American Society for Peripheral Nerve

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Carpal Tunnel Decompression on the Internet - Do You Know What Your Patients are Reading?
Satish Babu BSc, MBBS, MRCS4; Piyush Mahapatra, MA, MBBS, MRCS1; Edmund Ieong, BSc, MBBS, MRCS2; David Ahearne, MBChB, MSc, FRCS3
1Trauma & Orthopaedics, Kingston Hospital, Kingson, United Kingdom; 2Trauma & Orthopaedics, St Mary's Hospital, London, United Kingdom ; 3Trauma & Orthopaedics, Hillingdon Hospitals NHS Foundation Trust, London, United Kingdom; 4St George's University Hospital, London, UK

Introduction: It has been reported that 80% of American Internet users utilise the internet to obtain health information. With this ubiquitous usage of the internet it is important that patients are getting reliable and accessible information. We hypothesise that despite its prevalence, the quality and readability of medical websites on the internet is poor and that clinicians need to play a role in guiding their patients to suitable on-line information. The objective of this study was to test this hypothesis.

Methods: We searched the keywords “carpal tunnel decompression” (English Language, exact phrase setting) in the most popular three search engines: Google, Yahoo and MSN/Bing. The top 50 websites were evaluated from each search engine. Exclusion criteria were irrelevant information, repetition in the search or inaccessibility. Readability of the websites was assessed using the Flesch Reading Ease Score (FRES, index rating – score/100), Flesch Kincaid Grade Level (FKGL) Gunning-Fog Index (GFI), Simple Measure of Gobbledygook index (SMOG), Coleman – Liau Index (CLI) and Automated Readability Index (ARI), which all give a measure of the number of years of schooling required to understand the content.

Results: 84 appropriate websites were analysed out of 150. Excluded websites were due to irrelevant information (28), repetition (27) and inaccessibility (11). Although the reading indexes did show some variability, the mean combined readability index score was 11.26. This corresponds with the level of readability of the wall street journal and means that a reading level equivalent to 11 years of schooling (11th – 12th grade) The mean FRES was 56.78 (S.D:15.05), below the universally recommended target of 60-70. The results of the LIDA medical website validation tool were; accessibility 82.67% (S.D:11.07), usability 59.99% (S.D:15.70) and reliability 42.37% (S.D:29.39).

Conclusions: We have shown that readability scores of the websites are high and not easy to read. The best resources are those belonging to recognised medical and academic institutions, as well as those without financial interests in this field (newspapers). We have found the reliability to be very variable and generally poor. In conclusion, since patient decisions are likely to be influenced by the internet, it is essential that we guide and help patients identify reliable sources of information.

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