A method for the design and development of medical or health care information websites to optimize search engine results page rankings on Google

Dr. Google vs. Dr. ChatGPT: Exploring the Use of Artificial Intelligence in Ophthalmology by Comparing the Accuracy, Safety, and Readability of Responses to Frequently Asked Patient Questions Regarding Cataracts and Cataract Surgery

PURPOSE

Patients are using online search modalities to learn about their eye health. While Google remains the most popular search engine, the use of large language models (LLMs) like ChatGPT has increased. Cataract surgery is the most common surgical procedure in the US, and there is limited data on the quality of online information that populates after searches related to cataract surgery on search engines such as Google and LLM platforms such as ChatGPT. We identified the most common patient frequently asked questions (FAQs) about cataracts and cataract surgery and evaluated the accuracy, safety, and readability of the answers to these questions provided by both Google and ChatGPT. We demonstrated the utility of ChatGPT in writing notes and creating patient education materials.

METHODS

The top 20 FAQs related to cataracts and cataract surgery were recorded from Google. Responses to the questions provided by Google and ChatGPT were evaluated by a panel of ophthalmologists for accuracy and safety. Evaluators were also asked to distinguish between Google and LLM chatbot answers. Five validated readability indices were used to assess the readability of responses. ChatGPT was instructed to generate operative notes, post-operative instructions, and customizable patient education materials according to specific readability criteria.

RESULTS

Responses to 20 patient FAQs generated by ChatGPT were significantly longer and written at a higher reading level than responses provided by Google (p < .001), with an average grade level of 14.8 (college level). Expert reviewers were correctly able to distinguish between a human-reviewed and chatbot generated response an average of 31% of the time. Google answers contained incorrect or inappropriate material 27% of the time, compared with 6% of LLM generated answers (p < .001). When expert reviewers were asked to compare the responses directly, chatbot responses were favored (66%).

CONCLUSIONS

When comparing the responses to patients' cataract FAQs provided by ChatGPT and Google, practicing ophthalmologists overwhelming preferred ChatGPT responses. LLM chatbot responses were less likely to contain inaccurate information. ChatGPT represents a viable information source for eye health for patients with higher health literacy. ChatGPT may also be used by ophthalmologists to create customizable patient education materials for patients with varying health literacy.

Online Support Groups for Family Caregivers: Scoping Review

BACKGROUND

Caregiving can affect people of all ages and can have significant negative health impacts on family caregivers themselves. Research has shown that social support acts as a buffer against many negative health impacts. A common source of social support is support groups. Although traditionally, these groups were conducted in a face-to-face setting, the advent of the internet, social media applications, and the smartphone have seen online support groups (OSGs) develop as a space where many caregivers seek support. The number of OSGs has increased exponentially, but there is no clear consensus on what factors or characteristics of OSGs contribute to social support development within them or what types of OSGs are available to family caregivers.

OBJECTIVE

This study aimed to conduct a scoping review to contribute to the understanding of the types and characteristics of OSGs for family caregivers.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, the CINAHL, PsychInfo, Psych Articles, Social Sciences, Communication Source, Medline, and Web of Science databases were searched for studies (caregiver focused, adults aged 18 years or older, online social support groups, caring for a living person, peer-reviewed journal publications on empirical research). In total, 19 studies were included in the review. The research questions were (1) what type of social support groups are online for adult family caregivers, (2) what the communication mediums and characteristics of these OSGs are, and (3) what psychosocial or other factors make OSGs successful or unsuccessful for participants.

RESULTS

In response to the first research question, we found that the majority of OSGs took place on public text-based forums and were illness specific. Where demographics were reported, participants were predominately women, White, and working with university-level education. There were a variety of caregiving relationships. For the second research question, the most common communication medium found was text-based communication, with the use of emojis, photos, and GIF (Graphics Interchange Format) files as part of these exchanges. Most frequently, the OSGs were asynchronous with a degree of anonymity, not time-limited by the frequency of contact or duration, and moderated by peer or professional moderators or facilitators. Results for the third research question explored the overarching categories of safe communication and engagement and group management. These described successful OSGs as having a focus on similar others with shared lived experiences communicated in a nonjudgmental space overseen by trained peer or professional facilitators.

CONCLUSIONS

There are several key considerations for OSGs to be successful for family caregivers. A general recommendation for practitioners is to give importance to building active moderation and multifaceted structures of support to meet different levels of caregiver needs and the ability to engage.

Examining beliefs and information-seeking behaviors of young adults aged 20-39 to help inform cancer prevention communication

Successfully reaching young adults with cancer early detection information is urgently important given the rising rates of cancer in this age group. We sought to describe to describe the 'when, who, where, what and how' of young adult cancer information seeking and how it differs from that of older participants. We analyzed information seeking and beliefs among young adult (aged 20-39 years) and middle aged and older (aged 40-75 years) respondents to the Health Information National Trends Survey (HINTS) 5, cycle 4 (N = 2784). A little less than half of young adults had searched for cancer information (44%), which was just as often as middle aged and older adults. Seeking cancer information was greater among young adults more worried about the disease (aOR = 1.39, 95% CI = 1.04, 1.86, p = .026). Like middle aged and older adults, young adults most often chose a doctor as their first choice for cancer information; however, they were more likely than their older counterparts to make the internet their first choice (38.9% vs. 28.5%, p = .013) and more frequently sought health information from YouTube (p = .010). They were more trusting of cancer information from government organizations than older adults (p = .019). Communicators may be able to better persuade young adults with early detection information framed around cherished values. Though respondents of all ages were most likely to choose protecting family as their top value, young adults valued happiness over safeguarding their health more than middle aged and older adults.

Advances in e-learning in undergraduate clinical medicine: a systematic review

BACKGROUND

E-learning is recognised as a useful educational tool and is becoming more common in undergraduate medical education. This review aims to examine the scope and impact of e-learning interventions on medical student learning in clinical medicine, in order to aid medical educators when implementing e-learning strategies in programme curricula.

METHODS

A systematic review compliant with PRISMA guidelines that appraises study design, setting and population, context and type of evaluations. Specific search terms were used to locate articles across nine databases: MEDLINE/PubMed, ScienceDirect, EMBASE, Cochrane Library, ERIC, Academic Search Complete, CINAHL, Scopus and Google Scholar. Only studies evaluating e-learning interventions in undergraduate clinical medical education between January 1990 and August 2021 were selected. Of the 4,829 papers identified by the search, 42 studies met the inclusion criteria.

RESULTS

The 42 studies included varied in scope, cognitive domain, subject matter, design, quality and evaluation. The most popular approaches involved multimedia platforms (33%) and case-based approaches (26%), were interactive (83%), asynchronous (71%) and accessible from home (83%). Twelve studies (29%) evaluated usability, all of which reported positive feedback. Competence in use of technology, high motivation and an open attitude were key characteristics of successful students and preceptors.

CONCLUSIONS

Medical education is evolving consistently to accommodate rapid changes in therapies and procedures. In today's technologically adept world, e-learning is an effective and convenient pedagogical approach for the teaching of undergraduate clinical medicine.

The 'five star' fallacy: an analysis of online reviews and testimonials of dental practices in Northern England

Aims and objectives To develop a greater understanding of how dental practices in the UK utilise and promote patient reviews and testimonials. To compare and contrast the star ratings, levels of engagement and levels of identifiability by comparing those placed by patients on social media, review websites and search engines, to those placed on providers' own websites. To provide recommendations for future advertising guidance.Materials and methods All practices providing dental services in North East England and Cumbria were identified from the Care Quality Commission database. A web-based Google search for the respective dental practice websites, NHS listings, Facebook pages and Google results page listings was performed. The presence or absence of patient testimonials and reviews was recorded, alongside the total number of testimonials/reviews and the number of non-identifiable testimonials/reviews. Data were analysed using Microsoft Excel and SPSS Statistics.Results Of the 401 practice websites, 19.7% (n = 79) contained at least one graded review, while 40.9% (n = 158) of the 386 NHS listings; 87.2% (n = 272) of the 343 Facebook pages; and 94.4% (n = 442) of the 468 Google listings also contained at least one graded review. All of the 1,798 testimonials observed on practice websites were positive in their sentiment. Further, 22 practices utilised video testimonials. Each of the online review locations showed overall mean scores above 4.5 out of 5 stars.Conclusions Dental practice websites, the NHS website, Facebook and Google utilise testimonials and reviews in distinct and diverse ways. Unlike other jurisdictions around the world, the UK does not have guidance in this area. Electronic word of mouth is often replete with bias, and as such, patients need to be encouraged to seek out multiple sources before decision-making. Facebook and Google may be perceived to be more 'trustworthy' sources of information as they appear less curated and less susceptible to manipulation than practice websites, which the public may feel gives greater credence to the information they provide. In order to achieve the highest standards of integrity and honesty, advertising guidance surrounding reviews and testimonials would benefit from future revision.

Internet Search Results for Older Adult Physical Activity Guidelines: Scoping Review

Background

Older adults seek health-related information through casual internet searches. Yet, researchers focus on peer-reviewed journals and conference presentations as primary dissemination strategies. Representatives of mass media are alerted (passive diffusion) of new studies or recommendations, but the veracity of the information shared is not often analyzed, and when it is, the analysis is often not comprehensive. However, most older adults do not have access to peer-reviewed journal articles or paid subscription services for more reputable media outlets.

Objective

We aimed to determine what information was readily available (ie, open access) to older adults who may casually search the internet for physical activity recommendations.

Methods

We performed a 6-part scoping review to determine the research question and available evidence, and extract data within open-access top hits using popular online search engines. Results were categorized by a dissemination model that has categories of sources, channels, audience, and messages.

Results

After the iterative search process, 92 unique articles were included and coded. Only 5 (5%) cited physical activity guidelines, and most were coded as promoting healthy aging (82/92, 89%) and positive framing (84/92, 91%). Most articles were posed as educational, but the authors’ credentials were rarely reported (ie, 22% of the time). Muscle strengthening and balance components of the physical activity guidelines for older adults were rarely reported (72/92, 78% and 80/92, 87%, respectively) or inaccurately reported (3/92, 3% and 3/92, 3%, respectively).

Conclusions

Inconsistent messages lead to mistrust of science and public health representatives. This work highlights the lack of evidence within existing open-access resources. Further efforts are needed to ensure evidence-based public health messages are in the sources and channels older adults are using to inform their knowledge and behaviors.

Negative reviews online: an exploratory analysis of patient complaints about dental services in Western Australia

OBJECTIVE

Rates of online reviews are continually increasing. Coinciding with this, is the beneficial abundance of subjective information that is now available to patients. Such information can be persuasive in selecting a healthcare provider. This analysis of one-and-two-star Google reviews received by dental practices within the Perth metropolitan region aims to identify common themes within dental practice complaints.

METHODS

This mixed-methods study was conducted by gathering reviews from the 'Google review' feature, which have been published by users between 2013 and 2020. These data were then coded into recognised themes, and crucial quotes were selected and de-identified creating a narrative about the themes present which formed the qualitative component of this research.

RESULTS

A total of 413 negative reviews were included in this study. From these, 1071 specific complaints were identified. Major themes identified included treatment issues, staffing, communication and professionalism, finance, and premise. Spread across these five themes were an additional thirty-eight subthemes. Overall, treatment was a primary concern for patients, making up 37.1% of the results. Within the subthemes 'treatment dissatisfaction (unspecified)' was also high, at 23.1%.

CONCLUSION

This study identified the most common complaints received by dental clinics on Google review within the Perth metropolitan area. Further investigation is required to provide supplementary data regarding factors that may influence complaint rates and types, such as the socio-economic status of areas and geographical factors such as distance from the Perth metropolitan.

Availability and readability of online patient information on clubfoot: assessment of paediatric hospital clubfoot web pages

PURPOSE

To determine the availability and readability of online patient information (OPI) provided by paediatric hospitals in the United States using clubfoot as a model condition.

METHODS

The websites of the top 95 paediatric hospitals identified using US News & World Report were included. The names of paediatric hospitals and the terms "clubfoot", "clubfeet" and "talipes equinovarus" were entered into the Google search engine. Readability was assessed using five validated metrics and the composite grade level (CGL). The number of unpaid monthly visits was calculated with the Ahrefs Organic Traffic Score (OTS) tool. Data for paediatric hospitals were compared with the same metrics for the top ten Google search results.

RESULTS

Of 95 paediatric hospitals, 29 (30.5%) did not have at least one web page dedicated to clubfoot. The 128 web pages representing 66 paediatric hospitals had an average CGL of 9.4, representing a readability level requiring some high school education. The mean OTS for all paediatric hospitals was 116 estimated visits per month, which was significantly less than that for the top ten Google clubfoot search results (3035.1; p < 0.0001).

CONCLUSION

Paediatric hospital web pages on clubfoot were visited much less frequently than those from the top ten Google search results. Only two web pages (1.6%) from paediatric hospitals offered OPI on clubfoot that met the American Medical Association recommended reading level (sixth-grade level). Paediatric hospitals should create OPI on clubfoot with appropriate readability and accessibility for patient families.

LEVEL OF EVIDENCE

N/A.

Kinesiology Tape: A Descriptive Survey of Healthcare Professionals in the United States

BACKGROUND

The existing body of kinesiology tape (KT) research reveals inconsistent results which challenges the efficacy of the intervention. Understanding professional beliefs and KT clinical application might provide insight for future research and development of evidence-based guidelines.

PURPOSE

The purpose of this study was to survey and document the beliefs and clinical application methods of KT among healthcare professionals in the United States.

DESIGN

Cross-sectional survey study.

METHODS

A 30-question online survey was emailed to members of the National Athletic Trainers Association, Academy of Orthopedic Physical Therapy, and American Academy of Sports Physical Therapy. Professionals were also informed through a recruitment post in different private healthcare Facebook groups.

RESULTS

One thousand and eighty-three respondents completed the survey. Most respondents used KT for post-injury treatment (74%), pain modulation (67%), and neuro-sensory feedback (60%). Most believed that KT stimulates skin mechanoreceptors (77%), improve local circulation (69%), and modulates pain (60%). Some respondents believed KT only created a placebo effect (40%) and use it for such therapeutic purposes (58%). Most used a standard uncut roll (67%) in black (71%) or beige (66%). Most respondents did not use any specialty pre-cut tape (83%), infused tape (99.54%), or a topical analgesic with tape (65%). The most common tape tension lengths used by respondents were 50% tension (47%) and 25% (25%) tension. Patient reported outcomes (80%) were the most common clinical measures. Most respondents provided skin prep (64%) and tape removal (77%) instructions. Some did not provide any skin prep (36%) or tape removal (23%) instruction. The average recommended times to wear KT were two to three days (60%). The maximum times ranged from two to five days (81%).

CONCLUSION

This survey provides insight into how professionals use KT and highlights the gap between research and practice. Future research should address these gaps to better determine evidence-based guidelines.

LEVEL OF EVIDENCE

3.

Benefits of Structured Engagement with Target Audiences of a Health Website: Study Design for a Multi-Case Study

Access to evidence and practice knowledge precedes use, but availability does not guarantee reach and uptake by intended audiences. The CareSearch project provides online palliative care evidence and information to support health and aged care professionals as well as patients, carers and families to make informed decisions about care at the end of life. Already established in the palliative care sector, CareSearch commenced planning to extend its reach, and ensure website use is maximised for different audiences. This paper reports on the development of the Engagement Framework which will be used to guide and deliver an Engagement Project which will actively seek feedback and insights from intended users in a structured process. The process for developing the Engagement Framework commenced with a literature review of approaches used in knowledge translation, implementation science, and social marketing. The Engagement Framework comprising eight steps was then developed. The Engagement Framework outlines the series of tasks to be undertaken by team members when working with three target groups (Aged Care; Allied Health; and Patients, Carers and Families). A process/formative evaluation collecting data using qualitative methods is also described for use in the subsequent Engagement Project. The evaluation will explore the experiences of project participants as well as staff implementing the engagement activities. The three target groups will enable a cross-case comparison of the strengths and weaknesses of the approach. Planning, implementing and evaluating engagement with intended audiences, offers one mechanism to identify ways to increase interaction and integration with knowledge users.

Google Medical Update: Why Is the Search Engine Decreasing Visibility of Health and Medical Information Websites?

The Google search engine answers many health and medical information queries every day. People have become used to searching for this type of information. This paper presents a study which examined the visibility of health and medical information websites. The purpose of this study was to find out why Google is decreasing the visibility of such websites and how to measure this decrease. Since August 2018, Google has been more rigorously rating these websites, since they can potentially impact people’s health. The method of the study was to collect data about the visibility of health and medical information websites in sequential time snapshots. Visibility consists of combined data of unique keywords, positions, and URL results. The sample under study was made up of 21 websites selected from 10 European countries. The findings reveal that in sequential time snapshots, search visibility decreased. The decrease was not dependent on the country or the language. The main reason why Google is decreasing the visibility of such websites is that they do not meet high ranking criteria.

Systematic Analysis of Readability of Patient Information on Internet Pages from Departments for Trauma Surgery of German University Hospitals

INTRODUCTION

The need-based information transfer in education as well as for the recruitment of patients becomes more and more relevant. Here, the internet has emerged as an increasingly important factor in recent years and therefore information pages on hospital homepages can be very helpful. However, it is known that basic text comprehension skills are lacking among large populations.

METHOD

The aim of the present study was to evaluate the readability of the patient information available on the websites of trauma departments of German university hospitals. For this purpose, a search for information material on 10 different diagnoses was carried out. Out of 360 texts possible, 185 were found and assigned to 2 superordinate thematic areas (emergency vs. elective operations), subjected to a systematic text analysis via software "Text-Lab" and rated using 5 known readability indices (Amstad, G-SMOG, LIX, HIX, WSTF).

RESULTS

The indices used for both thematic complexes consistently showed poor readability, so that the texts only seem sufficiently comprehensible to readers with higher education. (Amstad: 21.4 ± 20.8; G-SMOG: 11.6 ± 2.0; WSTF 13.3 ± 2.1; LIX: 60.9 ± 7.6; HIX: 4.1 ± 3.2).

CONCLUSION

For the medical information provided by university hospitals, there is a clear need for improvement in order to make the adequate acquisition of knowledge accessible to a broader spectrum of patients.

Roller Massage: A Descriptive Survey of Allied Health Professionals

BACKGROUND

In sports medicine, the interprofessional care of athletes has become a frequent practice. This type of care often involves different interventions used among professionals. One common intervention prescribed is roller massage (RM) or self-myofascial release. The trends in the use of RM among allied health professionals are nonexistent. The surveillance of such responses has not been documented.

PURPOSE

To survey and document responses in the knowledge, clinical application, and use of RM devices among allied health professionals in the United States.

DESIGN

Cross-sectional descriptive survey study.

METHODS

A 20-question survey was sent to allied health professionals including physical therapists, athletic trainers, and fitness professionals. The survey covered topics such as demographics, beliefs about RM, preferred devices, exercise prescription, and client education.

RESULTS

One thousand and forty-two professionals (N = 1042) completed the survey. Most respondents believed that RM decreases pain (82%) and increases mobility (76%). A high percentage use a foam roller in their practice (81%), recommend a full-size foam roller (49%), and believe the medium density (48%) is the most effective. A high proportion of respondents prescribe RM for injury treatment (69%) and for preexercise and postexercise (61%). They also recommend rolling daily for 30 seconds to 2 minutes per muscle group (33%) at a self-paced cadence (46%). A high percentage of respondents use patient-reported outcomes (74%), joint range of motion (49%), and movement-based testing (48%) to measure effects of RM. Eighty-seven percent use live instruction to educate clients, and 88% believe there is a gap in the research.

CONCLUSION

The results of this survey document responses in the use of RM among allied health professionals. The reported responses provide insight into how professionals are using RM as an intervention and the potential gaps between the research and professional practice. Future studies are needed to further validate these findings.

Study of online information for anxious patients requiring dental extractions

Introduction Standard practice for dental extractions is to provide treatment under local anaesthesia (LA) without additional sedation or general anaesthesia. Even in oral surgery departments, the majority of patients receive this anxiety-provoking treatment under LA alone. All patients undergoing extractions could benefit from information on relaxation and anxiety management. This study aims to perform an in-depth analysis of the quality of websites that provide information on dental extractions and anxiety.Materials and methods Key phrases were searched on Google. The content, reliability and readability of the top ten websites for each key phrase were qualitatively evaluated using three tools: DISCERN, Flesch-Kincaid, and a specialised oral surgery website checklist (OSWC).Results Patient education was limited, with 70% of websites being either advertisements, forums or articles for healthcare professionals. The majority of websites poorly described treatment such as sedation and only 16% provided methods for relaxation. Readability was poor, with 92% above average UK adult literacy ability.Conclusion Extraction patients should be signposted to effective resources before treatment or referral. Dental anxiety advice can easily be incorporated into all treatment plans, with recommended website links included in digital communication, such as text messages or practice websites.

Low back pain websites do not meet the needs of consumers: A study of online resources at three time points

BACKGROUND

The popularity of the Internet as a source of health-related information for low back pain (LBP) is growing. Although research has evaluated information quality in health-related websites, few studies have considered whether content and presentation match consumer preferences.

OBJECTIVE

The aim of this study was to evaluate whether LBP website content and presentation matched preferences of consumers with LBP, whether matching preference of consumers changed over 8 years as recognition of people-centred healthcare has developed and whether this differs between countries of Internet searching.

METHOD

The most prominent and top 20 LBP websites were identified using common search engines in 2010, 2015 and 2018. Websites identified in the top 20 in 2010 were followed up if not identified in 2015 and 2018. Two reviewers independently evaluated websites with a 16-item checklist developed from research of consumer preferences. In 2015, websites were identified using searches conducted using IP addresses from Australia, the United States of America (USA), the United Kingdom and Canada. After removal of duplicates, 55 websites were evaluated in 2010. In 2015 and 2018, 33 and 28 new sites, respectively, were identified, and 37 previous websites were re-evaluated.

RESULTS

In 2010 and 2015, websites predominantly originated from USA and were sponsored by "for-profit" organisations. In 2018, most websites originated from Australian "not-for-profit" organisations. None of the websites provided information on all content areas. At least 55% of websites were rated as poor or fair. No site rated as excellent overall. There was some worsening over time. Country of search did not affect results.

CONCLUSION

Websites retrieved using typical searches did not meet information and presentation preferences of people with LBP.

Patterns of internet and social media use in colorectal surgery

Background

Surgeons use the Internet and social media to provide health information, promote their clinical practice, network with clinicians and researchers, and engage with journal clubs and online campaigns. While surgical patients are increasingly Internet-literate, the prevalence and purpose of searching for online health information vary among patient populations. We aimed to characterise patient and colorectal surgeon (CRS) use of the Internet and social media to seek health information.

Methods

Members of the Colorectal Society of Australia and New Zealand and patients under the care of CRS at the Royal Prince Alfred Hospital, Sydney, were surveyed. Questions pertained to the types of information sought from the Internet, the platforms used to seek it, and the perceived utility of this information.

Results

Most CRS spent 2–6 h per week using the Internet for clinical purposes and an additional 2–6 h per week for research. 79% preferred literature databases as an information source. CRS most commonly directed patients to professional healthcare body websites. 59% of CRS use social media, mainly for socialising or networking. Nine percent of surgeons spent > 1 h per week on social media for clinical or research purposes. 72% of surgeons have a surgical practice website.

43% of patients searched the Internet for information on their doctor, and 75% of patients sought information on their symptoms or condition. However, 25% used health-specific websites, and 14% used professional healthcare body websites. Around 84% of patients found the information helpful, and 8% found it difficult to find information on the Internet. 12% of patients used social media to seek health information.

Conclusions

Colorectal surgery patients commonly find health information on the Internet but social media is not a prominent source of health information for patients or CRS.

ROLLER MASSAGE: SURVEY OF PHYSICAL THERAPY PROFESSIONALS AND A COMMENTARY ON CLINICAL STANDARDS- PART II

BACKGROUND

Roller massage (RM) has become a popular intervention prescribed by physical therapy (PT) professionals. While this popularity has stimulated an increase in research and product development, the trends in the use of RM among PT professionals remain undocumented. It is unknown how professionals are using RM and integrating the research into their clinical practice.

PURPOSE

To survey and document responses in the knowledge, clinical application methods, and use of RM devices among PT professionals in the United States.

DESIGN

Cross-sectional survey study.

METHODS

A 20-question online survey related to personal and professional demographics, beliefs about RM, preferred RM devices, RM exercise prescription, and client education was emailed to PT members of the Orthopedic and Sports Physical Therapy Sections.

RESULTS

A total of 685 sports and orthopedic PT professionals completed the survey. Most professionals surveyed believe that RM decreases pain (80%), increases mobility (68%), and increases range of motion (ROM) (40%). Fifty-one percent believed moderate density rollers have the greatest effect. Eighty percent of professionals use a foam roller in their practice and 51% recommend to clients. A high proportion of professionals prescribe RM for injury treatment (82%) and for pre and post-exercise interventions (55%). Most professionals recommend rolling daily for 30 seconds to two minutes (55%), per muscle group (64%), at a self-paced cadence (47%). A high proportion of professionals use patient reported outcomes (80%), followed by joint ROM (59%), and movement-based testing (42%) to measure effects of RM. Eighty-seven percent of professionals use live instruction to educate clients and 91% believe there is a gap in the research.

CONCLUSION

The results of this survey should be considered descriptive and a starting point for future research to establish a consensus on optimal RM programming, devices, and application parameters for different musculoskeletal conditions. The observed responses provide some insight into how PT professionals are using RM in their practice and highlight the existing gap between the research and professional practice. Further research is needed to explore the responses documented in this study.

LEVEL OF EVIDENCE

3.

Online Decision Support Tool for Personalized Cancer Symptom Checking in the Community (REACT): Acceptability, Feasibility, and Usability Study

Background

Improving cancer survival in the UK, despite recent significant gains, remains a huge challenge. This can be attributed to, at least in part, patient and diagnostic delays, when patients are unaware they are suffering from a cancerous symptom and therefore do not visit a general practitioner promptly and/or when general practitioners fail to investigate the symptom or refer promptly. To raise awareness of symptoms that may potentially be indicative of underlying cancer among members of the public a symptom-based risk assessment model (developed for medical practitioner use and currently only used by some UK general practitioners) was utilized to develop a risk assessment tool to be offered to the public in community settings. Such a tool could help individuals recognize a symptom, which may potentially indicate cancer, faster and reduce the time taken to visit to their general practitioner. In this paper we report results about the design and development of the REACT (Risk Estimation for Additional Cancer Testing) website, a tool to be used in a community setting allowing users to complete an online questionnaire and obtain personalized cancer symptom-based risk estimation.

Objective

The objectives of this study are to evaluate (1) the acceptability of REACT among the public and health care practitioners, (2) the usability of the REACT website, (3) the presentation of personalized cancer risk on the website, and (4) potential approaches to adopt REACT into community health care services in the UK.

Methods

Our research consisted of multiple stages involving members of the public (n=39) and health care practitioners (n=20) in the UK. Data were collected between June 2017 and January 2018. User views were collected by (1) the “think-aloud” approach when participants using the website were asked to talk about their perceptions and feelings in relation to the website, and (2) self-reporting of website experiences through open-ended questionnaires. Data collection and data analysis continued simultaneously, allowing for website iterations between different points of data collection.

Results

The results demonstrate the need for such a tool. Participants suggest the best way to offer REACT is through a guided approach, with a health care practitioner (eg, pharmacist or National Health Service Health Check nurse) present during the process of risk evaluation. User feedback, which was generally consistent across members of public and health care practitioners, has been used to inform the development of the website. The most important aspects were: simplicity, ability to evaluate multiple cancers, content emphasizing an inviting community “feel,” use (when possible) of layperson language in the symptom screening questionnaire, and a robust and positive approach to cancer communication relying on visual risk representation both with affected individuals and the entire population at risk.

Conclusions

This study illustrates the benefits of involving public and stakeholders in developing and implementing a simple cancer symptom check tool within community. It also offers insights and design suggestions for user-friendly interfaces of similar health care Web-based services, especially those involving personalized risk estimation.

Minimally Invasive Spine Surgery: Analyzing Internet-based Education Material

STUDY DESIGN

This is a cross-sectional study.

OBJECTIVE

The purpose of this study is to evaluate the content of information available on the Internet regarding minimally invasive spine surgery (MISS).

SUMMARY OF BACKGROUND DATA

Patients look to the Internet for quick and accessible information on orthopedic procedures to help guide their personal decision making process regarding the care they receive. However, the quality of internet-based orthopedic education material varies significantly with respect to accuracy and readability.

MATERIALS AND METHODS

The top 50 results were generated from each of 3 search engines (Google, Yahoo!, and Bing) using the search term "minimally invasive spine surgery." Results were categorized by authorship type and evaluated for their description of key factors such as procedural benefits, risks, and techniques. Comparisons between search engines and between authorship types were done using the Freeman-Halton extension for the Fisher exact test. The content of websites certified by Health on the Net Foundation (HONcode) was compared with those not HONcode certified.

RESULTS

Of the 150 websites and videos, only 26% were authored by a hospital or university, whereas 50% were by a private physician or clinic. Most resources presented some benefits of MISS (84%, 126/150), but only 17% presented risks of the procedure (26/150). Almost half of all resources described the technique of MISS, but only 27% had thorough descriptions that included visual representations while 26% failed to describe the procedure. Only 12 results were HONcode certified, and 10 (83%) of these were authored by a medical industry company.

CONCLUSIONS

Internet-based resources on MISS provide inconsistent content and tend to emphasize benefits of MISS over risks.

Knowledge of self-myofascial release among allied health students in the United States: A descriptive survey

BACKGROUND

University and collegiate education of the human myofascial system is commonly taught in basic science courses such as anatomy. Allied health programs may expand upon these concepts by teaching interventions such as myofascial release in clinical education courses. Self-myofascial release (SMR) with a device such as a foam roller is an emerging intervention that has become popular among clinicians and active individuals. Currently, it's unknown if allied health programs provide SMR education.

PURPOSE

The purpose of this study was to survey and document responses in the knowledge of SMR among allied health students.

METHODS

12 undergraduate and graduate allied health programs in the United States were sent a 12-question electronic survey that represented three areas: 1) respondent demographics and beliefs, 2) experience with SMR, 3) future practice and education. Descriptive data including response frequency and percentage was calculated and reported for the 12 questions.

RESULTS

A total of 502 students from the different allied health programs completed the survey which represented a 33.00% response rate (502/1521). Approximately, half of respondents (49.6%, N = 249) reported learning about SMR in their degree program and the other half (50.40%, N = 253) report receiving no education. Most respondents (>50%) currently use or have used an SMR device and believe that SMR produces therapeutic benefits. Furthermore, most respondents (≥50%) had an idea of how they would integrate SMR into their future practice and where to purchase an SMR device.

CONCLUSION

A more global consensus on education for emerging therapeutic intervention such as SMR is needed in order to standardize and develop best teaching practices in allied health. This study highlighted the difference among allied health programs in the United States. This research should be a starting point for future survey research on this topic.

An Assessment of the Quality of CT Radiation Dose Information on the Internet

OBJECTIVES

Our goal was to ascertain the quality of health information related to CT radiation exposure using a simulated Internet search and from incident information that may be available during day-to-day Internet usage.

METHODS

We entered 14 terms relating to information on CT dose into the most commonly used Internet search engine and analyzed the first 100 web page results for each. A Rich Search Site (RSS) feed search was also used to evaluate incidental information over a 12-week period in 2014. Each web page was classified as being "completely accurate," "somewhat accurate," or "inaccurate."

RESULTS

Of 1,400 web pages, 290 were relevant and accessible. We deemed 12.8% of these pages as inaccurate and 67.2% of pages as completely accurate. The highest proportion of web pages was from media sources, which, along with discussion forums, commercial websites, and blogs, were found to have proportionally the largest amount of inaccurate information. Of 1,943 posts, 136 (7.0%) identified by the RSS were relevant, 9.6% were deemed inaccurate, and only 29.9% were deemed completely accurate. The results of our simulated query highlight the importance of public education regarding Internet usage when researching topics relating to radiation exposure associated with CT.

A Blended Intervention for Patients With Knee and Hip Osteoarthritis in the Physical Therapy Practice: Development and a Pilot Study

Background

Blended care, a combination of online and face-to-face care, is seen as a promising treatment option. However, actual use of blended interventions in practice is disappointing.

Objective

The objective of this study was two folded. The first aim was to develop a blended exercise therapy intervention for patients with knee and hip osteoarthritis that matches the values of the users and that can be implemented in the daily routine of physical therapists. The second aim was to investigate the feasibility through interviews and a pilot study.

Methods

In this paper, we employed the first 3 steps of the CeHRes road map to develop a blended intervention for patients with knee and hip osteoarthritis. We used interviews, a focus group and discussions with stakeholders to explore the needs, values, and requirements with respect to our to-be-developed blended intervention, which we called e-Exercise. The first version of e-Exercise was tested in a pilot study. Feasibility outcomes, including recruitment rates within each practice, website usage (assignments completed and website visits), and user satisfaction, were measured. In addition, therapists and patients from the pilot study were interviewed to investigate users’ experiences.

Results

The study captured important information about stakeholders’ needs and perspectives. Based on our findings, we created a first version and attuned the application’s content, functionality, and structure. Patients and, to lesser extent, physical therapists were satisfied with the e-Exercise intervention. Eight patients were recruited by 8 physical therapists. Of the 8 patients, 6 completed more than 7 of 12 modules.

Conclusions

This study outlines the development and feasibility of a blended exercise therapy intervention for patients with knee and hip osteoarthritis. E-Exercise offers an alternative approach in the physical therapy treatment of knee and hip osteoarthritis. This study provides valuable information to conduct a further trial to evaluate the (cost) effectiveness of e-Exercise compared to usual physical therapy.

Trial Registration

Netherlands Trial Register Number: NTR4224; www.trialregister.nl/trialreg/admin/rctview.asp?TC=4224 (Archived by WebCite at http://www.webcitation.org/6fOK4lrTO).

Transrectal Ultrasound Guided Biopsy of the Prostate: Is the Information Accessible, Usable, Reliable and Readable?

BACKGROUND/AIMS

To evaluate the accessibility, usability, reliability and readability of Internet information regarding transrectal ultrasound (TRUS) guided biopsy of the prostate.

MATERIALS AND METHODS

The terms "prostate biopsy", "TRUS biopsy" and "transrectal ultrasound guided biopsy of the prostate" were separately entered into the each of the top 5 most accessed Internet search engines. Websites were evaluated for accessibility, usability and reliability using the LIDA tool - a validated tool for the assessment of health related websites. Website readability was assessed using the Flesch Reading Ease Score and the Flesch Kincaid Grade Level.

RESULTS

Following the application of exclusion criteria, 82 unique websites were analyzed. There was a significant difference in scores depending on authorship categories (p ≤ 0.001), with health related charity websites scoring highest (mean 122.29 ± 13.98) and non-academic affiliated institution websites scoring lowest (mean 87 ± 19.76). The presence of advertisements on a website was associated with a lower mean overall LIDA tool score (p = 0.024). Only a single website adhered to the National Institutes for Health recommendations on readability.

CONCLUSIONS

This study demonstrates variability in the quality of information available to Internet users regarding TRUS biopsies. Collaboration of website design and clinical acumen are necessary to develop appropriate websites for patient benefit.

Quality of websites of obstetrics and gynecology departments: a cross-sectional study

Background

The internet has become an easily accessible and widely used source of healthcare information. There are, however, no standardized or commonly accepted criteria for the quality of Obstetrics and Gynecology websites. In this study, we aimed to evaluate the quality of websites of Obstetrics and Gynecology departments in German-speaking countries and to compare websites nationally and internationally.

Methods

We scored 672 websites from Germany (n = 566), Austria (n = 57), and Switzerland (n = 49) using the objective criteria: Google search rank (2 items), technical aspects (11 items), navigation (8 items), and content (6 items) for a 26 point score. Scores were compared nationally and internationally. Multivariable regression models assessed good quality scores (≥50% of maximum) as the dependent variables and country, academic affiliation, being member of a healthcare consortium, confessional affiliation, and content management system (CMS) use as independent variables.

Results

The mean score of websites was 13.8 ± 3.3. 4.2% were rated as good (≥75% of maximum), 61.8% as fair (≥50% of maximum). German (14.0 ± 3.2) and Swiss (13.8 ± 4.0) websites scored significantly higher compared to Austrian websites (11.6 ± 2.5) (P < 0.001 and P = 0.005, respectively). Within Germany, academic had higher scores than non-academic departments (14.9 ± 3.2 vs. 13.7 ± 3.1, P < 0.001). Single institutions had higher scores compared to healthcare consortium institutions (14.1 ± 3.2 vs. 13.2 ± 2.6, P = 0.003). Departments in Northern and Southern states had higher scores compared to Eastern states (14.4 ± 3.2 and 14.2 ± 3.2 vs. 13.0 ± 3.0, P < 0.001). In multivariate regression models, all subscores (all: P < 0.001) independently predicted a website’s reaching a good quality score, with navigation subscore as strongest predictor. Affiliations were predictors for some good individual subscores, but not for others. High content subscore was associated with good Google search rank, technical aspects, and navigation subscores.

Conclusions

The quality of websites of Obstetrics and Gynecology departments varies widely. We found marked differences depending on country, affiliation, and region.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-015-0537-9) contains supplementary material, which is available to authorized users.

Patient perceptions of generic medicines: a mixed-methods study

INTRODUCTION

In an attempt to benefit from the cost-savings associated with use of generic medicines, in June 2013 Ireland introduced generic substitution and reference pricing for the first time. However, perceptions of Irish patients towards generic medicines have not been published previously. Therefore, the objective of this study was to assess how generic medicines were perceived amongst patients in the time leading up to the enactment of the new legislation.

METHODOLOGY

A total of 42 patients were recruited from general practices affiliated with the Graduate Entry Medical School at the University of Limerick and from community pharmacies. Interviews were semi-structured and included quantitative assessments of opinions using 15 structured questions and a five-point Likert scale response system. Interview transcripts were coded and thematically analysed using NVivo (version 9), for qualitative data. Quantitative data were analysed using SPSS (version 20).

RESULTS

Nearly one-third (31 %) of patients had no knowledge of generic medicines and 39 % of those exhibited confusion between the words 'generic' and 'genetic'. Almost one-quarter (24 %) held the view that generics were of poorer quality than originators, while 18 % expressed the opinion that generics do not work as well as originator products. Approximately one-third (30 %) of patients believed that generics were manufactured to a poorer quality, with 29 % holding the view that generics are less expensive due to being of inferior quality. Nearly 90 % of patients stated they would take a generic medicine if it were prescribed by their GP; however, 24 % of patients stated a preference, if offered a choice, for the originator medication. Additionally, a majority of patients (86 %) were in favour of reference pricing and generic substitution. Of the patients interviewed, 50 % stated that a leaflet, or similar, with appropriate, understandable, and accessible information regarding generic medicines would be of use to them.

CONCLUSION

This is the first study of patients' attitudes towards generic medicines in Ireland. Conducted in the time period leading up to the implementation of legislation promoting the use of generic medicines, it highlights variable knowledge about generic medicines among this key stakeholder group. Although patients are supportive of their more widespread use, concerns regarding safety, clinical effectiveness, and manufacturing quality of generic medicines were identified.

Beliefs, perceptions and behaviours of GPs towards generic medicines

BACKGROUND

To benefit from cost-savings associated with generic medicine use; in June 2013, Ireland introduced generic substitution and reference pricing. The attitudes and behaviours of health care professionals may influence successful implementation of such changes.

OBJECTIVES

To assess perceptions of GPs in Ireland regarding generic medicines in the time leading up to the enactment of the new legislation and for the first time in at least the prior decade.

METHODS

Detailed one-to-one semi-structured interviews performed with a representative cohort of 34 urban- and rural-based GPs in Ireland.

RESULTS

Thirty of the participating 34 GPs prescribed generic medicines actively. Predominantly, participants believed that generics worked as effectively, and were of the same quality, as originator medicines. However, 32 GPs reported receiving patient complaints regarding generics; almost a third reported complaints of increased or altered side effects. Thirty-two GPs stated that they would take a generic medicine, although one in seven would choose the originator if offered a choice. A minority of GPs were of the view that generics are manufactured to a poorer quality than originators and may be a risk to patient safety.

CONCLUSION

This study of GPs' attitudes towards generic medicines in Ireland highlights that this key stakeholder group has generally positive attitudes towards both generic medicines and the new legislation. However, variable knowledge about generic medicines and concerns regarding patient experience, clinical effectiveness and manufacturing quality were identified. GPs' opinions could negatively influence patient opinions; enhancing such opinions may prove important in successfully implementing the new legislation.

Generic medicines: an evaluation of the accuracy and accessibility of information available on the Internet

Background

Internationally, generic medicines are increasingly seen as a key strategy to reduce healthcare expenditure, therefore awareness and knowledge transfer regarding generic medicines are valid areas of research. Although the Internet is a frequently used source of medical information, the accuracy of material found online is variable. The aim of this study was to evaluate information provided on the Internet regarding generic medicines in terms of quality of information and readability.

Methods

Internet searches for information regarding generic medicine were completed, with a pre-defined search term, using the Google search engine, in five English-speaking geographical regions (US, UK, Ireland, Canada and Australia). Search results likely to be looked at by a searcher were collated and assessed for the quality of generic medicine-related information in the websites, using a novel customised Website Quality Assessment (WQA) tool; and for readability, using existing methods. The reproducibility of the tools between two independent reviewers was evaluated and correlations between WQA score, readability statistics and Google search engine results page ranking were assessed.

Results

Wikipedia was the highest-ranking search result in 100% of searches performed. Considerable variability of search results returned between different geographical regions was observed, including that websites identified in the Australian search generated the highest number of country specific websites; searches performed using computers with Irish, British, American and Canadian IP addresses appear to be more similar to each other than the google.com search performed in Australia; and the Canadian google.ca results show a notable difference from any of the other searches. Of the 24 websites assessed, none scored a perfect WQA score. Notably, strong correlation was seen between WQA and readability scores and ranking on google.com search results.

Conclusions

This novel evaluation of websites providing information on generic medicines showed that, of the websites likely to be seen by a searcher, none demonstrated a combination of scoring highly on quality of information (as evinced by WQA score) and readability. Therefore, there is a gap in online knowledge provision on this topic which, if filled by a website designed using the WQA tool developed in this study, has an improved likelihood of ranking highly in google.com search results.