Quality and content of Internet-based information for ten common orthopaedic sports medicine diagnoses

Potential Reinforcement of Health Misconceptions in YouTube Videos: Example of Elbow Enthesopathy (Tennis Elbow)

BACKGROUND AND OBJECTIVES

We evaluated the prevalence of potential reinforcement of common unhealthy misinterpretations of bodily sensations in social media (YouTube videos) addressing elbow enthesopathy (eECRB, enthesopathy of the extensor carpi radialis brevis, tennis elbow).

METHODS

We recorded video metric data on 139 unique YouTube videos when searching "lateral epicondylitis" and "tennis elbow." We designed a rubric to assess the level of potential reinforcement of unhelpful thinking in videos about eECRB. Informational quality was scored with an adapted version of the DISCERN instrument. We then assessed the factors associated with these scores.

RESULTS

Sixty-five percent (91 of 139) of videos contained information reinforcing at least one common misconception regarding eECRB. Potential reinforcement of misconceptions was associated with longer video duration, higher likes per day, and higher likes per view. No factors were associated with information quality scores.

CONCLUSIONS

These findings of a high prevalence of potential reinforcement of misconceptions in YouTube videos, in combination with the known associations of misconceptions with greater discomfort and incapability, point to the potential of such videos to harm health. Producers of patient facing health material can add avoidance of reinforcement of unhelpful thinking along with readability, accuracy, and relevance as a guiding principle.

[Online resources for ankle sprains : A German language web analysis]

BACKGROUND

With the Internet as the main source of information for health content, the quality of websites with medical information is of high importance.

OBJECTIVE

This study analysed 250 websites on acute ankle sprain (ASD), one of the most common musculoskeletal disorders, for their quality and readability. Based on the results, a guide for patients was created.

METHOD

The quality of the websites was assessed using a 25-item content score and the EQIP36 score for medical information material. The reading level could be determined using the Flesch-Kincaid index and the calculated readability. The best three websites were evaluated in a user survey.

RESULTS

Of the 250 websites recorded 77 were included in the study. The quality of these varied significantly, with none achieving the maximum score. Sources in the healthcare system showed higher quality, while commercially influenced sites were below average in terms of completeness of content. Only 14% of the websites reached the recommended reading level. A significant negative correlation was found between completeness of content and readability. The user survey showed a mixed level of satisfaction and participants with previous medical knowledge were more critical than laypersons.

CONCLUSION

Online resources about ASD are suboptimal and differ considerably. Deficiencies in content, readability and structure were identified, which limit the effective use by patients. Health information publishers should work harder to improve the comprehensibility and quality of the information provided.

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.

Potential misinformation in websites on carpal tunnel syndrome

Objective

We sought to evaluate the potential reinforcement of misconceptions in websites discussing carpal tunnel syndrome (CTS).

Methods

After removing all cookies to limit personalization, we entered "carpal tunnel syndrome" into five search engines and collected the first 50 results displayed for each search. For each of the 105 unique websites, we recorded publication date, author background, and number of views. The prevalence of potential reinforcement and/or reorientation of misconceptions for each website was then scored using a rubric based on our interpretation of the best current evidence regarding CTS. The informational quality of websites was graded with the DISCERN instrument, a validated tool for assessing online health information.

Results

Every website contained at least one potentially misleading statement in our opinion. The most common misconceptions reference "excessive motion" and "inflammation." Greater potential reinforcement of misinformation about CTS was associated with fewer page views and lower informational quality scores.

Conclusions

Keeping in mind that this analysis is based on our interpretation of current best evidence, potential misinformation on websites addressing CTS is common and has the potential to increase symptom intensity and magnitude of incapability via reinforcement of unhelpful thoughts regarding symptoms.

Innovation

The prevalence of patient-directed health information that can increase discomfort and incapability by reinforcing common unhelpful thoughts supports the need for innovations in how we develop, oversee, and evolve healthy online material.

Retrograde Cricopharyngeal Dysfunction: A Google Search Analysis

OBJECTIVE

No studies describe what patients search for online in relation to retrograde cricopharyngeal dysfunction (RCPD). Our objectives were to describe the Google search volume for RCPD, identify the most common queries related to RCPD, and evaluate the available online resources.

STUDY DESIGN

Observational.

SETTING

Google Database.

METHODS

Using Ahrefs and Search Response, Google search volume for RCPD and "People Also Ask" (PAA) questions were documented. PAA questions were categorized based on intent, and the websites were categorized on source. The quality and readability of the sources were determined using the Journal of the American Medical Association (JAMA) benchmark criteria, Flesch Reading Ease score, and Flesch-Kincaid Grade Level.

RESULTS

Search volume for RCPD-related content has continually increased since 2021, with a combined average volume of 6287 searches per month. Most PAA questions were related to technical details (61.07%) and treatments (32.06%) for RCPD. Websites provided to answer these questions were most often from academic (25.95%) and commercial (22.14%) sources. None of the sources met the criteria for universal readability, and only 15% met all quality metrics set forth by JAMA.

CONCLUSION

Interest in RCPD is at an all-time high, with information related to its diagnosis and treatment most popular among Google users. Significantly, none of the resources provided by Google met the criteria for universal readability, preventing many patients from fully comprehending the information presented. Future work should aim to address questions related to RCPD in a suitable way for all patient demographics.

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.

Patients With Shoulder Labral Tears Search the Internet to Understand Their Diagnoses and Treatment Options

Purpose

To analyze the most frequently searched questions associated with shoulder labral pathology and to evaluate the source-type availability and quality.

Methods

Common shoulder labral pathology-related search terms were entered into Google, and the suggested frequently asked questions were compiled and categorized. In addition, suggested sources were recorded, categorized, and scored for quality of information using JAMA (The Journal of the American Medical Association) benchmark criteria. Statistical analysis was performed to compare the types of questions and their associated sources, as well as the quality of sources.

Results

In this study, 513 questions and 170 sources were identified and categorized. The most popular topics were diagnosis/evaluation (21.5%) and indications/management (21.1%.). The most common website types were academic (27.9%), commercial (25.2%), and medical practice (22.5%). Multiple statistically significant associations were found between specific question categories and their associated source types. The average JAMA quality score for all sources was 1.56, and medical websites had significantly lower quality scores than nonmedical sites (1.05 vs 2.12, P < .001).

Conclusions

Patients searching the internet for information regarding shoulder labral pathology often look for facts regarding the diagnosis and management of their conditions. They use various source types to better understand their conditions, with government sources being of the highest quality, whereas medical sites showed statistically lower quality. Across the spectrum of questions, the quality of readily available resources varies substantially.

Clinical Relevance

The use of online resources in health care is expanding. It is important to understand the most commonly asked questions and the quality of information available to patients.

Evaluating the Source and Content of Internet Information Regarding DeQuervain's Tenosynovitis

Introduction Patients are increasingly relying on the internet for information about their medical diagnoses, but there is little regulation on the content of these websites. The purpose of this study was to investigate the quality of the informational content available on the internet regarding DeQuervain's tenosynovitis.  Methods The search phrasing "'DeQuervain' OR 'DeQuervain's' OR 'Radial styloid tenosynovitis' OR 'DeQuervain's synovitis' OR 'Wrist tendonitis'" was entered into the five most commonly used search engines, and the first 50 universal resource locators (URLs) were recorded, including sponsored sites. Duplicate sites and URLs linking to other search engines were removed, yielding a roster of 109 websites that form the basis for this study. Each site was graded by two authors and scored based on a previously published information evaluation protocol regarding informational content. A third individual resolved any conflict before analysis. The sum of these scores resulted in an "Informational Score" on a scale from 0 to 100. Results Sixty-six (60.6%) of the websites evaluated were authored by an academic institution or a physician, and these all provided conventional information. Thirty-two (29.4%) of the sites were commercial sites or sold commercial products. The remaining 11 websites (10.1%) had nonphysician, unidentified, or lay authorship. The mean informational score for all sites was 46.7 out of a maximum of 100 points. The mean score of the academic or physician-authored websites was 53.3 out of 100 points, compared to 36.7 out of 100 for the remainder of the sites, which was significantly different. The mean score for the 14 sponsored websites was 11.6 out of 100. Discussion/conclusion We concluded that internet information on DeQuervain's tenosynovitis is of poor quality and incomplete. Patients looking for information about DeQuervain's tenosynovitis on the internet should be advised to focus on academic- and physician-authored sites in order to avoid commercial bias and misleading information.

Examining the Public's Most Frequently Asked Questions About Carpal Tunnel Syndrome and Appraising Online Information About Treatment

BACKGROUND

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Patients often search online for health information regarding common musculoskeletal complaints. Thus, the purpose of this study was to use language processing information from Google to assess the content of CTS frequently asked questions (FAQs) searched online and the transparency and quality of online CTS information.

METHODS

On March 11, 2021, we searched Google for 3 terms "carpal tunnel syndrome treatment," "carpal tunnel syndrome surgical treatment," and "carpal tunnel syndrome non-surgical treatment" until a minimum of 100 FAQs and their answer links were extracted from each search. We used Rothwell classification to categorize the FAQs. The Journal of the American Medical Association's benchmark criteria were used to assess information transparency. Information quality was assessed using the Brief DISCERN tool.

RESULTS

Our Google search returned 124 unique FAQs. Fifty-six (45.2%) were value based and most were related to the evaluation of treatment options (45/56, 80.4%). The most common source type was medical practices (26.6%). Nearly half of the answer sources (45.9%) were found to be lacking in transparency. One-way analysis of variance revealed a significant difference in mean Brief DISCERN scores among the 5 source types, F(4, 119) = 5.93, P = .0002, with medical practices averaging the worst score (13.73/30).

CONCLUSIONS

Patients are most commonly searching Google to gain information regarding CTS treatment options. Online sources such as medical practices should use widely accepted rubrics for ensuring transparency and quality prior to publishing CTS information.

Using Google web search to analyze and evaluate the application of ChatGPT in femoroacetabular impingement syndrome

Background

Chat Generative Pre-trained Transformer (ChatGPT) is a new machine learning tool that allows patients to access health information online, specifically compared to Google, the most commonly used search engine in the United States. Patients can use ChatGPT to better understand medical issues. This study compared the two search engines based on: (i) frequently asked questions (FAQs) about Femoroacetabular Impingement Syndrome (FAI), (ii) the corresponding answers to these FAQs, and (iii) the most FAQs yielding a numerical response.

Purpose

To assess the suitability of ChatGPT as an online health information resource for patients by replicating their internet searches.

Study design

Cross-sectional study.

Methods

The same keywords were used to search the 10 most common questions about FAI on both Google and ChatGPT. The responses from both search engines were recorded and analyzed.

Results

Of the 20 questions, 8 (40%) were similar. Among the 10 questions searched on Google, 7 were provided by a medical practice. For numerical questions, there was a notable difference in answers between Google and ChatGPT for 3 out of the top 5 most common questions (60%). Expert evaluation indicated that 67.5% of experts were satisfied or highly satisfied with the accuracy of ChatGPT's descriptions of both conservative and surgical treatment options for FAI. Additionally, 62.5% of experts were satisfied or highly satisfied with the safety of the information provided. Regarding the etiology of FAI, including cam and pincer impingements, 52.5% of experts expressed satisfaction or high satisfaction with ChatGPT's explanations. Overall, 62.5% of experts affirmed that ChatGPT could serve effectively as a reliable medical resource for initial information retrieval.

Conclusion

This study confirms that ChatGPT, despite being a new tool, shows significant potential as a supplementary resource for health information on FAI. Expert evaluations commend its capacity to provide accurate and comprehensive responses, valued by medical professionals for relevance and safety. Nonetheless, continuous improvements in its medical content's depth and precision are recommended for ongoing reliability. While ChatGPT offers a promising alternative to traditional search engines, meticulous validation is imperative before it can be fully embraced as a trusted medical resource.

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.

Analysis of patient-directed search content and online resource quality for ulnar collateral ligament injury and surgery

Background

Patients use the Internet to learn information about injuries, yet online content remains largely unstudied. This study analyzed patient questions posed online regarding ulnar collateral ligament (UCL) tears or UCL surgical management.

Methods

Three separate search strings about UCL tear and UCL surgery were queried on the Google search engine. The 300 most commonly asked questions were compiled for each topic and associated webpage information was collected from the "People also ask" section. Questions were categorized using the Rothwell classification and webpages by Journal of the American Medical Association (JAMA) benchmark criteria.

Results

The most frequent UCL tear questions were "how long does it take to heal a torn UCL?" and "what is nonsurgical treatment for the UCL?" The most frequent UCL surgery question was "can you retear your UCL after surgery?" The Rothwell classification of questions for UCL tear/UCL surgery was 55%/32% policy, 38%/57% fact, and 7%/11% value with highest subcategories being indications/management (46%/25%) and technical details (24%/25%). The most common webpages were academic (39%/29%) and medical practice (24%/26%). Mean JAMA score for all 600 webpages was low (1.2), with journals (mean = 3.4) having the highest score. Medical practice (mean = 0.5) and legal websites (mean = 0.0) had the lowest JAMA scores. Only 30% of webpages provided UCL-specific information.

Conclusion

Online UCL patient questions commonly pertain to technical details and injury management. Webpages suggested by search engines contain information specific to UCL tears and surgery only one-third of the time. The quality of most webpages provided to patients is poor, with minimal source transparency.

Assessing the readability of online information about jones fracture

BACKGROUND

Hand in hand with technological advancements, treatment modalities continue to grow. With the turn of the century, the internet has become the number one source of information for almost every topic. Thus, many patients look toward the internet as their primary source of information to learn about their respective medical conditions. The American Medical Association and National Institute of Health strongly recommend that online medical information be written at the 6^th to 8^th-grade level to aid comprehension by patients of all literacy backgrounds.

AIM

To assess the readability of online information regarding Jones fracture. Our hypothesis is that the reading level of medical information published on websites far exceeds the recommended reading level of 6^th-8^th grade as proposed by the American Medical Associate and National Institute of Health. The result of this study can help us formulate improved recommendations for publishing more comprehensible material and, thus, eventually improve patient compliance and clinical outcomes.

METHODS

The exact phrase “Jones fracture” was queried on the three most common search engines, Google, Yahoo!, and Bing, on December 28, 2022. As of December 2022, Google held 84%, Bing held 9%, and Yahoo! held 2% of the worldwide search engine market share. Web pages uniform resource locator from the first three pages of search results were recorded from each search engine. These web pages were classified according to academic, physician-sponsored, governmental and non-government organizations (NGO), commercial, and unspecified as per formally defined categories. Websites associated with an educational institution or medical organization were classified as academic. Websites with products for sale, corporate sponsorship, or advertisements were classified as commercial. Governmental websites or NGOs comprised those that received government subsidies or grants. Webpages that were independently owned by physicians or physician groups were respectively classed as physician sponsored. The remainder of websites that did not fall under the above categories were classified as unspecified.

RESULTS

A total of 93 websites were analyzed for reading assessment. A whopping 44% of websites were commercial, followed by 22% of physician-sponsored websites. Third place belonged to non-government organization websites holding a 15% share. The academic website held a meager 9% portion, while unspecified sites were 3%. The table illustrates mean readability scores, along with average cumulative grade level. The average grade level was 10.95 ± 2.28 for all websites, with a range of 6.18 to 18.90. Since P values were more than 0.05, there was not a significant statistical difference between the first page results and the results of all pages. Thus, we can rationalize that readability scores are consistent throughout all pages of a website.

CONCLUSION

Hand in hand with technological advancements, treatment modalities continue to grow. With the turn of the century, the internet has become the number one source of information for almost every topic. Thus, many patients look towards the internet as the primary source of information to learn about their respective medical conditions. Our study demonstrates that current online medical information regarding Jones fracture is written at an extraordinarily high-grade level, with an average grade level of all websites at 10.95, nearly an 10^th-grade educational level. The American Medical Association and National Institute of Health strongly recommend that online medical information should be written at the 6^th to 8^th-grade level to aid comprehension by patients of all literacy backgrounds. On the contrary, most of the medical information evaluated was at an 10^th-grade level, which far exceeds recommendations by AMA and NIH. This is particularly relevant because readability scores are directly proportional to the level of comprehension attained by readers, thus directly impacting patient outcomes. In conclusion, we suggest and encourage that all online reading materials should be re-written at the 6^th to 8^th-grade level in a public service effort to increase compliance with treatment goals and raise awareness of preventive measures.

Online Videos Regarding Relevant Postoperative Patient Information and Postoperative Rehabilitation After Arthroscopic Rotator Cuff Repair Provide Poor Information Quality, Accuracy, and Reliability

PURPOSE

To evaluate the information quality, accuracy, and reliability of YouTube videos regarding relevant postoperative patient information and postoperative rehabilitation after arthroscopic rotator cuff repair.

METHODS

By use of The Onion Router (TOR) software and predefined search terms, 102 videos were assessed. Four scoring systems were used to evaluate included videos: (1) Journal of the American Medical Association (JAMA) benchmark criteria score; (2) Global Quality Score (GQS); (3) DISCERN score; and (4) a newly developed score, the Rotator Cuff Score (RCS). The RCS (0-30 points) was built based on the latest published evidence and guidelines from the American Academy of Orthopaedic Surgeons. Videos that scored up to 9 points were regarded as poor-quality videos.

RESULTS

Most of the included videos provided poor information quality, accuracy, and reliability. Videos that were uploaded by medically trained professionals showed significantly better results for all scores compared with commercial or personal-testimony videos (JAMA benchmark criteria score, P < .001; GQS, P < .001; DISCERN score, P = .001; and RCS, P = .001). Multivariate linear regression showed that the involvement of medically trained professionals was a significant predictor of better results for all scores (JAMA benchmark criteria score, β = 1.496 [P < .001]; GQS, β = 1.105 [P < .001]; DISCERN score, β = 11.234 [P < .001]; and RCS, β = 5.017 [P < .001]). Surprisingly, the like ratio was significantly higher for videos that were uploaded by non-medically trained individuals (P = .041).

CONCLUSIONS

The average information quality, accuracy, and reliability of YouTube videos regarding relevant postoperative patient information and postoperative rehabilitation after arthroscopic rotator cuff repair are poor. Videos from medically trained professionals provide significantly higher information quality; however, even these videos lack important information for a better understanding of arthroscopic rotator cuff repair.

CLINICAL RELEVANCE

Because of the lack of a peer-review process, available videos on YouTube regarding relevant postoperative patient information and postoperative rehabilitation after arthroscopic rotator cuff repair are of low quality, accuracy, and reliability. However, patients increasingly visit YouTube to gather medical knowledge. Physicians should enlighten patients about these findings and should be able to provide alternative sources of high-quality information.

The quality of online information on Legg-Calvé-Perthes disease: can we do better?

INTRODUCTION

As patients increasingly utilize the Internet to obtain health-related information, the accuracy and usability of information prove critical, especially for patients and parents seeking care for relatively common orthopedic childhood disorders such as Legg-Calvé-Perthes (LCP) disease. Therefore, the purpose of this study is to evaluate available online health information regarding LCP disease. The study specifically seeks to (1) examine the accessibility, usability, reliability, and readability of online information, (2) compare the quality of sites from different sources, and (3) determine whether Health on the Net Foundation Code (HON-code) certification guarantees higher quality of information.

MATERIALS AND METHODS

Websites from a query of both Google and Bing were compiled and scored using the Minervalidation tool (LIDA), an appraisal tool quantifying website quality, along with the Flesch-Kinkaid (FK) analysis, a metric assessing readability of content. All sites were organized based on source category [academic, private physician/physician group, governmental/non-profit organization (NPO), commercial, and unspecified] and HON-code certification.

RESULTS

Physician-based and governmental/NPO sites had the highest accessibility, the unspecified site group were the most reliable and usable, and the physician-based group was found to require the least education to comprehend. Unspecified sites had a significantly higher rating of reliability than physician sites (p = 0.0164) and academic sites (p < 0.0001). HON-code-certified sites were found to have greater scores across quality domains along with being easier to read compared to sites without certification, with significantly higher reliability scoring (p < 0.0001).

CONCLUSIONS

As a whole, information on the Internet regarding LCP disease is of poor quality. However, our findings also encourage patients to utilize HON-code-certified websites due to their significantly higher reliability. Future studies should analyze methods of improving this publicly available information. Additionally, future analyses should examine methods for patients to better identify reliable websites, as well as the best mediums for optimized patient access and comprehension.

Online Patient Education Resources for Anterior Cruciate Ligament Reconstruction: An Assessment of the Accuracy and Reliability of Information on the Internet Over the Past Decade

PURPOSE

The purpose of this study is to evaluate the quality of patient education materials accessible through popular online search engines regarding anterior cruciate ligament (ACL) injuries and anterior cruciate ligament reconstruction (ACLR).  Methods: Two search terms ("ACL surgery" and "ACL reconstruction") were entered into three search engines (Google, Yahoo, and Bing). The quality of information was scored using a novel scoring system developed and overseen by sports medicine orthopedic clinical research fellows and fellowship-trained orthopedic surgeons. Website quality, credibility, and readability were further assessed by the DISCERN score, Journal of the American Medical Association (JAMA) benchmark criteria, and Flesch-Kincaid Reading Grade Level (FKRGL), respectively. The Health On the Net Code of Conduct (HONcode) certification was also utilized to assess the transparency of health information for each website.

RESULTS

We evaluated 39 websites. The average score for all websites was 11.2±5.6 out of 28 total points. Six out of the 39 websites (41%) were HONcode certified. The websites that contained HONcode certification had a higher average JAMA benchmark score (3.5±0.7) and DISCERN score (44.6±14.7) when compared to the websites without the certification, 2.2±1.2 and 37.6 ± 15.9 for JAMA and DISCERN, respectively. The mean JAMA benchmark score was 2.7±1.2 (67.5%) for all websites out of a possible four points. The average FKRGL for all 39 websites was 10.0±2.0 (range: 5.4-13).

CONCLUSION

The quality of patient education materials accessible on the internet regarding ACL injuries and ACLR can be misleading and directly impact the patient's decision-making process essential to the patient-physician relationship over the past decade.

CLINICAL RELEVANCE

The internet can be a helpful online resource, however, surgeon clarification and consultation with qualified healthcare professionals are strongly recommended prior to clinical decision-making regarding potential treatment options.

Indications for Surgery, Activities After Surgery, and Pain Are the Most Commonly Asked Questions in Anterior Cruciate Ligament Injury and Reconstruction

Purpose

To leverage Google's search algorithms to summarize the most commonly asked questions regarding anterior cruciate ligament (ACL) injuries and surgery.

Methods

Six terms related to ACL tear and/or surgery were searched on a clean-installed Google Chrome browser. The list of questions and their associated websites on the Google search page were extracted after multiple search iterations performed in January of 2022. Questions and websites were categorized according to Rothwell's criteria. The Journal of the American Medical Association (JAMA) Benchmark criteria were used to grade website quality and transparency. Descriptive statistics were provided. χ2 and Student t-tests identified for categorical differences and differences in JAMA score, respectively (significance set at P < .05).

Results

A total of 273 unique questions associated with 204 websites were identified. The most frequently asked questions involved Indications/Management (20.2%), Specific Activities (15.8%), and Pain (10.3%). The most common websites were Medical Practice (27.9%), Academic (23.5%), and Commercial (19.5%). In Academic websites, questions regarding Specific Activities were seldom included (4.7%) whereas questions regarding Pain were frequently addressed (39.3%, P = .027). Although average JAMA score was relatively high for Academic websites, the average combined score for medical and governmental websites was lower (P < .001) than nonmedical websites.

Conclusions

The most searched questions on Google regarding ACL tears or surgery related to indications for surgery, pain, and activities postoperatively. Health information resources stemmed from Medical Practice (27.9%) followed by Academic (23.5%) and Commercial (19.5%) websites. Medical websites had lower JAMA quality scores compared with nonmedical websites.

Clinical Relevance

These findings presented may assist physicians in addressing the most frequently searched questions while also guiding their patients to greater-quality resources regarding ACL injuries and surgery.

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.

Using a Google Web Search Analysis to Assess the Utility of ChatGPT in Total Joint Arthroplasty

BACKGROUND

Rapid technological advancements have laid the foundations for the use of artificial intelligence in medicine. The promise of machine learning (ML) lies in its potential ability to improve treatment decision making, predict adverse outcomes, and streamline the management of perioperative healthcare. In an increasing consumer-focused health care model, unprecedented access to information may extend to patients using ChatGPT to gain insight into medical questions. The main objective of our study was to replicate a patient's internet search in order to assess the appropriateness of ChatGPT, a novel machine learning tool released in 2022 that provides dialogue responses to queries, in comparison to Google Web Search, the most widely used search engine in the United States today, as a resource for patients for online health information. For the 2 different search engines, we compared i) the most frequently asked questions (FAQs) associated with total knee arthroplasty (TKA) and total hip arthroplasty (THA) by question type and topic; ii) the answers to the most frequently asked questions; as well as iii) the FAQs yielding a numerical response.

METHODS

A Google web search was performed with the following search terms: "total knee replacement" and "total hip replacement." These terms were individually entered and the first 10 FAQs were extracted along with the source of the associated website for each question. The following statements were inputted into ChatGPT: 1) "Perform a google search with the search term 'total knee replacement' and record the 10 most FAQs related to the search term" as well as 2) "Perform a google search with the search term 'total hip replacement' and record the 10 most FAQs related to the search term." A Google web search was repeated with the same search terms to identify the first 10 FAQs that included a numerical response for both "total knee replacement" and "total hip replacement." These questions were then inputted into ChatGPT and the questions and answers were recorded.

RESULTS

There were 5 of 20 (25%) questions that were similar when performing a Google web search and a search of ChatGPT for all search terms. Of the 20 questions asked for the Google Web Search, 13 of 20 were provided by commercial websites. For ChatGPT, 15 of 20 (75%) questions were answered by government websites, with the most frequent one being PubMed. In terms of numerical questions, 11 of 20 (55%) of the most FAQs provided different responses between a Google web search and ChatGPT.

CONCLUSION

A comparison of the FAQs by a Google web search with attempted replication by ChatGPT revealed heterogenous questions and responses for open and discrete questions. ChatGPT should remain a trending use as a potential resource to patients that needs further corroboration until its ability to provide credible information is verified and concordant with the goals of the physician and the patient alike.

Evaluation of the quality of information online for arthroscopic Bankart repair

PURPOSE

The purpose of this study was to evaluate the quality and readability of information online for patients searching terms related to arthroscopic Bankart repair (ABR).

METHODS

Google, Yahoo and Bing were searched with terms related to ABR. The quality of information was assessed using the Journal of the American Medical Association (JAMA) Benchmark criteria, DISCERN Score, and the Flesch-Kincaid Reading Ease & Grade Level. The presence of the HONcode marker was noted. Additionally, we used a scoring system specific to content relating to the ABR (AB score), a 1-20 Likert scale. Websites were also categorised according to the source: academic institution, physician, allied healthcare, commercial, media or social media. Statistical analysis was performed using GraphPad Prism.

RESULTS

Ninety-six unique websites were evaluated, with the most common website category being physician websites (52) and academic institution websites (24). There were nine websites with the HONcode marker. The average JAMA Benchmark criteria score was 1.95 (1-4), the average DISCERN score was 48.8 (20-78), with an average Flesch-Kincaid reading ease of 50.9 (11-96) and grade level of 8 (1-18). The average AB score was 5.9 (0-18), and there was a strong correlation with a higher DISCERN score (r=0.57), but not JAMA score (r=0.18) or Flesch-Kincaid grade (r=0.16). Websites with the HONcode marker did not score higher in any criteria than those without it (p>0.05). The quality of information on physician websites was better than (statistically insignificant) non-physician websites; however, the readability of information in the former was poorer (statistically significant) than the latter.

CONCLUSION

There was wide variability in the quality and readability online of the information on ABR, and the AB scoring system was shown to correlate strongly with increased quality.

TLIF Online Videos for Patient Education-Evaluation of Comprehensiveness, Quality, and Reliability

Over the last few decades, the number of lumbar interbody fusion surgeries performed has been constantly increasing, with transforaminal lumbar interbody fusion (TLIF) being one of the most common surgical techniques. Due to easy accessibility, patients frequently use YouTube to obtain information on health-related issues. Consequently, online video platforms may be a valuable tool for patient education. The aim of this study was to assess the quality, reliability, and comprehensiveness of online videos on TLIF. We screened 180 videos on YouTube, yielding a total of 30 videos that met the inclusion criteria. These videos were evaluated using Global Quality Scale, DISCERN reliability tool, and JAMA Benchmark Score, and assessed in regard to their comprehensiveness and coverage of relevant aspects. At the time of rating, the videos had between 9188 and 1,530,408 views and between 0 and 3344 likes. The median rater assessment for all videos was "moderate quality". GQS and subjective grades showed a moderate to strong statistically significant association with views and likes. Considering this association of GQS and subjective grade with views and likes, these criteria could be used by laypersons to identify good-quality content. Nevertheless, there is an urgent need for peer-reviewed content that covers all of the relevant aspects.

Temporomandibular disorders-related videos on YouTube are unreliable sources of medical information: A cross-sectional analysis of quality and content

Objective

The amount of online medical information available is rapidly growing and YouTube is considered as the most popular source of healthcare information nowadays. However, no study has been conducted to comprehensively evaluate YouTube videos related to temporomandibular disorders (TMD). So this study aimed to evaluate the content and quality of YouTube videos as a source of medical information on TMD.

Method

A total of 237 YouTube videos that were systematically searched using five keywords (temporomandibular disorders, tmd, temporomandibular joint, tmj, and jaw joint) were included. Included videos were categorized by purpose and source for analysis. The quality (DISCERN, Health on the Net (HON), Ensuring Quality Information for Patients (EQIP), and Global Quality Scale (GQS)) and scientific accuracy of video contents were evaluated.

Results

Total content, DISCERN, HON, EQIP, and GQS scores were 7.5%, 38.9%, 35.2%, 53.0%, and 48.6% of the maximum possible score, respectively. Only 69 videos (29.1%) were considered as "useful" for patients. News media, physician, and medical source videos showed higher evaluation scores than others. Quality evaluation scores were not significantly correlated or negatively correlated with public preference indices. In the ROC curve analysis, content and DISCERN score showed above excellent discrimination ability for high-quality videos based on GQS (P < 0.001) and total score (P < 0.001).

Conclusions

YouTube videos related to TMD contained low quality and scientifically inaccurate information that could negatively influence patients with TMD.

A critical appraisal of web-based information on shoulder pain comparing biomedical vs. psychosocial information

BACKGROUND

Websites have become a primary way for patients to access health-related information, which allows patients to not only understand their condition better but also to engage in better decision making with their health care provider. However, this can be a double-edged sword, as information patients access may not be of high quality, easily readable, or could be biased based on website authorship. This study examines the readability and content quality of common websites about shoulder pain, with a specific focus on biomedical vs. psychosocial information.

METHODS

The Flesch reading-ease score (FRES) and Flesch-Kincaid grade level (FKGL) instruments were used to assess website readability. Health on the net code of conduct (HONcode) certification and the DISCERN tool were used to evaluate the reliability and quality of information. Lastly, shoulder-specific content quality and focus was gauged using a Shoulder-specific Website Appraisal Tool (SWAT) created for this study. A systematic search protocol was used to identify popular shoulder injury websites. The websites were identified using 5 search terms (shoulder pain, shoulder muscle pain, shoulder impingement, shoulder rotator cuff pain, and shoulder pain diagnosis) across 5 English-speaking regions (United States, Canada, United Kingdom, Australia, and New Zealand) using the Google search engine. The top 10 websites for each term and region combination were included and combined, yielding 41 original websites for appraisal; several (6) websites were omitted as duplicates, behind paywalls, or nontext (video) for a total of 35 websites appraised.

RESULTS

On average, the FRES shoulder pain websites readability was 55.37, which is categorized as "fairly difficult" to read, and a seventh- or eighth-grade reading level based on the FKGL. For trustworthiness and bias, 57% (20 of 35) of the websites were HONcode certified. The quality of health care information using the DISCERN score averaged 50.92%. Examining shoulder-specific content quality, the average SWAT score was 10.54 out of 14 possible points, with only 1 website reporting information on psychosocial aspects of shoulder pain.

CONCLUSIONS

This study suggests that shoulder pain websites present information that is at too high of a reading level for public consumption, has a strong bias toward biomedical causes of shoulder pain, and would benefit from implementation of website screening tools to improve evidence-based content.

Quality and Content Analysis of Hallux Valgus Videos on YouTube®

Our aim in this study is to analyze the content and quality of the videos about hallux valgus on YouTube®. The first 50 videos published by typing "hallux valgus" in the search engine on the YouTube® site were analyzed. The number of views of all videos, likes, dislikes, who uploaded the video, video duration, content, watch rate, and how many days it was uploaded were analyzed and recorded. All videos were analyzed with Journal of the American Medical Association (JAMA), DISCERN, GQS, and VPI scores. Six of the videos (12%) were from academic sources, 14 (28%) from commercial product vendors, 13 (26%) by medical animation organizers, 8 (16%) by physicians, 4 (8%) by physiotherapists, 2 (4%) by physical training trainers, 1 (2%) by patients, and last 2 (4%) by trainers. The JAMA mean score of the videos was recorded as 2 (1-4), GQS 3.02 (2-5), DISCERN score 37.56 (26-68), and Video Power Index 41.35 (0-470). The quality of YouTube® videos about hallux valgus is low. The content and quality of health-related information obtained through the Internet are of increasing importance for both healthcare professionals and patients.

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

Purpose

To investigate the type of questions patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) are searching online and determine the type and quality of the online sources from the top results to each query by the "people also ask" Google algorithm.

Methods

Three search strings pertaining to FAI were carried out through Google. The webpage information was manually collected from the "People also ask" Google algorithm. Questions were categorized using Rothwell's classification method. Each website was assessed using Journal of the American Medical Association Benchmark Criteria for source quality.

Results

A total of 286 unique questions were collected with their associated webpages. The most common questions included: "How do you treat femoroacetabular impingement and labral tears without surgery?" "What is the recovery process after hip arthroscopy and are there limitations after surgery?" and "How do you diagnose hip impingement and differentiate from other causes of hip pain?" The Rothwell Classification of questions were fact (43.4%), policy (34.3%), and value (20.6%). The most common webpage categories were Medical Practice (30.4%), Academic (25.8%), and Commercial (20.6%). The most common subcategories were Indications/Management (29.7%) and Pain (13.6%). Government websites had the highest average Journal of the American Medical Association score (3.42), whereas Single Surgeon Practice websites had the lowest (1.35). Conclusions: Commonly asked questions on Google regarding FAI and labral tears pertain to the indications and management of pathology as well as pain control and restrictions in activity. The majority of information is provided by medical practice, academic, and commercial sources, which have highly variable academic transparency.

Clinical Relevance

By better understanding which questions patients ask online, surgeons can personalize patient education and enhance patient satisfaction and treatment outcomes after hip arthroscopy.

An Investigation of Google Searches for Knee Osteoarthritis and Stem Cell Therapy: What are Patients Searching Online?

Background

Stem cell therapies have emerged as a potential treatment for osteoarthritis (OA), but their role remains controversial. Their growing popularity may lead patients to search for information online, but search queries and sources are unknown.

Purpose

We sought to (1) identify the most frequently asked questions on Google related to knee OA and stem cell therapy, (2) assess the types of websites accessed through these searches, and (3) evaluate the transparency of these websites.

Methods

The search terms "knee," "osteoarthritis," and "stem cell" were entered into Google. Frequently asked questions suggested by Google, and their corresponding websites were extracted. Questions and websites were classified by type. Journal of the American Medical Association (JAMA) benchmark criteria were used as a measure of website transparency (range: 0-4). Analysis of variance tests were performed to compare JAMA benchmark criteria between website types.

Results

Of the 145 questions and website extracted, the most common question subtype pertained to non-stem cell treatments (41.4%) for knee OA; the most common website types were medical publishers (24.8%) and nonacademic medical practices (22.8%). JAMA scores were highest for medical publishers (mean: 3.81) and lowest for nonacademic medical practices (mean: 1.55). Nonacademic medical practices had significantly worse JAMA scores compared with commercial, academic, and medical publishers.

Conclusion

The most frequent questions pertained to non-stem cell treatments, although questions related to stem cell efficacy were most common among the 10 most frequent questions. Google searches on knee OA and stem cell therapies often directed the user to websites lacking transparency and verifiable information. Further research is warranted.

Who writes this stuff? Musculoskeletal information quality and authorship of popular health websites: A systematic review

BACKGROUND

Highly trafficked health websites are major sources of information, but the quality of their musculoskeletal information has not been thoroughly evaluated or their authorship characterized.

OBJECTIVES

To review information about common musculoskeletal conditions on highly trafficked websites and characterize their credibility, authorship, accuracy of information (as compared to treatment guidelines), and consistency with best practice recommendations.

DESIGN

Systematic review.

METHODS

We reviewed the top 15 most highly trafficked health websites, identified by web traffic data. Information about 7 common musculoskeletal conditions was identified and data extracted. Credibility was assessed using the Trust It or Trash It? tool, author backgrounds were identified, accuracy was determined by comparing webpage treatment recommendations to guidelines or systematic reviews, and consistency with best practice recommendations was assessed.

RESULTS

Of 1760 webpages screened, 87 were reviewed. Less than half (44.8%, 39/87) had appropriate sources listed, but 65.5% (57/87) were updated in the previous 5 years. Journalists authored most webpages (55.2%, 48/87). Physician involvement was mostly editorial, and they often lacked expertise in musculoskeletal conditions. Information accuracy was concordant with guidelines for 49.4% (43/87) of webpages, but varied by condition. About half of best practice recommendations were followed (49.1%, 427/870). Pages were unlikely to mention psychosocial factors (16.1%, 14/87), limitations of imaging (18.4%, 16/87), or staying at work (4.6%, 4/87).

CONCLUSIONS

Popular health websites scored poorly for credibility, accuracy, and consistency with best practice recommendations for musculoskeletal conditions. Authorship, bias, and unsupported information are potential sources of inaccuracies that should be addressed in future by these websites.

YouTube as a Source of Patient Information for Ankle Arthroplasty: Quantitative Analysis of Video Reliability, Quality, and Content

Background. There are limited data on the quality and content of videos discussing total ankle arthroplasty (TAA) on the YouTube video platform. Methods. The first 60 unique YouTube videos resulting from the keyword query "ankle arthroplasty" and "ankle replacement" were analyzed for comprehensiveness and quality. Content was assessed using the Journal of American Medical Association (JAMA) benchmark criteria, DISCERN, Global Quality Scale (GQS), and an arthroplasty-specific score. Results. Videos demonstrated low mean DISCERN (49.2/80), GQS (3.2/5), and arthroplasty-specific scores (4.3/12) with substantial variability between videos. Most of the content was produced by nonacademic physicians (46.7%) and academic sources (21.7%). Academic videos saw significantly higher mean JAMA scores (P = .013) but were otherwise comparable to non-academic physicians. Commercial content demonstrated significantly low-quality scores compared to academic (P = .012) and physician (P = .008) sources despite the highest mean viewership. Conclusions. Information on TAA on the YouTube platform is highly variable based on video source, with generally poor quality and content.Level of Evidence: Level V, systemic review of non-peer reviewed resources.

Readability of Patient Educational Materials in Sports Medicine

Background

The internet has become an increasingly popular resource among sports medicine patients seeking injury-related information. Numerous organizations recommend that patient educational materials (PEMs) should not exceed sixth-grade reading level. Despite this, studies have consistently shown the reading grade level (RGL) of PEMs to be too demanding across a range of surgical specialties.

Purpose

To determine the readability of online sports medicine PEMs.

Study Design

Cross-sectional study.

Methods

The readability of 363 articles pertaining to sports medicine from 5 leading North American websites was assessed using 8 readability formulas: Flesch-Kincaid Reading Grade Level, Flesch Reading Ease Score, Raygor Estimate, Fry Readability Formula, Simple Measure of Gobbledygook, Coleman-Liau Index, FORCAST Readability Formula, and Gunning Fog Index. The mean RGL of each article was compared with the sixth- and eighth-grade reading level in the United States. The cumulative mean website RGL was also compared among individual websites.

Results

The overall cumulative mean RGL was 12.2 (range, 7.0-17.7). No article (0%) was written at a sixth-grade reading level, and only 3 articles (0.8%) were written at or below the eighth-grade reading level. The overall cumulative mean RGL was significantly higher than the sixth-grade [95% CI for the difference, 6.0-6.5; P < .001] and eighth-grade (95% CI, 4.0-4.5; P < .001) reading levels. There was a significant difference among the cumulative mean RGLs of the 5 websites assessed.

Conclusion

Sports medicine PEMs produced by leading North American specialty websites have readability scores that are above the recommended levels. Given the increasing preference of patients for online health care materials, the imperative role of health literacy in patient outcomes, and the growing body of online resources, significant work needs to be undertaken to improve the readability of these materials.

Quality and readability of online resources on chronic ankle instability

BACKGROUND

Online resources on medical conditions often provide misleading or outdated information for patients. The aim of this study was to evaluate the quality of online patient information on ankle instability.

METHODS

The terms "ankle instability", "ankle instability treatment" and "ankle laxity" were entered into the three largest internet search engines. The quality, accuracy and readability were evaluated using the EQIP36, a custom 25-item list and the Flesch-Kincaid-Score.

RESULTS

The mean 25-item score of 102 included websites reached 10 ± 5, the mean EQIP36 score was 41 ± 11 and 96% of evaluated websites exceeded the recommended 8th-grade reading level for patient information. The quality was significantly higher with reading levels of college graduates (P < 0.001).

CONCLUSIONS

Online resources on ankle instability are often inaccurate or at inappropriately high reading level. The quality and accuracy depend on the reading levels, with high reading levels providing more in-depth information. Foot and ankle surgeons should be aware of available online resources to direct patients to adequate websites.

LEVEL OF EVIDENCE

Level V.

YouTube is inadequate as an information source on delayed ejaculation

The prevalence of delayed ejaculation in sexually active men is reportedly 3%. Due to its rarity and uncertain definitions, people seek information about delayed ejaculation on the internet. YouTube is one of the largest video platforms preferred global for gathering medical information. We aimed to determine the quality of YouTube videos on delayed ejaculation. YouTube search was performed with the keywords “delayed and retarded ejaculation”, and we recorded the first 400 videos according to relevance. The search results were saved in the playlist, and the first 400 videos were evaluated by two independent urologists. DISCERN and Global Quality Scale (GQS) were used to assess the reliability and quality of videos. Repeated (n = 17), off-topic (n = 279), non-English videos (n = 37), and videos with no audio (n = 16) were excluded from the study. The remaining 51 videos were evaluated. DISCERN and GQS scores were statistically significantly associated with video durations (r = 0.329, P = 0.018 and r = 0.349, P = 0.012; respectively). A statistically significant association was also observed between and DISCERN and GQS scores with video power index values (r = 0.466, P = 0.001 and r = 0.422, P = 0.002; respectively). 62.7% (n = 32) videos were low quality, 23.5% (n = 12) were intermediate quality, and 13.7% (n = 7) were high quality according to the GQS. Most of the YouTube content on delayed ejaculation was of poor quality. Physicians should be aware of this situation, and take the lead in bringing high-quality videos about delayed ejaculation to the community.

Evaluation of the Accuracy and Quality of Information in Videos About Lateral Epicondylitis Shared on Internet Video Sharing Services

Purpose

In this study, it was aimed to determine the quality and accuracy of the videos on YouTube about lateral epicondylitis.

Methods

The first 100 videos were included in the study by typing the keyword "lateral epicondylitis" in the YouTube search tab without using any filters. The video power index (VPI) was used to evaluate the popularity of the videos, and the global quality score (GQS), Journal of the American Medical Association (JAMA), and DISCERN scoring systems were used to evaluate the quality. The obtained data were statistically analyzed according to these scoring systems.

Results

The mean DISCERN, JAMA, and GQS of the analyzed videos were 46.66, 3.13, and 3.85, respectively. According to these results, it was determined that the videos were of medium quality. A statistically insignificant and weak correlation was found between the VPI and DISCERN, GQS, and JAMA scores (p>0.05, intraclass correlation coefficient, ICC: −0.05, 0.09, and −0.05, respectively). While there was no significant relationship between the video source and the DISCERN, JAMA, and GQS scores (p>0.05), it was determined that the DISCERN, JAMA, and GQS scores in the exercise videos were significantly higher than in the other content types in terms of the video content (p=0.041).

Conclusions

According to the results obtained, it was determined that YouTube videos about lateral epicondylitis were not of sufficient quality. In order to ensure standardization for quality videos, internationally acceptable guidelines should be determined and studies should be carried out to provide an adequate infrastructure for the preparation of quality medical videos that can meet the increasing needs of patients by health institutions.

Assessing the United States' most frequently asked questions about osteopathic medicine, osteopathic education, and osteopathic manipulative treatment

CONTEXT

Osteopathic medicine in the United States continues to produce a substantial number of physicians and medical educators. However, recently popularized misconceptions about osteopathic medical practice, education, and manual therapy suggest an unsettling prevalence of inaccurate beliefs held by the public. The public often searches the internet to find out information about osteopathic medicine, but the content of questions and the transparency of the resulting information is unknown.

OBJECTIVES

We sought to explore frequently asked questions (FAQs) generated by Google to assess commonly searched questions about the osteopathic profession and to determine the level of information transparency associated with resulting sources.

METHODS

On June 16, 2021, we searched Google for three terms: "osteopathic medicine," "doctor of osteopathic medicine," and "DO," until a minimum of 100 FAQs and their answer links were extracted from each search. After excluding irrelevant FAQs, we used Rothwell's Classification of Questions to categorize the FAQs. We then used the Journal of the American Medical Association's Benchmark Criteria to assess information transparency for each corresponding answer source provided by Google. The answer sources were screened for the inappropriate use of "osteopathy" in place of "osteopathic medicine" and for "osteopath" in place of "DO," "Doctor of Osteopathic Medicine," or "Osteopathic Physician." We performed statistical tests to ascertain the differences in information transparency between osteopathic and nonosteopathic information sources.

RESULTS

Our Google search revealed 110 unique FAQs about osteopathic medicine. The majority of FAQs were classified as fact-based (82/110; 74.55%), nearly half of which (45.12%) were related to the medical practicing privileges of DOs. The FAQs were most commonly answered by academic institutions (44/110, 40.0%). Nearly half (49.09%) of the linked answer sources were deemed inadequate by JAMA benchmark criteria. Of the 110 linked answer sources, 19 (17.27%) misused either osteopathy, osteopath, or both to describe osteopathic physicians. Only 30 sources were linked to US-based osteopathic organizations. Osteopathic organizations were statistically less likely to meet high-transparency criteria than nonosteopathic organizations (p=0.002).

CONCLUSIONS

Our study shows that the US public may be unsure about the physician status of DOs, which may prevent securing the professional identity of osteopathic physicians in the eyes of the public. Osteopathic organizations should tailor awareness campaigns toward addressing the common misconceptions revealed by our study. Osteopathic organizations should use transparency criteria as a rubric when publishing information to enhance transparency.

Sinus Surgery and Balloon Sinuplasty: What Do Patients Want to Know?

OBJECTIVE

Limited knowledge exists regarding the information patients seek online about sinus procedures. The goals of our study were to identify the most searched online queries regarding functional endoscopic sinus surgery (FESS) and balloon sinuplasty and evaluate the sources to which patients are directed.

STUDY DESIGN

Observational.

SETTING

Online Google Database.

METHODS

Google data were analyzed using the search engine optimization tool Ahrefs. People Also Ask (PAA) questions (extracted from Google searches) helped identify questions for analysis of search query volume. Search results were categorized into specific topics, and the source (eg, academic vs medical practice) of the information was identified. The JAMA benchmark criteria were used to determine the quality of the online resource.

RESULTS

The most searched term (average monthly queries) on Google was "sinus surgery" (13,190), followed by "balloon sinuplasty" (9212). For FESS and balloon sinuplasty, most questions focused on treatment of sinusitis (71.64% vs 79.19%) and preoperative inquiries about sinus issues (11.50% vs 11.35%). Answers to PAA questions for FESS were obtained from academic sources at a higher frequency compared to balloon sinuplasty (26.7% vs 10.3%, P = .016) but a lower frequency from medical practice websites (15.2% vs 29.3%, P = .042). The mean (SD) JAMA scores for FESS and balloon sinuplasty sources were 1.59 (1.46) and 1.40 (1.46), respectively.

CONCLUSION

There is a high volume of online search queries regarding FESS and balloon sinuplasty. The quality of the sources could be improved by addressing authorship, attribution, disclosure, and currency. This information may help otolaryngologists better address patient queries.

Assessing the Quality and Readability of Online Resources for Plantar Fasciitis

The Internet is utilized now more than ever to research medical conditions and treatments by patients and physicians alike. The aim of this study was to evaluate the quality and readability of information available online for plantar fasciitis. Web sites were identified using the search term "plantar fasciitis." The first 25 Web sites from 5 different search engines gave a total of 125 being evaluated. Readability of each Web site was assessed using the Flesch Reading Ease score, the Flesch-Kincaid grade level, and the Gunning Fog Index. Quality was assessed using the DISCERN instrument (www.discern.org.uk) and the Journal of the American Medical Association (JAMA) benchmark criteria. The presence of Health on the Net (HON) code certification was also assessed. The authorship of each Web site was categorized into 1 of 5 categories (Physician, Academic, Commercial, Allied health or Other eg, blogs). A total of 83 Web site pages were evaluated with the majority of the web sites being authored by physicians (32.53%) and blogs (25.30%). Only 24 Web sites were HON certified (28.91%). Physician and Academic Web sites were the most credible sources, with the highest mean DISCERN (p = .00001) and JAMA (p = .0278.) scores, respectively. These Web sites were also the most difficult to read according to the readability score testing. The information available on the Internet pertaining to plantar fasciitis is highly variable and provides moderate quality information about treatment choices. Given this variability in quality, health care providers should direct patients to known sources of reliable, readable online information.

The Quality and Content of Internet-Based Information on Orthopaedic Sports Medicine Requires Improvement: A Systematic Review

Purpose

To evaluate the quality and content of internet-based information available for some of the most common orthopaedic sports medicine terms.

Methods

A search of the PubMed, Embase, and Cochrane databases following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines was performed. All English-language literature published from 2010 to 2020 discussing information quality pertaining to orthopaedic sports medicine terms was included. Outcomes included the search engines used, number and type of websites evaluated, platform, and quality scoring metrics. Descriptive statistics are presented.

Results

This review includes 21 studies. Of these, 3 evaluated both the upper and lower extremity. Twelve focused on either the upper or lower extremity, most commonly rotator cuff tears (3 of 12) and/or anterior cruciate ligament pathologies (7 of 12). The most common engines were Google (18 of 21), Bing (16 of 21), Yahoo (16 of 21), YouTube (3 of 21), Ask (3 of 21), and AOL (2 of 21). The average number of media files assessed per study was 87 ± 55. Website quality was assessed with DISCERN (7 of 21), Flesch-Kincaid (9 of 21), Health on the Net (7 of 21), and/or Journal of the American Medical Association Benchmark (7 of 21) scores. YouTube was evaluated with Journal of the American Medical Association Benchmark scores (1.74 ± 1.00). Image quality was reported in 2 studies and varied with search terminology.

Conclusions

The results of this systematic review suggest that physicians should improve the quality of online information and encourage patients to access credible sources when conducting their own research.

Clinical Relevance

Doctors can and should play an active role in closing the gap between the level of health literacy of their patients and that of most common online resources.

Most YouTube Videos About Carpal Tunnel Syndrome Have the Potential to Reinforce Misconceptions

BACKGROUND

Studies of online health information have addressed completeness and adherence to evidence, which can be difficult because current evidence leaves room for debate about etiology, diagnosis, and treatment. Fewer studies have evaluated whether online health information can reinforce misconceptions. It can be argued that information with the potential to harm health by reinforcing unhelpful misconceptions ought to be held to a higher standard of evidence.

QUESTIONS/PURPOSES

(1) What is the prevalence and nature of health information in YouTube videos with the potential to reinforce common misconceptions about symptoms and treatment associated with carpal tunnel syndrome (CTS)? (2) What factors (such as the number of views, likes, and subscribers) are associated with Potential Reinforcement of Misconception scores of YouTube videos about CTS?

METHODS

After removing all personalized data, we searched for the term "carpal tunnel syndrome" on YouTube, reviewed the first 60 English-language videos that discussed the diagnosis and treatment of CTS, and collected available metrics. The primary outcome was the number of statements that could reinforce misconceptions about CTS, rated by two authors using a checklist. As a secondary outcome, we counted the number of statements that could help patients by reorienting or balancing common misconceptions, providing agency, and facilitating decisions, and we subtracted the number of potential misconceptions from this count. A modified version of the DISCERN instrument (a validated scoring system designed to gauge the quality and reliability of health information) was used to evaluate each video. We sought factors associated with the Potential Reinforcement of Misconception score-in both the negative-only and combined (positive and negative) variations-accounting for various YouTube metrics (such as the number of views, number of likes and dislikes, and duration) and the modified DISCERN score. The interrater reliability was excellent for both the Potential Reinforcement of Misconceptions checklist (ICC = 0.97; Pearson correlation [r] = 0.97) and DISCERN information quality score (ICC = 0.96; r = 0.97).

RESULTS

Seventy-eight percent of the YouTube videos (47 of 60 videos) contained at least one statement that could reinforce common misconceptions about CTS. The median number of potentially misconception-reinforcing statements was two (range one to three), with the most common statements being that CTS is caused by hand use (38%; 23 of 60 videos) and that splints can alter the natural history of the disease (37%; 22 videos). Videos that were more popular (higher number of views or likes) did not contain less potential reinforcement of misconceptions. In the multivariable analysis, we found a strong association between the DISCERN score and the CTS Potential Reinforcement of Misconceptions score (regression coefficient = 0.67; 95% CI 0.22-1.2; partial r2 = 0.13; p = 0.004) and a lower number of subscribers (calculated per one million subscribers: regression coefficient = -0.91; 95% CI -1.8 to -0.023; p = 0.045).

CONCLUSION

Potential reinforcement of misconceptions is prevalent in YouTube videos about CTS, more so in videos with lower information quality scores.

CLINICAL RELEVANCE

Online health information should be held to a standard of accuracy (alignment with best evidence), and where such evidence leaves room for debate, it should be held to a standard by which unhealthy misconceptions are not reinforced.

Google Search Analysis: What Do People Want to Know About Rhinoplasty and Where Do They Find the Answers?

Background: During online search queries, Google uses machine learning algorithms to provide frequently associated ("People Also Ask" [PAA]) questions with corresponding websites answering the question. We aimed to identify the most frequent questions about rhinoplasty asked online and the sources used to answer them. Materials and Methods: PAA questions were extracted for the terms "rhinoplasty," "nose surgery," and "nose job." Questions were categorized into specific topics. Websites were categorized by type and assessed for quality using Journal of the American Medical Association (JAMA) benchmark criteria. A search engine optimization tool determined search volume for individual questions and specific topics. Results: Internet searches for the PAA questions (n = 102) and associated websites were related to preoperative factors (46%), cost (35.7%), and recovery timeline (7.3%). Sources for the answers to PAA questions were single surgeon personal (39.3%) and medical practice (20.6%) websites. Conclusions: Surgeons may wish to emphasize specific patient education topics, including preoperative factors, cost, and recovery timeline, on their websites to address the most frequently sought-after information regarding rhinoplasty online.

YouTube Is a Poor-Quality Source for Patient Information on Rehabilitation and Return to Sports After Hip Arthroscopy

Purpose

To investigate the information quality on YouTube regarding rehabilitation and return to sport (RTS) after hip arthroscopy.

Methods

By use of private browsing and predefined search terms, 217 unique videos regarding RTS and rehabilitation after hip arthroscopy were included and systematically reviewed. A total of 164 videos were included in the final analysis. Videos were scored using 4 scoring systems: (1) Journal of the American Medical Association benchmark criteria, (2) the Global Quality Score, (3) a score for RTS after hip arthroscopy, and (4) a score for rehabilitation after hip arthroscopy.

Results

A large majority of the included videos provided substandard information quality, dependability, and precision. RTS videos that were uploaded by physicians had a significantly higher Journal of the American Medical Association score, Global Quality Score, and RTS score compared with commercial and personal testimony videos (P = .0003, P = .0021, and P = .0005, respectively). Physician videos pertaining to RTS were also significantly longer than videos in other categories (P = .0397).

Conclusions

The quality and reliability of video content on YouTube pertaining to rehabilitation and RTS after hip arthroscopy are generally poor. The educational content of YouTube videos produced by physicians is of significantly higher quality as compared with non-physicians, patient testimonials, and commercials.

Clinical Relevance

The quality of the information patients receive on rehabilitation and RTS after hip arthroscopy is important for successful outcomes.

A quality analysis of nocturnal enuresis videos on YouTube

INTRODUCTION

The internet is a popular area for collecting medical information and YouTube is one of the largest platforms used worldwide in this regard.

AIM

The aim of the study was to investigate the quality of nocturnal enuresis videos on YouTube.

STUDY DESIGN

In this cross-sectional study, a YouTube search was made by using the keyword "nocturnal enuresis" and the first 200 videos were examined according to their relevance. Video features (like, dislike, number of views, video length, upload source, etc.) were evaluated by 2 independent urologists. Individual correlations and inter-observer agreement of data for each video were statistically analyzed. The education quality of the mentioned videos was evaluated according to the JAMA, Global Quality Scale and DISCERN scoring system.

RESULTS

A total number of 93 videos were analyzed after they were sorted according to the exclusion criteria. Videos were uploaded by the physicians (49.5%) most commonly and the majority of their content was about etiology, symptoms and treatment (33.3%). Good agreement between the 2 urologists in terms of JAMA, GQS and DISCERN scores (0.84, 0.86 and 0.85, respectively) was determined. There was a positive correlation between the duration of the video and GQS/DISCERN scores. Of the 93 videos evaluated, 74 (80%) contained real images (video of the presenter) while 19 (20%) contained animation. There was no statistically significant correlation between the GQS, JAMA and DISCERN scores in terms of VPI values, view rate, number of comments, views, likes and dislikes (Summary Table). Of the 93 videos evaluated, 58% (n = 54) were of low quality, 16.2% (n = 15) were of intermediate quality, and 25.8% (n = 24) were of high quality according to GQS scale. There was a positive correlation between GQS, JAMA and DISCERN scores.

CONCLUSION

Unfortunately, most of the YouTube contents about nocturnal enuresis were determined to have poor quality. Therefore, the healthcare professionals must be aware of the importance of health-related information on YouTube and ensure the flow of correct medical information to patients.

Online Information for Treatment for Low-Risk Thyroid Cancer: Assessment of Timeliness, Content, Quality, and Readability

The Internet is a key source of health information, yet little is known about resources for low-risk thyroid cancer treatment. We examined the timeliness, content, quality, readability, and reference to the 2015 American Thyroid Association (ATA) guidelines in websites about thyroid cancer treatment. We identified the top 60 websites using Google, Bing, and Yahoo for "thyroid cancer." Timeliness and content analysis identified updates in the ATA guidelines (n = 6) and engaged a group of stakeholders to develop essential items (n = 29) for making treatment decisions. Website quality and readability analysis used 4 validated measures: DISCERN; Journal of the American Medical Association (JAMA) benchmark criteria; Health on the Net Foundation certification (HONcode); and the Suitability Assessment of Materials (SAM) method. Of the 60 websites, 22 were unique and investigated. Content analysis revealed zero websites contained all updates from the ATA guidelines and rarely (18.2%) referenced them. Only 31.8% discussed all 3 treatment options: total thyroidectomy, lobectomy, and active surveillance. Websites discussed 28.2% of the 29 essential items for making treatment decisions. Quality analysis with DISCERN showed "fair" scores overall. Only 29.9% of the JAMA benchmarks were satisfied, and 40.9% were HONcode certified. Readability analysis with the SAM method found adequate readability, yet 90.9% scored unsuitable in literacy demand. The overall timeliness, content, quality, and readability of websites about low-risk thyroid cancer treatment is fair and needs improvement. Most websites lack updates from the 2015 ATA guidelines and information about treatment options that are necessary to make informed decisions.

Online Videos as a Source of Physiotherapy Exercise Tutorials for Patients with Lumbar Disc Herniation-A Quality Assessment

Background: During the last few decades the prevalence of lumbar disc herniation has been increasing constantly, thereby imposing a significant socioeconomic burden. Physiotherapy plays a crucial role in both surgical and conservative treatment of lumbar disc herniation, consequently the current COVID-19 pandemic with concomitant lockdowns has led to a shortage of physiotherapeutical care. In the light of these recent events publicly available physiotherapy tutorials may be a useful tool to address this problem. Aim: The main aim of this study was to assess the quality of online physiotherapy exercise tutorials for lumbar disc herniation. Materials & Methods: With YouTube being a widely known and used platform we screened 240 of the most viewed videos. A total of 76 videos met the inclusion criteria and were statistically analyzed. The videos were assessed using Global Quality Score, DISCERN Score and JAMA benchmark criteria and in regard to their applicability. Results: They displayed a wide range of views (44,969 to 5,448,717), likes (66 to 155,079) and dislikes (6 to 2339). The videos were assessed using Global Quality Score, DISCERN Score and JAMA benchmark criteria and in regard to their applicability. Neither the number of "Views", "Likes", nor "Dislikes" was found to have a significant association with any of the quality measures used in this study. Conclusion: Overall quality grade was determined as "moderate". Based on the data examined in this study, the use of YouTube videos as a source of therapy advice for lumbar spine disc herniation cannot be recommended universally.

An Evaluation of the Source and Content of Kienböck's Disease Information on the Internet

Introduction  The use of the internet for health-related information continues to increase. Because of its decentralized structure, information contained within the World Wide Web is not regulated. The purpose of the present study is to evaluate the type and quality of information on the internet regarding Kienböck's disease. We hypothesized that the information available on the World Wide Web would be of good informational value. Materials and Methods  The search phrase "Kienböck's disease" was entered into the five most commonly used internet search engines. The top 49 nonsponsored Web sites identified by each search engine were collected. Each unique Web site was evaluated for authorship and content, and an informational score ranging from 0 to 100 points was assigned. Each site was reviewed by two fellowship-trained hand surgeons. Results  The informational mean score for the sites was 45.5 out of a maximum of 100 points. Thirty-one (63%) of the Web sites evaluated were authored by an academic institution or a physician. Twelve (24%) of the sites were commercial sites or sold commercial products. The remaining 6 Web sites (12%) were noninformational, provided unconventional information, or had lay authorship. The average informational score on the academic or physician authored Web sites was 54 out of 100 points, compared with 38 out of 100 for the remainder of the sites. This difference was statistically significant. Conclusion  While the majority of the Web sites evaluated were authored by academic institutions or physicians, the informational value contained within is of limited completeness. More than one quarter of the Web sites were commercial in nature. There remains significant room for improvement in the completeness of information available for common hand conditions in the internet.

Quality and Content of Internet-Based Information for Osteoporosis and Fragility Fracture Diagnoses

INTRODUCTION

We aimed to assess the quality and content of websites addressing orthopaedic conditions affecting older adults, emphasizing osteoporosis and fragility fracture.

METHODS

Ten diagnoses were chosen. The transparency of information was assessed via the Health On the Net (HON) score; information content was assessed via diagnosis-specific grading templates. A total of 140 websites (14 per diagnosis) were reviewed by three raters. HON scores and information quality were compared by diagnosis, website type, and website source. The correlation between HON score and information quality score was calculated.

RESULTS

Most websites were commercial (59.3%). Cronbach alpha for Hall scores exceeded the a priori threshold of 0.7. Analysis proceeded using averages across raters. HON score was significantly associated with higher content scores (r = 0.56; P < 0.0001). Content scores ranged from 21.1 to 59.4. Content scores differed significantly by diagnosis (P = 0.0008) and website source (P < 0.0001).

DISCUSSION

The quality and content of websites is highly variable for osteoporosis and fragility fracture diagnoses. Patients should be encouraged to access reputable sites, including sites displaying a HON seal. Academic and medical specialty societies demonstrate opportunity for improvement of their own websites and might be able to lead efforts to increase accessibility of high-quality content.

Increased Prevalence and Associated Costs of Psychiatric Comorbidities in Patients Undergoing Sports Medicine Operative Procedures

PURPOSE

To evaluate the prevalence of preoperatively diagnosed psychiatric comorbidities and the impact of these comorbidities on the healthcare costs of ten common orthopaedic sports medicine procedures.

METHODS

Patients undergoing 10 common sports medicine procedures from 2007 to 2017q1 were identified using the Humana claims database. These procedures included anterior cruciate ligament reconstruction; posterior cruciate ligament reconstruction; medial collateral ligament repair/reconstruction; Achilles repair/reconstruction; Rotator cuff repair; meniscectomy/meniscus repair; hip arthroscopy; arthroscopic shoulder labral repair; patellofemoral instability procedures; and shoulder instability repair. Patients were stratified by preoperative diagnoses of depression, anxiety, bipolar disorder, or schizophrenia. Cohorts included patients with ≥1 psychiatric comorbidity (psychiatric) versus those without psychiatric comorbidities (no psychiatric). Differences in costs across groups were compared using Mann-Whitney U tests, with significance defined as P < .05. Linear regression analysis was used to assess rates of procedures per year from 2006 to 2016.

RESULTS

In total, 226,402 patients (57.7% male) from 2007 to 2017q1 were assessed. The prevalence of ≥1 psychiatric comorbidity within the entire database was 10.31% (reference) versus 21.21% in those patients undergoing the 10 investigated procedures. Patients with psychiatric comorbidity most frequently underwent rotator cuff repair (28%), hip labral repair (26.3%) and meniscectomy/meniscus repair (25.0%%) had ≥1 psychiatric comorbidity. Compared with the no psychiatric cohort, diagnosis of ≥1 psychiatric comorbidity was associated with increased health care costs for all 10 sports medicine procedures ($9678.81 vs $6436.20, P < .0001).

CONCLUSIONS

The prevalence of preoperatively diagnosed psychiatric comorbidities among patients undergoing orthopaedic sports medicine procedures is high. The presence of psychiatric comorbidities preoperatively was associated with increased postoperative costs following all investigated orthopaedic sports medicine procedures.

LEVEL OF EVIDENCE

Level III; retrospective comparative study.

Adverse Effects of Radiotherapy and Chemotherapy for Common Malignancies: What Is the Quality of Information Patients Are Finding Online?

Little is known about the availability of high-quality online health information (OHI) for adverse effects (AEs) of radiotherapy (RT) and chemotherapy (CHT). Optimal search strategies for gaining access to high-quality OHI for these topics are not well-established. This study explores the quality of, potential disparities in, and possible search strategies for OHI pertaining to AEs of RT and CHT. One hundred twenty phrases on generalized and malignancy site-specific AEs of RT and CHT were searched on Google. The Health on the Net Foundation (HONcode) framework was applied to assess the quality of the first 100 websites for each search phrase. Comparisons of the availability of high-quality OHI were made between different languages, malignancy sites, and treatment modalities (RT vs CHT). Of the 12,000 RT and CHT AE websites analyzed, approximately half of the first 10 websites returned for each search were HONcode-accredited; approximately a fifth of the first 100 websites returned were HONcode-accredited. Such low availability of high-quality OHI persisted throughout different languages (English, French, Spanish) and common malignancy sites (breast, prostate, lung), with some variations between languages, malignancy sites, and RT vs CHT. Despite the important role of OHI in cancer patients' approach to health information gathering and decision-making, the availability of high-quality OHI for the AEs of common oncologic treatments, RT and CHT, is low across different languages and common malignancy sites. Our findings demonstrate the need for improvement in the availability of high-quality OHI. Therefore, providers should take an active stance in directing patients to high-quality OHI.

Examining the Public's Most Frequently Asked Questions Regarding COVID-19 Vaccines Using Search Engine Analytics in the United States: Observational Study

BACKGROUND

The emergency authorization of COVID-19 vaccines has offered the first means of long-term protection against COVID-19-related illness since the pandemic began. It is important for health care professionals to understand commonly held COVID-19 vaccine concerns and to be equipped with quality information that can be used to assist in medical decision-making.

OBJECTIVE

Using Google's RankBrain machine learning algorithm, we sought to characterize the content of the most frequently asked questions (FAQs) about COVID-19 vaccines evidenced by internet searches. Secondarily, we sought to examine the information transparency and quality of sources used by Google to answer FAQs on COVID-19 vaccines.

METHODS

We searched COVID-19 vaccine terms on Google and used the "People also ask" box to obtain FAQs generated by Google's machine learning algorithms. FAQs are assigned an "answer" source by Google. We extracted FAQs and answer sources related to COVID-19 vaccines. We used the Rothwell Classification of Questions to categorize questions on the basis of content. We classified answer sources as either academic, commercial, government, media outlet, or medical practice. We used the Journal of the American Medical Association's (JAMA's) benchmark criteria to assess information transparency and Brief DISCERN to assess information quality for answer sources. FAQ and answer source type frequencies were calculated. Chi-square tests were used to determine associations between information transparency by source type. One-way analysis of variance was used to assess differences in mean Brief DISCERN scores by source type.

RESULTS

Our search yielded 28 unique FAQs about COVID-19 vaccines. Most COVID-19 vaccine-related FAQs were seeking factual information (22/28, 78.6%), specifically about safety and efficacy (9/22, 40.9%). The most common source type was media outlets (12/28, 42.9%), followed by government sources (11/28, 39.3%). Nineteen sources met 3 or more JAMA benchmark criteria with government sources as the majority (10/19, 52.6%). JAMA benchmark criteria performance did not significantly differ among source types (χ 2 4=7.40; P=.12). One-way analysis of variance revealed a significant difference in mean Brief DISCERN scores by source type (F 4,23=10.27; P<.001).

CONCLUSIONS

The most frequently asked COVID-19 vaccine-related questions pertained to vaccine safety and efficacy. We found that government sources provided the most transparent and highest-quality web-based COVID-19 vaccine-related information. Recognizing common questions and concerns about COVID-19 vaccines may assist in improving vaccination efforts.