Original Research

Web Page Content and Quality Assessed for Shoulder Replacement

Am J Orthop. 2016 January;45(1):E20-E24

References

1. Eysenbach G, Powell J, Kuss O, Sa ER. Empirical studies assessing the quality of health information for consumers on the world wide web: a systematic review. JAMA. 2002;287(20):2691-2700.

2. Bruce-Brand RA, Baker JF, Byrne DP, Hogan NA, McCarthy T. Assessment of the quality and content of information on anterior cruciate ligament reconstruction on the internet. Arthroscopy. 2013;29(6):1095-1100.

3. Computer and internet use in the United States: population characteristics. US Census Bureau website. http://www.census.gov/hhes/computer/. Accessed December 11, 2015.

4. Fox S, Duggan M. Health online 2013. Pew Research Center website. http://pewinternet.org/Reports/2013/Health-online.aspx. Published January 15, 2013. Accessed November 24, 2015.

5. Smith A. Older adults and technology use. Pew Research Center website. http://www.pewinternet.org/2014/04/03/older-adults-and-technology-use. Published April 3, 2014. Accessed November 24, 2015.

6. Shuyler KS, Knight KM. What are patients seeking when they turn to the internet? Qualitative content analysis of questions asked by visitors to an orthopaedics web site. J Med Internet Res. 2003;5(4):e24.

7. Meredith P, Emberton M, Wood C, Smith J. Comparison of patients’ needs for information on prostate surgery with printed materials provided by surgeons. Qual Health Care. 1995;4(1):18-23.

8. Charnock D, Shepperd S, Needham G, Gann R. DISCERN: An instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health. 1999;53(2):105-111.

9. Kaicker J, Debono VB, Dang W, Buckley N, Thabane L. Assessment of the quality and variability of health information on chronic pain websites using the DISCERN instrument. BMC Med. 2010;8(1):59.

10. Griffiths KM, Christensen H. Website quality indicators for consumers. J Med Internet Res. 2005;7(5):e55.

11. Wiater JM. Shoulder joint replacement. American Academy of Orthopedic Surgeons website. http://orthoinfo.aaos.org/topic.cfm?topic=A00094. Updated December 2011. Accessed November 24, 2015.

12. Kim SH, Wise BL, Zhang Y, Szabo RM. Increasing incidence of shoulder arthroplasty in the united states. J Bone Joint Surg Am. 2011;93(24):2249-2254.

13. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151(4):W65-W94.

14. Nason GJ, Baker JF, Byrne DP, Noel J, Moore D, Kiely PJ. Scoliosis-specific information on the internet: has the “information highway” led to better information provision? Spine. 2012;37(21):E1364-E1369.

15. Starman JS, Gettys FK, Capo JA, Fleischli JE, Norton HJ, Karunakar MA. Quality and content of internet-based information for ten common orthopaedic sports medicine diagnoses. J Bone Joint Surg Am. 2010;92(7):1612-1618.

16. Bernstein J, Ahn J, Veillette C. The future of orthopaedic information management. J Bone Joint Surg Am. 2012;94(13):e95.

17. Berland GK, Elliott MN, Morales LS, et al. Health information on the Internet: accessibility, quality, and readability in English and Spanish. JAMA. 2001;285(20):2612-2621.

18. Fallowfield LJ, Hall A, Maguire GP, Baum M. Psychological outcomes of different treatment policies in women with early breast cancer outside a clinical trial. BMJ. 1990;301(6752):575-580.

19. Chong YM, Fraval A, Chandrananth J, Plunkett V, Tran P. Assessment of the quality of web-based information on bunions. Foot Ankle Int. 2013;34(8):1134-1139.

20. Brody DS, Miller SM, Lerman CE, Smith DG, Caputo GC. Patient perception of involvement in medical care. J Gen Intern Med. 1989;4(6):506-511.

21. Greenfield S, Kaplan S, Ware JE Jr. Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985;102(4):520-528.

22. Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27(3 suppl):S110-S127.

Using the 2 search terms, academic websites and commercial websites, such as WebMD, consistently received higher reliable and overall DISCERN scores. Advertisement websites, which need to deliver a clear message, frequently scored high on explicitly stating their aims and relevance to consumers, but focused on their products without discussing the benefits of other treatment options. This is significant because Internet search engines, such as Google, offer sponsor links for which organizations pay to appear at the top of the search results. This creates the potential for consumers to receive biased information because most individuals only visit the top 10 websites generated by a search engine.¹⁹

We concluded that the quality of online information relating to SR and TSA was highly variable and frequently of moderate-to-poor quality, with most overall DISCERN scores <3. The quality of information found online for this study using the DISCERN instrument is consistent with those studies using DISCERN to evaluate other medical conditions (eg, bunions, chronic pain, general anesthesia, and anterior cruciate ligament reconstruction).^2,9,15,19 These studies also concluded that online information varies tremendously in quality and completeness.

This study has several limitations. Websites were searched at a single time point and, because Internet resources are frequently updated, the results of this study could vary. Furthermore, although Google, Yahoo, and Bing are 3 of the most popular search engines, these are not the only resources patients use when searching the Internet for health-related information. Other search engines, such as Pubmed.gov and MSN.com, could provide additional websites for Internet users. Lastly, although DISCERN is validated to address the quality of information available online, it does not evaluate the accuracy of the information.⁸ Our use of DISCERN involves 2 scales, a binary yes/no (ratings, 1 and 5) and an ordinal scale (ratings, 2-4). As such, a single mean summary statistic cannot be calculated.

Conclusion

The information available on the Internet pertaining to TSA and SR is highly variable and provides mostly moderate-to-poor quality information based on the DISCERN instrument. Many websites failed to describe the benefits and the risks of different treatment options, including nonoperative management. Health care professionals should be aware that patients often refer to the Internet as a primary resource for obtaining medical information. It is important to direct patients to websites that provide accurate information, because patients who educate themselves about their conditions and actively participate in decision-making may have improved health outcomes.20-22 Overall, academic websites and commercial websites, such as WebMD and OrthoInfo, generally had higher DISCERN scores when using either search term. Of major concern is the potential for misleading advertisements or incorrect information that can negatively affect health outcomes. This study found that using nonmedical terminology (SR) provided more noncommercial and patient-oriented websites, especially through Yahoo. This study highlights the need for more comprehensive online information pertaining to shoulder replacement that can better serve as a resource for Internet users.