Quality and Content of Internet-Based Information for Ten Common Orthopaedic Sports Medicine Diagnoses

BACKGROUND: Although the use of the Internet to access health information has grown quickly, the emergence of quality controls for health information web sites has been considerably slower. The primary objective of this study was to assess the quality and content of Internet-based information for commonly encountered diagnoses within orthopaedic sports medicine. METHODS: Ten common diagnoses within the scope of orthopaedic sports medicine were chosen. Custom grading templates were developed for each condition, and they included an assessment of web-site type, the accountability and transparency of the information (Health On the Net Foundation HON score), and the information content. Information content was divided into five subcategories: disease summary, pathogenesis, diagnostics, treatment and complications, and outcomes and prognosis. Two popular search engines were used, and the top ten sites from each were independently reviewed by three authors. Data were evaluated for interobserver variability, HON scores, information content scores, and subgroup score comparisons. RESULTS: After eliminating duplicate sites, a total of 154 unique sites were reviewed. The most common web-site types were commercial (seventy-four sites) and academic (thirty-two sites). Average HON scores, on a 16-point scale, were 9.8, 9.5, and 8.5, for reviewers 1, 2, and 3, respectively. Average information content scores, on a 100-point scale, were 56.8, 56.0, and 54.8 for reviewers 1, 2, and 3, respectively. Average content scores in each subgroup ranged between 45% and 61% of the maximum possible score. The presence of the HONcode seal was associated with significantly higher HON (p = 0.0001) and content scores (p = 0.002). CONCLUSIONS: The quality and content of health information on the Internet is highly variable for common sports medicine topics. Patients should be encouraged to exercise caution and to utilize only well-known sites and those that display the HONcode seal of compliance with transparency and accountability practices.