor-quality profile (Brief DISCERN < 16) regarding digital materials and readability scores which do not meet grade-level recommendations in the United States. This indicates a need to improve the current body of educational materials used by clinicians for diagnosing and managing xanthelasma palpebrarum.

Insights Into Patients Questions Over Bunion Treatments: A Google Study

Background

Approximately 1 in 4 adults will develop hallux valgus (HV). Up to 80% of adult Internet users reference online sources for health-related information. Overall, with the high prevalence of HV combined with the numerous treatment options, we believe patients are likely turning to Internet search engines for questions relevant to HV. Using Google's people also ask (PAA) or frequently asked questions (FAQs) feature, we sought to classify these questions, categorize the sources, as well as assess their levels of quality and transparency.

Methods

On October 9, 2022, we searched Google using these 4 phrases: "hallux valgus treatment," "hallux valgus surgery," "bunion treatment," and "bunion surgery." The FAQs were classified in accordance with the Rothwell Classification schema and each source was categorized. Lastly, transparency and quality of the sources' information were evaluated with the Journal of the American Medical Association's (JAMA) Benchmark tool and Brief DISCERN, respectively.

Results

Once duplicates and FAQs unrelated to HV were removed, our search returned 299 unique FAQs. The most common question in our sample was related to the evaluation of treatment options (79/299, 26.4%). The most common source type was medical practices (158/299, 52.8%). Nearly two-thirds of the answer sources (184/299; 61.5%) were lacking in transparency. One-way analysis of variance revealed a significant difference in mean Brief DISCERN scores among the 5 source types, F(4) = 54.49 (P < .001), with medical practices averaging the worst score (12.1/30).

Conclusion

Patients seeking online information concerning treatment options for HV search for questions pertaining to the evaluation of treatment options. The source type encountered most by patients is medical practices; these were found to have both poor transparency and poor quality. Publishing basic information such as the date of publication, authors or reviewers, and references would greatly improve the transparency and quality of online information regarding HV treatment.

Level of Evidence

Level V, mechanism-based reasoning.