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 Therefore, patients who consult the Internet may receive outdated or incorrect medical information.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.
This study had several limitations. During an Internet search, the number of websites a user visits drops precipitously after the first page of results. Studies have shown the top 20 sites in a given search receive 97% of the views, and the top 3 receive 58.4%. Whether patients visit websites far down in the list of 150 we found in our given search is unknown. Last, the Flesch-Kincaid readability test is flawed in several ways but nevertheless is used extensively in research. Grading is based on number of words and syllables used in a given sentence; it does not take into account the complexity or common usage of a given word or definition. Therefore, websites may receive low Flesch-Kincaid scores—indicating ease of reading—despite their use of complex medical terminology and jargon that complicate patients’ comprehension of the material.
Conclusion
Numerous authors have evaluated orthopedic patients’ accessing of medical information from the Internet. Although the Internet makes access easier, unreliable content can lead patients to develop certain notions about the direction of their care and certain expectations regarding their clinical outcomes. With there being no regulatory body monitoring content, the peer review process, an essential feature of academic publishing, can be easily circumvented.25
In this study, the highest-quality websites had academic affiliations. Quality of information about rotator cuff repairs was similar to what was found for other orthopedic topics in comparable studies. Surprisingly, there was little change in authorship and content of web information between our 2 search periods (2011, 2014). Although there has been a rapid increase in the number of medical websites, quality of content seems not to have changed significantly. Patients look to physicians for guidance but increasingly are accessing the Internet for additional information. It is essential that physicians understand the quality of information available on the Internet when counseling patients regarding surgery.
