Original Research

Web Page Content and Quality Assessed for Shoulder Replacement

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

References

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Results

A total of 90 websites were assessed with the search term total shoulder arthroplasty and another 90 with shoulder replacement. When 37 duplicate websites for TSA and 52 for SR were eliminated, 53 (59%) and 38 (42%) unique websites were evaluated for each search term, respectively (Figure 1). (These unique websites are included in the Appendix.) Between the 2 search terms, 20 websites were duplicated. Figure 3 shows the distribution of websites by category. Total shoulder arthroplasty provided the highest percentage of health professional–oriented information; SR had the greatest percentage of patient-oriented information. Both TSA and SR had nearly the same number of advertisements and websites labeled “other.” The percentage of noncommercial websites from each search engine is represented in Figure 4. For SR, Google had 40% (12/30) noncommercial websites compared with Yahoo at 53% (16/30) and Bing at 46% (14/30). Total shoulder arthroplasty had 43% (13/30) noncommercial websites on Google, 27% (8/30) on Yahoo, and 40% (12/30) on Bing. In total, SR had more noncommercial websites, 47% (42/90), compared with 37% (33/90) for TSA.

The mean of all 3 raters for reliablity (DISCERN questions 1-8) and treatment options (DISCERN questions 9-15) is represented in the Table. For both search terms, we found that websites identified as health professional–oriented had the highest reliable mean scores, followed by patient-oriented, and advertisement at the lowest (SR: P = .054; TSA: P = .134). For SR, treatment mean scores demonstrated similar results with health professional–oriented websites receiving the highest, followed by patient-oriented and advertisement (P = .005). However, the treatment mean scores for TSA differed with patient-oriented websites receiving higher scores than health professional–oriented websites, but this was not statistically significant (P= .407). Regarding search terms, there were no significant differences between mean reliable and treatment scores across all categories.

The average overall DISCERN score for TSA websites was 2.5 (range, 1-5), compared with 2.3 (range, 1-5) for SR websites. The overall reliable score (DISCERN questions 1-8) for TSA websites was 2.6 and 2.5 for SR websites (P < .001). For TSA websites, 38% (20/53) were classified as good, having an overall DISCERN score ≥3, versus 26% (10/38) of SR websites. The overall DISCERN score for health professional–oriented websites was 2.7, patient-oriented websites received a score of 2.6, and advertisements had the lowest score at 2.4.

Discussion

Both patients and health professionals obtain information on health care subjects through the Internet, which has become the primary resource for patients.^15,16 However, there are no strict regulations of the content being written. This creates a challenge for the typical user to find credible and evidence-based information, which is important because misleading information could cause undue anxiety, among other effects.^17,18 The aims of this study were to determine the quality of Internet information for shoulder replacement surgeries using the medical terminology total shoulder arthroplasty (TSA) and the nontechnical term shoulder replacement (SR), and to compare the results.

After analyzing the types of websites returned for both total shoulder arthroplasty and shoulder replacement (Figure 4), it was interesting to find that using nonmedical terminology as the search term provided more noncommercial websites compared with total shoulder arthroplasty. Furthermore, Yahoo provided the highest yield of noncommercial websites at 16, with Bing at 14, when using SR as the search term. We believe the increase in noncommercial websites returned for SR was greater than for TSA because SR yielded more patient-oriented websites, which usually had html endings of .edu and .org, as shown in Figure 3 (48% of SR websites offered patient-oriented information).

Although there were more noncommercial websites for SR, the majority of the DISCERN values between the 2 search terms did not differ significantly. This is a direct result of the number of sites (20) that were duplicated across both search terms. However as seen in the Table, TSA had similar reliable mean scores for advertisements and patient-oriented websites but a slightly higher reliable score for health professional–oriented websites. We correlated this with the increased number of health professional–oriented websites returned when using TSA as the search term (Figure 3). The health professional–oriented websites explained their aims and cited their sources more consistently than did patient-oriented sites and advertisements, resulting in higher reliable scores. Although patient-oriented websites frequently lacked citations, they provided information about multiple treatment options, which were more relevant to consumers. This resulted in nearly equivalent reliable scores. Treatment means for advertisements in both SR and TSA were similar. However, treatment means for professional-oriented websites in TSA were lower than those for SR because health professional–oriented websites often were only moderately relevant to consumers, with their focus usually on 1 treatment option or on rehabilitation protocols. Although the DISCERN scores were similar between the search terms, total shoulder arthroplasty provided more websites (20) classified as good—overall DISCERN score, ≥3—than SR did (10). Advertisement websites had similar overall DISCERN scores, which we anticipated because most of the advertisements were duplicated across the search terms.