Comparison of the Source and Quality of Information on the Internet Between Anterolateral Ligament Reconstruction and Anterior Cruciate Ligament Reconstruction: An Australian Experience

Abstract

Background:The internet is a valuable tool, but concerns exist regarding the quality and accuracy of medical information available online.Purpose:To evaluate the source and quality of information on the internet relating to anterolateral ligament reconstruction (ALLR) compared with anterior cruciate ligament reconstruction (ACLR).Study Design:Cross-sectional study.Methods:A questionnaire was administered to 50 ACLR patients in Australia to determine their use of the internet to research their operation and their familiarity with the anterolateral ligament (ALL) of the knee. The most common search terms were determined, and the first 70 websites returned by the 5 most popular search engines were used to assess the quality of information about ACLR and ALLR. Each site was categorized by type and was assessed for quality and validity using the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark criteria, and a novel specific content score for each procedure. The presence of the Health on the Net Code (HONcode) seal was also recorded.Results:The majority (84%) of ACLR patients used the internet to research their operation. The quality of information available for ALLR was significantly inferior to that for ACLR according to the DISCERN score (37.3 ± 3.4 vs 54.4 ± 4.6; P < .0001) and specific content score (5.3 ± 1.3 vs 11.0 ± 1.5; P < .0001). ACLR websites were predominantly physician produced, while the majority of ALLR websites were academic. In contrast to ACLR websites, the majority of ALLR websites did not provide information on the indication for treatment or potential complications. ALLR websites scored better on the JAMA benchmark criteria due to the predominance of academic websites. A greater proportion of ACLR websites (14.6%) versus ALLR websites (2.5%) provided an HONcode seal. Correlation was demonstrated between the DISCERN score and specific content scores for both ACLR and ALLR but not with JAMA benchmark criteria. The specific content score had high reliability for both ACLR and ALLR.Conclusion:The majority of patients undergoing ACLR in Australia used the internet to research the procedure. The quality of information on the internet relating to ALLR was significantly inferior to information about ACLR. Most ALLR websites failed to include crucial information about the indication or options for treatment, prognosis, and potential complications. Surgeons should be aware of the information to which their patients are exposed through the internet and should be proactive in directing patients to appropriate websites.

The Quality and Content of Internet-Based Information on Orthopaedic Sports Medicine Requires Improvement: A Systematic Review

“…Seven studies reported on the HON foundational principles. 14,17,20,23,27,28,31 The average percentage of websites with HON certifications was 17.79%. Two studies searched Ask.…”

“…Among the included studies, Google (86%), 5,12,14,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Bing (76%), 5,14,[17][18][19][20][21][22][23][24][25][26][27][28][29][30] and Yahoo (76%) 5,14,17,[19][20][21][22][23][24][25][26][27][28][29]31 were the most commonly assessed search engines and were used for both website and image searches (Appendix Table 1).…”

“…This key point was highlighted by Wang et al, 29 who found that most websites, even if considered "high quality," failed to distinguish between focal chondral defects and diffuse osteoarthritis, an important clinical factor in an orthopaedic setting. [13][14][15][16][17]20,25 The average contentspecific DISCERN score was 5.24, whereas the average nonecontent-specific DISCERN score was 40.55. The average FK grade level was 10.24, with scores ranging from 7.9 to 13.4.…”

“…Dalton et al 17 reported DISCERN scores on Ask, Bing, Google, Yahoo, and AOL averaging 39.47 AE 11.39. Devitt et al 20 reported overall and content-specific DISCERN scores across Bing, Google, Yahoo, AOL, and Lycos (Brightcom Group, Hyderabad, Telangana, India) (overall scores of 37.3 AE 3.4 for anterolateral ligament reconstruction vs 54.4 AE 4.6 for ACL reconstruction, P < .0001; content-specific scores of 5.3 AE 1.3 vs 11.0 AE 1.5, P < .0001). Houck et al 25 reported an average content-specific DISCERN score across Bing, Google, and Yahoo of 3.4 AE 0.59.…”

Help or hinder? An assessment of the accessibility, usability, reliability and readability of disability funding website information for Australian mental health consumers

“…While reviews of the accessibility, usability, reliability and readability of general health-related sites (Berland et al, 2001), as well as those related to specific conditions (Devitt et al, 2017;Harland & Bath, 2007;Kaicker et al, 2013;Maloney et al, 2005;Nasser et al, 2012;Simpson & Baldwin, 2017;Surman & Bath, 2013) have been undertaken, to date there has been limited focus on the online experience of those living with mental illness. There is limited understanding of what makes the internet a comprehensible and approachable place for this group (Kalckreuth et al, 2014).…”