Original Research

Evaluation of Internet Information About Rotator Cuff Repair

Am J Orthop. 2016 March;45(3):E136-E142

The content and quality of Internet websites are not governed or regulated. Therefore, patients who consult the Internet may receive outdated or incorrect medical information. Researchers have analyzed the quality of web information about various orthopedic surgeries, but no such analysis has been performed on websites covering rotator cuff repair.

We conducted a study to evaluate and analyze rotator cuff repair information available to the general public through the Internet; to assess changes in the quality of information over time; to determine if sites sponsored by academic institutions offered higher-quality information; and to assess whether the readability of the material varied according to DISCERN scores.

Two Internet searches were conducted, in 2011 and 2014. The 3 most commonly used search engines were used to search for rotator cuff repair. The first 50 websites from each search engine were evaluated for authorship and content. The DISCERN instrument was used to analyze the quality of each website’s health information.

The 2011 search revealed 21% of websites were associated with an academic institution, 38% were authored by a hospital or physician group, and 11.5% were industry-sponsored. The 2014 search revealed a similar distribution of contributors. The highest DISCERN scores were given to academic institution websites (51.6) and public education websites (49). There was no correlation between readability and DISCERN scores.

Websites associated with academic institutions produced the highest-quality medical information. Over the past few years, authorship and content have changed little with respect to Internet information about rotator cuff repair.

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References

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Patients are learning about health and disease more independently than before, but such self-education may pose a unique challenge for practicing physicians. Although educated patients can assist in the critical appraisal of treatment options,¹ misinformed patients may have preconceived treatment biases and unrealistic expectations. More than 66 million Americans use the Internet daily, and recent surveys have shown 86% have used the Internet for health-related information.^2,3 With Internet use increasing, the number of patients turning to the web for medical information is increasing as well.⁴ For many patients, this information can be useful in making decisions about their health and health care.⁵

Although accessing medical information from the Internet has grown exponentially, analysis of information quality has grown considerably slower.⁶ With no regulatory body monitoring content, there is easy circumvention of the peer review process, an essential feature of academic publishing.⁷ With no external regulation, the information retrieved may be incorrect, outdated, or misleading. Many orthopedic studies have analyzed Internet content about numerous diagnoses.^3-6,8-18 Most of these studies have found this information highly variable and of poor quality.

Rotator cuff repairs are among the most common surgeries performed by orthopedic surgeons. To our knowledge, this is the first study to assess the quality of web information about rotator cuff repairs. We hypothesized that the quality of information would positively correlate with the reading level of the material presented, that academic institutions would present the highest-quality information, and that the type of information presented would change over time.

Materials and Methods

We used the search phrase rotator cuff repair on the 3 most popular search engines: Google, Yahoo!, and Bing. Google is the dominant engine, taking 83.06% of total market share, followed by Yahoo! (6.86%) and Bing (4.27%).5 The first 50 websites identified by each search engine were selected for evaluation, excluding duplicates or overlapping websites. Similarly, advertisements and strictly video results lacking text were excluded. After each engine was queried, a master list of 150 websites was created for individual evaluation and assessment. To assess changes in results over time, we performed 2 searches, on November 16, 2011, and May 18, 2014.

The content of each website was analyzed for authorship, ability to contact the author, discussion of disorder, surgical treatment, complications, surgical eligibility, rehabilitation, other treatment options, and use of peer-reviewed sources. Authorship was placed in 1 of 6 categories:

1. Academic—university-affiliated physician or research group.

2. Private—physician or group without stated affiliation to an academic organization.

3. Industry—manufacturing or marketing company advertising a product or service for profit.

4. News source—bulletin or article without affiliation to a hospital or an academic institution.

5. Public education—individual or organization with noncommercial website providing third-party information (eg, Wikipedia, About.com).

6. Blog—website publishing an individual’s personal experiences in diary or journal form.

Websites were also assessed for accuracy and validity based on presence or absence of Health On the Net code (HONcode) certification and DISCERN score. Designed by the Health On the Net Foundation in 1996, HONcode provides a framework for disseminating high-quality medical information over the web.¹⁹ Website owners can request that their sites be evaluated for HONcode certification; a site that qualifies can display the HONcode seal.²⁰ The DISCERN project, initially funded by the National Health Service in the United Kingdom, judges the quality of written information available on health-related websites.²¹ It determines the quality of a publication on the basis of 16 questions: The first 8 address the publication’s reliability, the next 7 involve specific details of treatment choices, and the last is an overall rating of the website.

Website readability was assessed with the Flesch-Kincaid test. This test, designed under contract with the US Navy in 1975, has been used in other orthopedic studies.¹⁹ Regression analysis was performed to check for correlation between website readability and DISCERN score. Analysis of variance was used to analyze differences between scores.

Results

We performed a comprehensive analysis of the top 50 websites from each of the 3 search engines (N = 150 websites) (Figures 1–5, Table). Regarding authorship, our 2 searches demonstrated similar values (Figure 1). In 2011, 21% of websites were associated with an academic institution, 38% were authored by private physicians or hospital or physician groups not associated with an academic institution, 11.5% were industry-sponsored, 5% were news bulletins or media reports, 21.5% were public education websites, and 3% were personal blogs. Our 2014 search found a similar distribution of contributors. Between 2011 and 2014, the largest change was in academic authors, which decreased by 7%, from 21% to 14%. Percentage of websites authored by private physicians remained constant from the first to the second search: 38%.