An Assessment of the Quality of YouTube Videos as a Resource for Adolescents Experiencing Abnormal Uterine Bleeding

STUDY OBJECTIVE

YouTube, the largest accessible media-sharing platform, has become an important tool for pursuing health-related information. Adolescents may find it challenging to seek counseling or access adolescent-friendly services for menstruation-related problems, so YouTube may be a useful resource. The aim of this study was to examine the reliability, quality, and accuracy of YouTube videos concerning abnormal uterine bleeding in adolescents.

METHODS

A YouTube search using the key words "adolescent, teens, heavy period, abnormal uterine bleeding, heavy menstrual bleeding" yielded 109 videos. Video features (duration, time since upload, likes, views, comments), sources of upload, and content were recorded. All the videos were reviewed by 2 adolescent medicine specialists and scored using the Journal of the American Medical Association, the 5-point modified DISCERN tool, and the Global Quality Scale.

RESULTS

Fifty-eight videos met the inclusion criteria. Most (62.1%) were created by non-professionals, and a significant portion (81%) contained general descriptions. On the basis of the DISCERN classification, 50% exhibited poor quality. Similarly, the Journal of the American Medical Association assessment indicated that only 36.2% satisfied the requirements for good quality. The videos uploaded by professionals exhibited notably superior quality in comparison with those uploaded by non-professionals. Additionally, higher-quality videos were longer (P = .040) and more recent (P = .011).

CONCLUSION

Mot YouTube videos about adolescent abnormal uterine bleeding provide low-quality information. We believe that increasing the number of videos tailored by health care providers specializing in adolescent gynecology to address the specific physical and psychosocial needs of adolescents with menstrual problems would be beneficial.

IVC filter - assessing the readability and quality of patient information on the Internet

OBJECTIVE

The internet is an increasingly favorable source of information regarding health-related issues. The aim of this study is to apply appropriate evaluation tools to assess the evidence available online about inferior vena cava (IVC) filters with a focus on quality and readability.

METHODS

A search was performed during December 2022 using three popular search engines, namely Google, Yahoo, and Bing. Websites were categorized into academic, physician, commercial, and unspecified websites according to their content. Information quality was determined using Journal of the American Medical Association (JAMA) criteria, the DISCERN scoring tool, and whether a Health On the Net Foundation certification (HONcode) seal was present. Readability was established using the Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL). Statistical significance was accepted as P < .05.

RESULTS

In total, 110 websites were included in our study. The majority of websites were categorized as commercial (25%), followed by hospital (24%), academic (21%), unspecified (16%), and physician (14%). Average scores for all websites using JAMA and DISCERN were 1.93 ± 1.19 (median, 1.5; range, 0-4) and 45.20 ± 12.58 (median, 45.5; range, 21-75), respectively. The highest JAMA mean score of 3.07 ± 1.16 was allocated to physician websites, and the highest DISCERN mean score of 52.85 ± 12.66 was allocated to hospital websites. The HONcode seal appeared on two of the selected websites. Physician, hospital, and unspecified websites had a significantly higher mean JAMA score than academic and commercial websites (all with P < .001). Hospital websites had a significantly higher mean DISCERN score than academic (P = .007), commercial (P < .001), and unspecified websites (P = .017). Readability evaluation generated a mean FRES score of 51.57 ±12.04, which represented a 10th to 12th grade reading level and a mean FKGL score of 8.20 ± 1.70, which represented an 8th to 10th grade reading level. Only 12 sources were found to meet the ≤6th grade target reading level. No significant correlation was found between overall DISCERN score and overall FRES score.

CONCLUSIONS

The study results demonstrate that the quality of online information about IVC filters is suboptimal, and academic and commercial websites, in particular, must enhance their content quality regarding the use of IVC filters. Considering the discontinuation of the HONcode as a standardized quality assessment marker, it is recommended that a similar certification tool be developed and implemented for the accreditation of patient information online.

Suprapubic catheter change: Evaluating YouTube videos as a resource for teaching junior doctors

Objectives

The objectives of this study are to assess the current level of experience and teaching practices for SPC change at our institution and, second, to assess the quality of YouTube videos as an educational tool for teaching SPC change.

Methods

A survey was conducted of 40 JMOs at our institution regarding SPC change. The first 20 YouTube videos on SPC change were included for analysis. A JAMA and DISCERN score was calculated for each video. Using linear regression, the association between collected variables and the assigned JAMA and DISCERN scores were determined.

Results

The survey showed that 18 (45%) of JMOs had done an SPC change. None had received formal teaching. The consensus was that the quality of the YouTube videos was poor. There was a statistically significant positive correlation between the score assigned to videos by each scoring system (Pearson's r 0.81, p < 0.001). There was no statistically significant association between video quality as measured by either of the scoring systems and number of views. No association between any video characteristic and JAMA and DISCERN score was found.

Conclusion

An SPC change is often a requirement of JMOs; however, this skill is not formally taught. The quality of YouTube videos describing an SPC change is poor.

Assessing the Quality of YouTube's Incontinence Information after Cancer Surgery: An Innovative Graphical Analysis

BACKGROUND

Prostate and colorectum cancers rank among the most common cancers, and incontinence is a significant postsurgical issue affecting the physical and psychological well-being of cancer survivors. Social media, particularly YouTube, has emerged as a vital source of health information. While YouTube offers valuable content, users must exercise caution due to potential misinformation.

OBJECTIVE

This study aims to assess the quality of publicly available YouTube videos related to incontinence after pelvic cancer surgery.

METHODS

A search on YouTube related to "Incontinence after cancer surgery" was performed, and 108 videos were analyzed. Multiple quality assessment tools (DISCERN, GQS, JAMA, PEMAT, and MQ-VET) and statistical analyses (descriptive statistics and intercorrelation tests) were used to evaluate the characteristics and popularity, educational value, quality, and reliability of these videos, relying on novel graphical representation techniques such as Sankey and Chord diagrams.

RESULTS

Strong positive correlations were found among quality rating scales, emphasizing agreement. The performed graphical analysis reinforced the reliability and validity of quality assessments.

CONCLUSIONS

This study found strong correlations among five quality scales, suggesting their effectiveness in assessing health information quality. The evaluation of YouTube videos consistently revealed "high" quality content. Considering the source is mandatory when assessing quality, healthcare and academic institutions are reliable sources. Caution is advised with ad-containing videos. Future research should focus on policy improvements and tools to aid patients in finding high-quality health content.

The Readability and Quality of Web-Based Patient Information on Nasopharyngeal Carcinoma: Quantitative Content Analysis

BACKGROUND

Nasopharyngeal carcinoma (NPC) is a rare disease that is strongly associated with exposure to the Epstein-Barr virus and is characterized by the formation of malignant cells in nasopharynx tissues. Early diagnosis of NPC is often difficult owing to the location of initial tumor sites and the nonspecificity of initial symptoms, resulting in a higher frequency of advanced-stage diagnoses and a poorer prognosis. Access to high-quality, readable information could improve the early detection of the disease and provide support to patients during disease management.

OBJECTIVE

This study aims to assess the quality and readability of publicly available web-based information in the English language about NPC, using the most popular search engines.

METHODS

Key terms relevant to NPC were searched across 3 of the most popular internet search engines: Google, Yahoo, and Bing. The top 25 results from each search engine were included in the analysis. Websites that contained text written in languages other than English, required paywall access, targeted medical professionals, or included nontext content were excluded. Readability for each website was assessed using the Flesch Reading Ease score and the Flesch-Kincaid grade level. Website quality was assessed using the Journal of the American Medical Association (JAMA) and DISCERN tools as well as the presence of a Health on the Net Foundation seal.

RESULTS

Overall, 57 suitable websites were included in this study; 26% (15/57) of the websites were academic. The mean JAMA and DISCERN scores of all websites were 2.80 (IQR 3) and 57.60 (IQR 19), respectively, with a median of 3 (IQR 2-4) and 61 (IQR 49-68), respectively. Health care industry websites (n=3) had the highest mean JAMA score of 4 (SD 0). Academic websites (15/57, 26%) had the highest mean DISCERN score of 77.5. The Health on the Net Foundation seal was present on only 1 website, which also achieved a JAMA score of 3 and a DISCERN score of 50. Significant differences were observed between the JAMA score of hospital websites and the scores of industry websites (P=.04), news service websites (P<.048), charity and nongovernmental organization websites (P=.03). Despite being a vital source for patients, general practitioner websites were found to have significantly lower JAMA scores compared with charity websites (P=.05). The overall mean readability scores reflected an average reading age of 14.3 (SD 1.1) years.

CONCLUSIONS

The results of this study suggest an inconsistent and suboptimal quality of information related to NPC on the internet. On average, websites presented readability challenges, as written information about NPC was above the recommended reading level of sixth grade. As such, web-based information requires improvement in both quality and accessibility, and healthcare providers should be selective about information recommended to patients, ensuring they are reliable and readable.

Evaluating YouTube as a source of patient information for pediatric tracheostomy care

OBJECTIVES

To evaluate YouTube's usefulness as a source of information concerning pediatric tracheostomy care.

MATERIALS AND METHODS

On August 10, 2022, the top 50 YouTube search results for "pediatric tracheostomy care" were displayed. Each video was evaluated by a jury of three otolaryngologists with at least 2 years of professional experience in pediatric otolaryngology using DISCERN, scoring system of Journal of the American Medical Association (JAMA), and the Global Quality Score (GQS).

RESULTS

After exclusion criteria 24 videos were evaluated. Fifteen of the evaluated videos were produced by health professionals, and the other nine videos were produced by independent users. The average duration of the videos were 337.5 s, varying between 82 s and 1364 s. The average Discern score of videos produced by health professionals was 38.9 ± 13, compared to 36.6 ± 14 for independent users. The mean JAMA score was 1.04 ± 0.68 for health professionals and 1.11 ± 0.94 for independent users. The GQS score was 2.82 ± 0.73 for health professionals and 3.19 ± 0.84 for independent users. There was no statistically significant difference between the two groups for Discern, JAMA, and GQS scoring.

CONCLUSION

YouTube does not seem to be a good option for parents to get useful information about pediatric tracheostomy care at this time. Health professionals should provide websites with high-quality materials to improve awareness of pediatric tracheostomy care.

Quality of Information in Gallstone Disease Videos on TikTok: Cross-sectional Study

BACKGROUND

TikTok was an important channel for consumers to access and adopt health information. But the quality of health content in TikTok remains underinvestigated.

OBJECTIVE

Our study aimed to identify upload sources, contents, and feature information of gallstone disease videos on TikTok and further evaluated the factors related to video quality.

METHODS

We investigated the first 100 gallstone-related videos on TikTok and analyzed these videos' upload sources, content, and characteristics. The quality of videos was evaluated using quantitative scoring tools such as DISCERN instrument, the Journal of American Medical Association (JAMA) benchmark criteria, and Global Quality Scores (GQS). Moreover, the correlation between video quality and video characteristics, including duration, likes, comments, and shares, was further investigated.

RESULTS

According to video sources, 81% of the videos were posted by doctors. Furthermore, disease knowledge was the most dominant video content, accounting for 56% of all the videos. The mean DISCERN, JAMA, and GQS scores of all 100 videos are 39.61 (SD 11.36), 2.00 (SD 0.40), and 2.76 (SD 0.95), respectively. According to DISCERN and GQS, gallstone-related videos' quality score on TikTok is not high, mainly at fair (43/100, 43%,) and moderate (46/100, 46%). The total DISCERN scores of doctors were significantly higher than that of individuals and news agencies, surgery techniques were significantly higher than lifestyle and news, and disease knowledge was significantly higher than news, respectively. DISCERN scores and video duration were positively correlated. Negative correlations were found between DISCERN scores and likes and shares of videos. In GQS analysis, no significant differences were found between groups based on different sources or different contents. JAMA was excluded in the video quality and correlation analysis due to a lack of discrimination and inability to evaluate the video quality accurately.

CONCLUSIONS

Although the videos of gallstones on TikTok are mainly provided by doctors and contain disease knowledge, they are of low quality. We found a positive correlation between video duration and video quality. High-quality videos received low attention, and popular videos were of low quality. Medical information on TikTok is currently not rigorous enough to guide patients to make accurate judgments. TikTok was not an appropriate source of knowledge to educate patients due to the low quality and reliability of the information.

Insights from full-text analyses of the Journal of the American Medical Association and the New England Journal of Medicine

Analysis of the content of medical journals enables us to frame the shifting scientific, material, ethical, and epistemic underpinnings of medicine over time, including today. Leveraging a dataset comprised of nearly half-a-million articles published in the Journal of the American Medical Association (JAMA) and the New England Journal of Medicine (NEJM) over the past 200 years, we (a) highlight the evolution of medical language, and its manifestations in shifts of usage and meaning, (b) examine traces of the medical profession's changing self-identity over time, reflected in its shifting ethical and epistemic underpinnings, (c) analyze medicine's material underpinnings and how we describe where medicine is practiced, (d) demonstrate how the occurrence of specific disease terms within the journals reflects the changing burden of disease itself over time and the interests and perspectives of authors and editors, and (e) showcase how this dataset can allow us to explore the evolution of modern medical ideas and further our understanding of how modern disease concepts came to be, and of the retained legacies of prior embedded values.

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.

Quality analysis of testicular cancer videos on YouTube

The aim of this study was to assess the content, reliability and quality of information regarding testicular cancer in YouTube videos. The search was performed by using term 'testicular cancer' on YouTube, and the first 168 videos were listed according to relevancy. Video features and source of upload were recorded. The quality, reliability and accuracy of the information were evaluated by two independent urologists using the Journal of American Medical Association (JAMA) score, the 5-point modified DISCERN tool and the Global Quality Score (GQS). A total number of 152 videos were analysed. The most common source of upload was talk show programmes/TV programmes (25.7%), and majority of the content was about (24.3%) symptoms and diagnosis options. The mean JAMA score, modified DISCERN score and GQS were 1.59, 2.13 and 2.61 respectively. These scores were significantly higher in videos that were uploaded by physicians/nonprofit physicians/professional organisations/universities (p < 0.001). There is a positive correlation between the video length, DISCERN, JAMA scores and GQS. YouTube is a widely used source of information and advice about testicular cancer, but much of the content is of poor quality.

Transjugular intrahepatic portosystemic shunt (TIPS) procedure: an assessment of the quality and readability of online information

Purpose

Transjugular intrahepatic portosystemic shunt (TIPS) procedure is an established procedure carried out by interventional radiologists to achieve portal decompression and to manage the complications of portal hypertension. The aim of this study was to evaluate the quality and readability of information available online for TIPS procedure.

Methods

Websites were identified using the search terms “TIPS procedure”, “TIPSS procedure”, “transjugular intrahepatic portosystemic shunt procedure”, with the first 25 pages from the three most popular search engines (Google, Bing and Yahoo) being selected for evaluation with a total of 225. Each Website was grouped by authorship into one of five categories: (1) Physician, (2) Academic, (3) For-profit, (4) Non-profit (including government and public health), or (5) Other (discussion/social media). Readability of each Website was assessed using the Flesch-Reading Ease score, Flesch–Kincaid grade level, Gunning-Fog Index, Coleman–Liau and SMOG index. Quality was calculated using the DISCERN instrument, the Journal of the American Medical Association (JAMA) benchmark criteria and the presence of Health on the Net (HON) code certification.

Results

After disregarding duplicate and non-accessible Websites a total of 81 were included. The mean DISCERN score assessing the quality of information provided by Websites was “good” (59.3 ± 10.2) with adherence to the JAMA Benchmark being 54.3%. Websites with HON-code certification were statistically significantly higher in terms of DISCERN (p = 0.034) and JAMA scores (p = 0.003) compared to HON-code negative sites. The readability scores of Websites ranged from 10 to 12th grade across calculators. Thirty-two out of the 81 Websites were targeted towards patients (39.5%), 46 towards medical professionals (56.8%) and 3 were aimed at neither (3.7%). The medical professional aimed Websites were statistically significantly more difficulty to read across all readability formulas (all p < 0.001).

Conclusion

While quality of online information available to patients is “good”, the average readability for information on the internet for TIPS is set far above the recommended 7th-grade level. Academic Websites were of the highest quality, yet most challenging for the general public to read. These findings call for the production of high-quality and comprehensible content around TIPS procedure, where physicians can reliably direct their patients for information.

[Discussion on Acupuncture as adjunctive therapy for chronic stable angina: a randomized clinical trial published in JAMA Internal Medicine]

Professor LIANG Fan-rong's team from Chengdu University of TCM published Acupuncture as adjunctive therapy for chronic stable angina: a randomized clinical trial in JAMA Internal Medicine on July 29, 2019, which demonstrates that acupuncture as an adjunctive therapy is safety and effective for mild and moderate chronic stable angina. Sixteen experts at home and abroad conducted serious discussions on the research design, evaluation methods, principles and mechanisms, clinical significance and enlightenment of future acupuncture research, and provided practical suggestions for acupuncture and moxibustion to go global and gain international recognition.

Female genital cosmetic surgery (FGCS): Evaluation of YouTube videos

OBJECTIVES

The purpose of our study is to evaluate the information available on YouTube regarding FGCS procedures in terms of content, accuracy, reliability and quality.

METHODS

Videos were listed on YouTube on 01.10.2020 by searching the terms "plastic surgery for female genital", "vaginoplasty", "labiaplasty" and selecting their relevance from the filtering options. Among these listed videos, the 50 most watched videos were listed and recorded excluding commercials, repeating videos, those shorter than 60s and non-English ones. The videos were scored by two researchers using DISCERN and JAMA scales. The DISCERN scale varies between 0-75 points and according to the scores obtained from the scale, videos are classified as 63-75: (excellent); as 51-62: (good); as 39-50: (moderate) as 28- 38: poor and as <28 very poor. JAMA scale is a scale that evaluates the accuracy, usefulness and reliability of video sources between 0-4. Insufficient data on 1 point video source obtained from the scale, refers to. 2-3 (partially sufficient data) and 4: (completely sufficient data).

RESULTS

The evaluation on DISCERN scores given to the videos revealed that the average DISCERN score of the first researcher was 45.65±13.271 and the average of the second researcher's DISCERN score was 44.65±14.235. The average of JAMA scores was 2.67±0.826 for the first researcher and 2.49±0.845 for the second researcher. Accordingly, a statistically significant linear relationship was found between DISCERN (r=0.812) scores and JAMA (r=0.622) scores by the researchers.

CONCLUSION

We found that YouTube has the potential to provide patients with easy access to a large amount of information on FGCS, although almost all of the videos we included in the study were uploaded by health professionals, the overall quality of the content on the subject was moderate. We strongly suggest that any videos on health should be uploaded by experts and these videos should definitely be reviewed by a referee.

Evaluation of the quality of information on the internet about 2019 coronavirus outbreak in relation to orthodontics

This study aims to evaluate the content of information in three different search engines in terms of orthodontics as the source of information at the current stage of the COVID-19 outbreak. An internet search was conducted on April 10th, 2020, using the most popular search engines: GoogleTM, BingTM, and Yahoo!® with the keyword "coronavirus orthodontics". Top 10 websites were evaluated for each search engine. After excluding duplicates the remaining 23 sites were saved in Microsoft Excel programme and evaluated by two independent researchers (HKO and RSO; both experienced orthodontists) using the modified DISCERN tool and JAMA benchmarks. The websites were also classified as "useful, misleading and news updates". Sixty one percent of the websites were classified as useful, 26% as misleading, and 13% as news updates. Most of the authors of the websites were unknown (35%) and followed by orthodontists (30%). The DISCERN and JAMA scores of the four websites were excellent and their target audience were orthodontists. The average modified DISCERN score of 23 websites was moderate (average score 2,8). Useful websites had a significantly higher number of DISCERN and JAMA scores than the misleading websites (p < 0.05). Most of the information available in three different search engines about orthodontics related to COVID-19 were useful. The most reliable websites belonged to American Association of Orthodontists (AAO), Australian Society of Orthodontists (ASO), and British Orthodontic Society (BOS), and they appeared on the first page of the GoogleTM.

Quality and reliability of information available on YouTube and Google pertaining gastroesophageal reflux disease

BACKGROUND

Evaluation of the accuracy, quality and reliability of written and visual health contents on the internet by healthcare professionals.

AIMS

The objective of this study was to evaluate gastroesophageal reflux health contents in Google search engine and videos on YouTube, in terms of quality, actuality, treatment diversity, accuracy and reliability.

METHODS

A total of 77 YouTube videos and 57 Google contents related to gastroesophageal reflux disease were included in the study. The contents were assessed by two independent reviewers. Quality of the content included in this study was evaluated using DISCERN, which is commonly used for the assessment of health information on the internet, JAMA and video power index scores.

RESULTS

Among YouTube videos; 44.7 % (n = 34) were uploaded by experts, 44.7 % (n = 34) by non-experts, 9.0 % (n = 7) by media and 2.7 % (n = 2) by academic institutions, while 10.5 % (n = 6) of the Google contents were uploaded by experts, 59.6 % (n = 34) by non-experts and 22.4 % (n = 17) by academic institutions. The mean total DISCERN score (5-80 points) of reflux related YouTube was found as 37.2 ± 16.5. The mean total DISCERN scores of the evaluated Google contents was found as 42.1 ± 15.6. The mean JAMA score (0-4 points) was found as 2 ± 0.9 for YouTube videos and 2 ± 0.9 for Google contents. There was a strong correlation between all scores given by the two reviewers.

CONCLUSIONS

Overall quality of YouTube videos and Google contents about reflux was low. Healthcare professionals and organizations should be encouraged to provide more beneficial material and animated videos to people who seek reliable information on the internet.

[Comments on "Effect of Acupuncture vs Sham Acupuncture on Live Births Among Women Undergoing In Vitro Fertilization: A Randomized Clinical Trial " from Journal of the American Medical Association]

In recent years, acupuncture has been used widely as an adjuvant treatment for the in vitro fertilization (IVF). "Effect of Acupuncture vs Sham Acupuncture on Live Births Among Women Undergoing In Vitro Fertilization: A Randomized Clinical Trial " published in Journal of the American Medical Association (JAMA) on May 15, 2018, the research findings do not support the use of acupuncture to improve the rate of live births among the women undergoing IVF. In order to avoid the misunderstanding of the scholars at home and abroad for the clinical effects of acupuncture on IVF assistance, the authors put forward the doubts after the analysis from the following 3 aspects, including the acupuncture scheme, outcomes and result explanation. Additionally, the thinking and suggestions are proposed for the future development of the clinical trials of acupuncture IVF assistance in terms of selecting the proper participants, being abided by the standards of the evidence-based medicine, designing multi-acupuncture schemes and setting up the rational control, as well as conducting the overall analysis of the trial data.

Availability of accessible and high-quality information on the Internet for patients regarding the diagnosis and management of rotator cuff tears

BACKGROUND

In the era of informed patient decision-making, educated patients are vital contributors. The Internet provides a vast information source that patients will access. It is imperative that this information be relevant and understandable. Various treatments, each with advantages and disadvantages, are available. We sought to examine the standard of information about the diagnosis and management of rotator cuff tears available to patients on the Internet.

METHODS

We identified 125 websites from searching "rotator cuff tear" in the 5 most popular Internet search engines. The websites were examined for readability by measuring the Flesch Reading Ease Score, the Flesch-Kincaid Grade Level, and the Gunning Fog Index. The quality of the websites was measured by the DISCERN instrument, the Journal of the American Medical Association benchmark criteria, and Health on the Net Foundation certification.

RESULTS

There were 59 individual URLs analyzed. Overall, the quality was poor, with the average DISCERN score being only 39.47. Furthermore, the mean reading grade level was above 9 (recommended level, 6). Health on the Net Foundation certification did correspond to significantly worse readability scores (P = .004) but did not correlate with improved DISCERN scores. Those that satisfied more of the Journal of the American Medical Association benchmark criteria had significantly better DISCERN scores (P < .001).

CONCLUSION

Information about rotator cuff tears is of a low standard and is in many cases written at too high a level for the general population. There are instruments of which we, as surgeons, must be aware to evaluate the resources available and to recommend them to patients to ensure that they understand their condition and treatment options.