Evaluation of Internet Information About Rotator Cuff Repair
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 Therefore, patients who consult the Internet may receive outdated or incorrect medical information.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.
When the 2011 and 2014 website content was compared, several changes were noted. Percentage of websites providing an author contact method increased from 21% to 50% (Figure 2), percentage detailing rotator cuff repairs increased from 82% to 91%, and percentage introducing treatment options in addition to surgical management increased from 11.5% to 61%. Percentage discussing surgical eligibility, however, decreased from 43% to 18%. Percentage citing peer-reviewed sources remained relatively constant (28%, 26%), as did percentage discussing surgical technique for rotator cuff repair (55%, 59%) (Figure 3). A major decrease was found in percentage of websites discussing surgical complications, 42% in 2011 down to 25% in 2014, whereas a major increase was found in percentage discussing rehabilitation, from 39% in 2011 up to 73% in 2014. In 2014, no websites discussed double- versus single-row surgery—compared with 6% in 2011. False claims remained low between 2011 and 2014. In both searches, no website guaranteed a return to sport, and few made claims of painless or bloodless surgery.
DISCERN scores for websites found during the 2014 search were averaged for each of the 6 authorship groups (Figure 4). The highest DISCERN scores were given to academic institution websites (51.6) and public education websites (49). For the academic websites, this difference was significant relative to news, blog, and private physician websites (Ps = .012, .001, .001) The lowest DISCERN scores were given to news organization websites and personal blogs. DISCERN scores were 43.8 for industry sources and 40.7 for private physician groups; the difference was not significant (P = .229). Overall mean DISCERN score for all websites was 44. Eleven percent of websites were HONcode-certified.
No correlation was found between website readability and DISCERN score; correlation coefficient r was .01 (Figure 5). For the websites in 2014, mean Flesch-Kincaid readability score was 50.17, and mean grade level was 10.98; coefficient of determination r2 was 0.00012.
The Table compares our data with data from other orthopedic studies that have analyzed the quality of Internet information about various orthopedic injuries, diseases, and procedures.3-6,8,9,11-18 With its mean DISCERN score of 44, the present rotator cuff tear study was ranked third of 6 studies that have used this scoring system to analyze website content. Of these 6 studies, those reviewing osteosarcoma and juvenile idiopathic arthritis were ranked highest (mean scores, 49.8 and 48.9, respectively), and the study reviewing scoliosis surgery was ranked lowest (38.9). Bruce-Brand and colleagues9 recently found a mean DISCERN score of 41 for anterior cruciate ligament (ACL) reconstruction. When considering HONcode-certified websites, our Internet search for rotator cuff tears found the third lowest percentage, 10.5%, compared with the other studies (Table); the highest percentage, 30%, was found for websites discussing concussions in athletes. When considering authorship, our rotator cuff study found the third highest percentage, 76%, authored by academic centers, physicians, and public education websites; the highest percentage was found in websites discussing ACL reconstruction. Websites discussing ACL reconstruction also had the highest percentage of websites authored by industry.9
Discussion
To our knowledge, this is the first study specifically analyzing the quality of Internet information about rotator cuff repairs. A similar study, conducted by Starman and colleagues15 in 2010, addressed the quality of web information about 10 common sports medicine diagnoses, one of which was rotator cuff tears. In that study, only 16 of the websites included discussed rotator cuff tears. In addition, the authors used a customized, HONcode-based grading system to analyze each website, making their data difficult to compare across studies.
Ideally, a high-quality medical website should be written by a credible source and should cover a disorder, treatment options, eligibility, rehabilitation, and complications. As there is no standard grading system for analyzing web content about rotator cuff repairs, we analyzed the websites for specific information we thought should be included in a high-quality website (Figures 2, 3). When considering authorship, we found academic centers, private physicians, and educational sources comprised 76% of the sources; industry sources made up only 12%. Similar findings were noted by investigators analyzing Internet information about other orthopedic topics, including ACL reconstruction, lumbar arthroplasty, osteosarcoma, and cervical spine surgery.5,11,22 Studies analyzing websites for information on ACL tears and distal radius fractures found have a higher percentage of industry-sponsored websites.9,10
DISCERN showed that the highest-quality information came from websites with academic affiliations, consistent with previous studies,3,9,17 and its mean score (51.6) was significantly higher than the scores for private physician websites, news sites, and blogs (Ps = .001, .016, .001); the least reliable information was from personal blogs and news outlets. Of note, mean DISCERN score was higher for the industry websites we found than for private physician websites (43.8 vs 40.7), though the difference was not significant (P = .229). Previous investigators considered number of industry-sponsored websites as a marker of poor quality of information relating to a given topic; however, given the DISCERN scores in our study, this might not necessarily be true.6 Based on the present study’s data, websites affiliated with academic institutions would be recommended for patients searching for high-quality information about rotator cuff tears.
