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PATIENT INFORMATION ON INTERNET |
Effects of preoperative information
Internet as information source
Requirements on the "good quality" of Internet information
Search machines & retrieval of information
Portal -is it a realizable idea?
Existence of a "hidden" Internet
1 Why is the patient information important?
To achieve the best results after a total joint replacement, the patient must participate whole-heartily in vigorous rehabilitation exercises.
Only the patient who gets suitable and repeated preoperative
information experiences the feeling that he / she is in the
control of his / her progress after the total joint surgery. This feeling
makes the patient relaxed and encourages him / her to be more
active in the rehabilitation process.
2 Effects of preoperative patient information
Several studies demonstrated that patients who received thorough preoperative information (attendance in a pre-admission class, video tape, and written information) have had better results of their total joint surgery than patients without such information.
Some studies even found that the preoperative anxiety, the stress during the operation, and the postoperative pain have been lower and the hospital stay has been shorter in patients who received comprehensive preoperative education. ( Dalroy 1998).
To provide the patient with only a booklet together with a short verbal information is not much efficient, because the information is quickly forgotten.
One study showed that only 53 % of the patients who were given such short information remembered later the risks of possible complications that may follow the total joint surgery. Curiously enough, the majority of these patients were satisfied with the information received. (Turner, 2002).
3 Internet as information source
Today, many patients turn to Internet to enhance their knowledge about total joint replacement and other orthopedic conditions.
Who uses internet:
Younger patients in higher socioeconomic class
people with long suffering
people with back pain
Studies demonstrated (Wright 2001) that orthopedic patients using the Internet for health information were younger ( mean age 30 years) and have had higher socioeconomic class than patients who did not use the Internet (mean age 49 years)
Patients with more complicated orthopedic conditions, with long periods of suffering use Internet more often than patients with less serious orthopedic conditions. The highest use of Internet among the orthopedic patients was observed in people with chronic back pain.
People seeking medical information on Internet usually scan through the first four-five pages produced by search machines to retrieve health information.
The people seeking health information on the Internet are usually assessing the credibility of a website by looking for the professional design of the site, for a "scientific touch", and above all for the ease of use of the site. On the other hand, they almost never check any "about-us" sections, Disclaimers or disclosure statements on the websites.
4 Requirements on the "good quality" website
Requirements on the "good quality" website are very modest:
A "good quality" website should disclose who provided information and
the source of information.
The information should be "accurate and readable"
The design of the site should be "appropriate"
Yet even according to such loose criteria, only 9 % of all studied websites with patient health information have been of " good quality". (Eysenbach 2002).
It is then reassuiring to find that in spite of the generally low quality of health information found on the Internet, Internet information did not cause any harm to patients seeking such information (Besell 2002).
5 Search machines & retrieval of information
The searching machines (Yahoo, Google, etc) select a huge quantity of information from the Internet, but the quality of retrieved information varies.
Try for yourself assembling information through one of the most used searching machines
I did it with the following seek terms:
"total hip total knee replacement preoperative patient education"
on three searching machines Google, Yahoo, and altavista.
The three searching machines produced these quantities of information (Jan 2005):
| SEARCH MACHINE | No of "HITS" |
| google.com | 71 000 |
| yahoo.com | 91 000 |
| altavista.com | 393 |
A more scientific term for a "hit" is the term URL" (Unique Resource Locator).= unique sources of information
For example, the search machine google found 71 000 sources of information (URL) that should contain information about subjects: "patient information" and subjects "total hip" and/ or "total knee replacement". Was this information relevant? Most often not.
On the other hand, search through specific databases, for example MEDLINE, a database in the National Library of Medicine in Washington, USA, is much more effective. There is a direct link to MEDLINE database in the NEWS section of this Website: Go to Medline.
Only 5 % of all web sites with patient health information on the Internet are owned by American universities. The popular search machines, however, usually cannot find them (Rozenthal 2001)..
Several studies demonstrated that the popular Internet search machines are retrieving mainly commercially oriented web-sites with little intention to educate. Be careful how you use information from the search machines!
5a Portal - can it be realized?
You perhaps believe that there should be a group of renowned scientists who should select the reliable (and rather rare) web pages and place them on one protected area on Internet. The interested people could then be able to access this protected area through a "portal". The people would know that all information on this protected area is reliable. There were several attempts to create such portals. The problem is that there is no recognized authority to select the "reliable websites" and to maintain the hedged place. Moreover, you may often find contradicting information on identical subjects when browsing through the "scientific data" on artificial joints. (For example: there are amny surgeons believing that total joint loosening is caused by reaction to wear particles but there are well supported opinions that loosening is cause by unrevealed chronic bacterial infection).
Another problem with maintaining "reliable portal" is that the information on Internet is highly volatile: a lot of websites are disappearing every day and more new websites are emerging to replace them. Information on Internet is often "fresh only" product, which applies especially on all information on total joints. Because of quick development of total joints information on them becomes soon old and obsolete.
My website adheres to the eight sound but still minimal demands for a "reliable" website established by the Association of Health On Net Foundation (HON). You may verify it by clicking on the seal. My website is thus included in the HON database of websites with "trustworthy" information.
More information about the Health On the Net Foundation internationally working organization with many interesting projects will you find on:
There you may find other trustworthy databases
This website is also listed in another portal for "reliable" orthopaedic information called Orthopaedic Web Links (OWL)
http://www.orthopaedicweblinks.com/about.html You may also look into the LINKS page for more information on some websites that in my view present useful information on total joints.
5b Manufacturer's websides
for example DePuys
http://www.allaboutarthritis.com
are created professionally, the information is presented in an easy comprehensible way. The information is true but it may be selected. The focus is often on the good characteristics of the manufacturer's product. Less advantageous characteristics of the product may be omitted.
6 Existence of the "hidden" Internet.
The popular search machines do not retrieve information from library databases, from databases with limited access and like sources of information on Internet. These sources of information are also called "hidden" Internet.
One supposes that up to 40 % of all Internet information is located in this "hidden Internet". Currently, however, some search machines are improving their search capacity in these "hidden areas".
Again: be careful when you use information provided by popular search machines.
7 Patient-support websites
for ex.
http://members.tripod.com/totallyhip1/index1.htm
One fifth of all orthopedic patients who use Internet look into patient-support websites to find information there.
The reliability of the information provided on the patient support web-sites has not been studied as yet. It seems, however, that the postings on these websites are usually of two kinds:
To the first group belong the postings that tell the experience of an individual patient with his / her total joint operation. These postings contain valuable practical information, for example about suitable support devices, tricks how to ease the rehabilitation, tips how to solve problems encountered while living with the new joint.
To this group also belong the postings which provide strong emotional support to individual members of the support group. ("We will pray for you tomorrow...") Such support may be very valuable for people in preoperative anguish and other stressful situations.
To the second group belong the postings that offer individual recommendations. Although these postings may sometimes reveal valuable information, they actually try to step in the doctor's place.
Such postings may increase the anguish and stress in the patients who are reading them. "Huh, should the material in my total hip / my total knee be so bad as this posting says?"
Remember always when you read recommendations on a patient support side that that the advice is based on an individual patient's experience. But we are all quite different individuals. What applies to your neighbor may not apply to you.
Discuss all such recommendations, if you believe they are worth it, always carefully with your surgeon.
References
Besell TL et al. Health Expect 2002;5: 28-37
Biermann JS et al: Orthopaedic Information, How to Find It Fast on the Internet.
J Bone Joint Surg-A, 2006; 88-A: 1134 - 40
Dalroy LH et al Arthritis Care Res 1998; 11:469-78
Eysenbach G et al JAMA 2002; 287:2691-700
Rozental TD et al. J Bone Joint Surg -Am 2001; 83-A: 987- 91
Turner P, Williams C N Z Med J 2002;115:: U 218
Wright JED et al. J Bone Joint Surg-B 2001-B;83-B;1096-7