Online Patient Resources for Ankle Instability
Authors: Abousayed Mostafa , Tartaglione Jason , Zonshayn Samuel , Johnson Christopher , Rosenbaum Andrew 
Published: September 2018

Category: Ankle Introduction/Purpose: The Internet has drastically changed how patients access health-related information. There are several ways the public can access online health-related information such as search engines, blogs, support groups and webinars. A recent study found that 45% of orthopedic patients searched for information online regarding their injury. Also, 78% believed they had better understanding of their condition after visiting these websites; furthermore, 41% felt the Internet supplied them with questions and concerns to discuss with their physicians. While most patients experience favorable outcomes after proper management of an isolated ankle sprain, inadequate treatment can lead to chronic ankle instability. The aim of our study is to evaluate the accuracy, quality and readability of online available information using the search terms “ankle sprain” and “ankle instability”. Methods: Three websites [Google, Bing, and Yahoo] were searched for the terms “ankle sprain” and “ankle instability”. The first 25 websites from each search were collected. After removal of duplicates, 65 websites were left for evaluation. Nine websites were excluded: contained video links only (n=3), lacked information (n=3), presented unrelated information (n=2), or was not written in English (n=1). A total of 56 websites met the inclusion criteria. Each website was assessed for quality, accuracy, and readability by three orthopedic residents blinded to the search term utilized. The quality was evaluated using a previously developed grading rubric containing 25 points pertaining to relevant anatomy, diagnosis, treatment, and complications of ankle sprains. The accuracy of the websites was assessed using a scale from 1-4. The Flesch-Kincaid (F-K) scale was used to evaluate readability of the websites. Lastly, websites were evaluated for any commercial bias and whether written by physicians or not. Results: Table 1 displays the quality results of all websites. The mean quality of websites written >7th grade level was statistically significantly higher than those written at =7th grade (p=0.01). A summary of the accuracy results is depicted in Table 2. The mean accuracy of websites written >7th grade level was statistically higher than websites written at =7th grade level (p=0.01). Only six websites (10.7%) included in this study were written at a 7th grade level or below. Multivariable regression analysis revealed the accuracy of websites was significantly associated with the F-K score and absence of commercial bias. Furthermore, the quality of websites was positively correlated with the F-K score, use of the search term “ankle instability”, websites written by physicians, and absence of commercial bias. Conclusion: The current study highlights the poor quality and accuracy of online information related to ankle sprains, especially those with commercial bias. Furthermore, while websites written by or under supervision of physicians were found of superior quality, a majority of sites were found to have an unacceptably high reading level. As the importance of health literacy becomes more apparent, it is critical to remember the physician’s role in guiding patients to high quality and accurate resources written at an appropriate level.