## 4 Discussion  
This is the first study that aimed to investigate the quality, reliability and content of online audio-visual information on the treatment of OSA with MAD. The Internet has \begin{table}
\begin{tabular}{l l l l l l l l} \hline \hline \multirow{2}{*}{**Source of Upload**} & \multicolumn{2}{c}{**VIQI**} & \multicolumn{2}{c}{**m-DISCERN**} & \multicolumn{2}{c}{**JAMA**} & \multicolumn{2}{c}{**Content**} \\ \cline{2-9}  & **Mean** & **95\%CI** & **Mean** & **95\%CI** & **Mean** & **95\%CI** & **Mean** & **95\%CI** \\ \hline Healthcare & 12.38 & 11.28–13.47 & 2.13 & 1.73–2.52 & 1.90 & 1.62–2.19 & 3.25 & 2.66–3.84 \\ professionals & 13.00 & 11.70–14.30 & 3.00 & 1.70–4.30 & 2.25 & 0.25–4.25 & 2.75 & 0.75–4.75 \\ Commercial & 11.21 & 9.61–12.81 & 1.43 & 1.13–1.73 & 2.07 & 1.80–2.35 & 2.36 & 1.66–3.06 \\ Laypeople & 7.92 & 5.90–9.95 & 1.15 & 0.93–1.40 & 1.54 & 1.22–1.85 & 1.54 & 0.60–2.48 \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Individual scores for videos categorized by different sources. VIQI, video information and quality index; m-DISCERN, modified-DISCERN; JAMA, _Journal of the American Medical Association_ benchmark criteria. Figure 4: Scores by sources of upload. Data are shown as medians. Video information and quality index (VIQI): *** Healthcare professionals vs. Laypeople, \(p\) < 0.0001; ** Commercial vs. Laypeople, \(p\) = 0.009. Modified-DISCERN (M-DISCERN): ** Healthcare professionals vs. Laypeople, \(p\) = 0.003; ** Hospital/University vs. Commercial, \(p\) = 0.005; ** Hospital/University vs. Laypeople, \(p\) = 0.002. Content: ** Healthcare professionals vs. Laypeople, \(p\) = 0.003.  
gained more and more importance among patients willing to learn about medical conditions and desirous of an active role in healthcare decision-making. Research reports that more than 80% of patients use online resources to learn and find information about their health state, and 70% of them assert that it consistently influences their treatment decisions and judgements [31; 32]. In addition, it has been proven that audio-visual media makes content and messages more engaging and much easier to remember for people compared with other forms of communication, increasing the capability to retain information [33]. In detail, [PERSON] et al. suggested that audio-visual information could improve orthodontic patient knowledge better than oral communication or information provided by leaflets [34]. Nowadays, there is no standardized regulation or peer review process, and anyone can freely and easily upload videos on many online platforms. For that reason, the identification of the video uploaders has a substantial impact on the reliability and quality of the videos. An evaluation tool like the Health-on-the-Net (HON) certification (used to assess the trustworthiness of online information on websites) should be developed and validated in order to verify and guarantee the reliability of online audio-visual health information [35]. The content and usefulness of YouTube videos concerning various medical issues and health conditions have been investigated by several researchers [17; 29; 36; 37]. This is the first study evaluating the overall quality of videos related to MAD on four Internet platforms of common use. We decided to extend the research not only on YouTube but also on Google Video, Microsoft Bing and Watch Facebook in order to include a wider and more varied pool of users. Most of the videos included were from YouTube, and most of those searched on the three other platforms referred to videos originally posted on YouTube and then shared on Google, Bing or Facebook. Our investigation showed that most of the videos were uploaded by healthcare professionals, in agreement with the results obtained by [PERSON] et al., [PERSON] et al. and [PERSON] et al. [25; 38; 39] but in contrast with those by [PERSON] et al. and [PERSON] et al., where laypeople were the first source of upload [18; 21].