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A Snapshot of Orthopaedic Internet Quality PDF Print E-mail
Written by ChrisOliver   
Wednesday, 10 April 2020
Jason Auld, MB ChB
Senior House Officer Orthopaedics

Christopher W. Oliver, FRCS (Orth) DM
Consultant Trauma and Orthopaedic Surgeon

Edinburgh Orthopaedic Trauma Unit,
Royal Infirmary of Edinburgh,
Lauriston Place,
Edinburgh, Scotland

There has been an exponential rise in the use and quantity of information on the Internet. As orthopaedic surgeons, we are faced with a public who has access to a vast amount of medical information about their condition, gleaned from web pages of uncertain quality. Such patients may have unreasonable expectations; they may have frankly misunderstood the information they have found, or accessed unreliable sites, which are not qualified to give such information. On the other hand, we are keen to use the Internet ourselves to improve our understanding of new treatments and published research. If the information we find is of dubious quality, or difficult to find amidst a mass of useless links, then our enthusiasm to use the web for these purposes declines.
Strategies to address these concerns have been developed recently. They include OMNI (Organising Medical Networked Information http//omni.ac.uk) and HON (Health on the Net Foundation http://www.hon.ch), sites that act as ‘filters’ of useful and reliable medical information. OWL (Orthopaedic Web Links http://owl.orthogate.org) was developed in Canada in 1995 as a specific Orthopaedic filter. Once the orthopaedic web ‘surfer’ arrives at one of these sites, he assumes that the information on subsequent linked pages will be of good quality.

Sixteen major established orthopaedic sites were reviewed, with respect both to their content and their usefulness. It is not intended to be a comprehensive or individual review of all trauma and orthopaedic sites, but rather a ‘snapshot’ of the current quality of a few, randomly chosen sites which are easily accessed by the professional and public alike and in our opinion represent the better quality end of the orthopaedic Internet. The study was performed in March 2000. We have assessed each website in the same way, although there is inherent subjectivity in the method as use of the Internet is easier and quicker at certain times of day. Having said this, we will demonstrate that despite the responsibility that orthopaedic medical sites should have when posting easily accessible information, significant numbers of sites are posting unreliable, out of date information.

The websites were:

1.|American Academy of Orthopaedic Surgeons http://www.aaos.org
2.|AO-ASIF http://www.ao-asif.ch
3.|Belgian Orthoweb http://www.belgianorthoweb.be
4.|British Orthopaedic Association http://www.boa.ac.uk
5.|Canadian Orthopaedic Association http://www.coa-aco.org/
6.|Department Of Orthopaedics University of Edinburgh http://www.orthopaedic.ed.ac.uk
7.|Egyptian Orthopaedic Association http://www.eoa.org.eg/
8.|Institute of Orthopaedics Oswestry http://www.keele.ac.uk/depts/rjah/rjah.htm
9.|Internet Society of Orthopaedics and Trauma Surgery http://www.isost.org
10.|Journal of Bone and Joint Surgery UK http://www.jbjs.org.uk/
11.|Medscape Orthopaedics http://www.medscape.com
12.|Orthogate http://www.orthogate.org
13.|Orthogate Patient Information http://patient.orthogate.org/
14.|Orthopaedic Product News http://www.opnews.co.uk/
15.|Orthopaedic Trauma Association http://www.ota.org
16.|Organising Medical Networked Information http://omni.ac.uk/

Each website was assessed. Some questions were rated as ‘objective’ and others as ‘subjective’. We analysed the results of the objective questions only. Answers to the subjective questions have only been used in the discussion as points of interest, rather than facts.

Problems with this study were; Intra-observer variation (time of day, computer speed, internet traffic), Bias with respect to sites chosen, wide variety of sources, some have already been cherry picked to be ‘good’ in someone else’s opinion and therefore yet more bias. A summary of results is shown in Table 1.

Table 1. Summary Results of Snapshot of the Quality of the Orthopaedic Internet

|Most of the chosen sites had some kind of academic affiliations.
|Most sites showed a clear source for the information and were qualified to give such information.
|Half of the websites did not clearly state the aims of the material posted.
|Half of the websites had apparently not been updated within the last one month.
|Half of the websites were not clearly referenced.
|Almost seventy five percent did not clearly state the intended audience (ie lay or professional).
|Just under half of the websites had commercial sponsorship but in only two websites did there appear to be a conflict of interest.
|Just over half had no website disclaimer.
|Three-quarters gave no statement of the website’s limitations.

Most had an attractive layout with useful hyperlinks, which worked and are of good quality. Often the same links (e.g. OMNI, Orthogate) were used by different originating sites.
To an orthopaedic trainee, the language was easy to understand but we only rated 12/16 as suitable for a lay audience.

These results are suggest that, despite purporting to be sources of quality, reliable information, many sites do not adhere to the standards expected in printed texts and journals. Whilst this may be seen to allow freedom of expression of opinions from individuals and organisations across the globe, it also provides potentially misleading interpretations of established or experimental practice.

We feel that a ‘good’ website is one in which the points in Table 1 are answered positively.

The points on which the websites failed are shown below, the commonest first:

1.|Not stating any limitations of the website.
2.|Not stating the intended audience.
3.|Not posting a disclaimer.
4.|Not stating the sources interests.
5.|Not stating time of last update.
6.|Not stating references or sources.

A majority of these websites were of only fair or poor standard according to our criteria.
Where the aims and interests of the website were unclear, there was a higher chance of there being no disclaimer or stated limitations to the website. Whether or not the hyperlinks work is dependent to some extent on Internet traffic and so this question was excluded from the above analysis

We have shown that Internet quality varies greatly even in established, reputable sites. If these shortcomings were remedied these sites would become even more and reliable to a more appropriately targeted audience.
Last Updated ( Saturday, 16 July 2020 )
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