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Quality of Patient Information on the Orthopaedic Internet PDF Print E-mail
Written by ChrisOliver   
Sunday, 05 May 2020
William A. Doward MB ChB
Orthopaedic Surgical House Officer

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

Edinburgh Orthopaedic Trauma Unit
Royal Infirmary of Edinburgh

The Internet is now becoming a working tool rather than a toy. It is estimated that the Internet is growing fast with 10,900 new users a day in the United Kingdom (1). More and more patients are looking for credible patient information on the Internet (2) and it is now common to meet a patient armed with information who has surfed the web prior to consultation. Well-informed patients may change the role of a surgeon to more of an advocate and with little or no mechanisms available at present to limit or edit sites, this can often lead to more problems occurring than it aims to solve (3,4,5,6). The aim of this study was to assess a number of websites regarding "orthopaedic patient information". Silberg (7) described four core standards to allow readers to decide whether what they were reading was credible, reasonable or useful. These are authorship, attribution, disclosure and currency. The details are in table 1. The preservation of doctor-patient relationship and credible surgical content that patients could readily understand was also recorded.

Using the non-peer reviewed Altavista (8) Internet search engine the first twenty-five sites found when the term “orthopaedic patient information” was searched for in the last week of July 1999 were recorded. The objective was to find information pertaining to any orthopaedic problems and their management that the average patient might expect from using the above generalised search command. A single individual (WAD) using the following criteria assessed each website in turn:

Authorship: Could it be determined clearly who was the author responsible for producing the website?

Attribution: Did the website have any copyright information present?

Disclosure: Could it be determined who was clearly the owner responsible for the website?

Currency: Did the website clearly disclose the time the page was updated?

Content: Was the site relevant to discovering information on orthopaedic complaints relevant to patients? Was this information written for patents in a language they would be thought to understand?

Preservation of Doctor Patient relationship: Did the website have a prominent disclaimer clearly present on the web-pages detailing in some form that the information contained was as an aid to the patient and should not ultimately interfere with the doctor-patient relationship and any advice imparted?


Authorship: Of all the 25 websites 24 had an identifiable author (96%) of the material on the sites pertaining to patient information. Although the author was identifiable it was not possible to verify the medical qualifications of the person writing the page. It thus could not be known from this study that a medically qualified person or trainee had written the page.

Attribution: There were only 13 out of 25 (52%) websites that had any copyright information relating to material on the website.

Disclosure: There were only 9 of 25 (36%) websites that the ownership could be accurately determined.

Currency: The website frequency of last update is shown in Table 2.

Content: A total of nine out of the twenty-five sites (36%) offered any sort of patient information in their website relating to general orthopaedic diseases such as that which would be useful and understandable to a patient. One website listed a list of medical journals, which would not be intelligible by patients whilst another website gave information relating to computer software available for use by medical practitioners. The majority of other sites offered information on how to obtain consultations from an orthopaedic surgeon, pricing structures and details of the hospitals where the doctors practised. Two of the websites visited were irrelevant to the subject offering no information relating to orthopaedics whatsoever.

Preservation of Doctor Patient relationship: Only four of the sites had a disclaimer present (16%) detailing that the information contained within was as an aid to the patient and should not ultimately interfere with the doctor-patient relationship and any advice imparted.


This study illustrates serious problems of using the Internet for locating "orthopaedic patient information". The current quality of orthopaedic patient information webpages is extremely poor and the problems of controlling and filtering the information on the Internet are well described (9). This study admits to have limitations in the subjective variables regarding the scope of the categories used and the lack of site subcritieria employed.

The search engine command “orthopaedic patient information” resulted in a relatively disappointing yield of specific webpages authored for patients and it would appear that Silberg's criteria have largely been ignored. In addition, the acknowledgement of the doctor-patient relationship by the writers of orthopaedic patient education pages was also ignored by websites in the main.

The Internet is dynamic and websites change, move, and disappear with regular occurrence. Therefore, the quality ranking found in this study may not be replicated in a similar study within a few days. Different search engines have different search strategies and inherent weaknesses so it may be possible to find different results across other engines. Search engines cannot identify all websites of a specific kind, nor is it possible to identify a truly representative sample of unselected patient information.

A survey of health information on the web (10) found that only a few websites provided complete and accurate advice on managing fever in children. This study supports our finding above that only a very few sites provided comprehensive information. However, the information actually provided was mostly correct and useful to patients when located. Wildman (11) reports that the public can choose accurately whom to ask for medical advice on the Internet even when it comes to subspecialties.

Tools for rating quality on the Internet have been developed but these attempts are invalidated and clumsy to apply (6). The overall assessment of website quality is difficult and in order to make searching on the Internet easier there will need to be improvements in the metadata of webpages and possibly the usage of peer-reviewed distributed networked quality rating systems.

We would strongly recommend that author writing webpages for orthopaedic patient information in the future should:

1.|Adhere to Silberg's criteria.
2.|Write a disclosure statement to protect the doctor-patient relationship.
3.|Write specific content aimed at a level at which patients should be able to understand.

1. http://www.nop.co.uk/
2. http://www.boa.ac.uk/
3.|Heathfeild H, Pitty D, Hanka R. Evaluating information technology in health care: barriers and challenges. BMJ 1998: 1959-1960
4.|Blumental D. The future of quality measurement and management in a transforming health care system. JAMA 1997; 278: 1622-1625
5.|Wyatt JC. Commentary: Measuring quality and impact of the World Wide Web. BMJ 1997; 314: 1879-1881
6.|Jadad AR, Gagliardi A. Rating Health Information on the Internet. Navigating to Knowledge or to Babel? JAMA 1998; 279(8): 611-615
7.|Silberg WM, Lundberg GD, Musacchio RA. Assessing, Controlling, and Assuring the Quality of Medical Information on the Internet. JAMA 1997; Vol 277(15): 1244-1245
9.|Eysenbach G, Diepgen TL. Towards quality management of medical information on the Internet: evaluation, labelling, and filtering of information. BMJ 1998; 317: 1496-1500.
10.|Impicciatore P, Pandolfini C, Casella N, Bonati M. Reliability of health information for the public on the world wide web: systematic survey of advice on managing fever in children at home. BMJ 1997; 314: 1875-1881
11.|Wildman LE, Tong DA. Requests for medical advice from patients and families to health care providers who publish on the World Wide Web. Arch Intern Med 1997; 157: 209-212

Table 1. Silberg’s Core Criteria for Measuring Quality

Authorship - authors and contributors, their affiliations, and relevant credentials should be provided

Attribution - references and sources for all content should be listed clearly, and all relevant copyright information noted

Disclosure - web site “ownership” should be prominently and fully disclosed, as should any sponsorship, advertising, underwriting, commercial funding arrangements or support, or potential conflicts of interest.

Currency - dates that content was posted and updated should be indicated

Table 2. Last date when patient information on the Internet was updated

Time to when last updated| Number of sites
Less than 2/52 - 1
Between 2/52 and 1/12| - 0
Between 1/12 and 2/12| - 1
Between 2/12 and 3/12| - 4
Between 3/12 and 6/12| - 7
Between 6/12 and 1 year| - 7
Over 1 year but under 2 years| - 4
Between 2 and 3 years| -1

Last Updated ( Saturday, 16 July 2020 )
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