Internet Literacy of Orthopaedic Patients

The internet has become increasingly part of daily life. Most orthopaedic surgeons you speak to get the impression that patients are increasingly becoming more aware of their medical conditions and have been reading up before seeing doctors in the hospital. Is this because of easy and widespread access to medical information offered by the web? We have found no studies in the UK looking at the use of internet by orthopaedic patients and have surveyed patients attending new patients Orthopaedic Clinic to assess the percentage who browse the internet prior to their appointments.

We invited all orthopaedic patients who attended the orthopaedic new patient clinic in a district general hospital to take part in the survey which was done during a four week period in May 2008. The patients were given a questionnaire to complete seeking details such as age, sex, region of complaint, previous orthopaedic appointment and previous orthopaedic surgery. The patients were also asked regarding their internet use and whether they had searched for orthopaedic information in preparation for their appointment.

One hundred and thirteen orthopaedic patients who took part were asked to fill in the questionnaire. Elective patients were included as it was thought that only they would have had symptoms for long enough to have time to browse the internet if so desired. The average age of the patients in the survey was 53.5 years (range 18 to 83 years). There were 68 female and 45 male patients. Twenty four patients had knee problems, 23 patients had foot complaints, 21 had hip problems, 14 hand and 6 wrist problems, 9 shoulder complaints and 8 patients presented with back pain.

Forty nine patients had previous orthopaedic appointments whereas for 64 patients it was their first contact with the orthopaedic department. Thirty five patients had had previous orthopaedic surgery. In this survey 82 (73%) patients had access to internet either at home or at work and 76 (67%) used the internet regularly. Twenty five (22%) patients had searched the internet for orthopaedic information using search engines such as Google, Yahoo and AOL. None of them were aware of any sites specifically recommended for orthopaedic conditions. By far the majority of patients used Google alone (20). Yahoo was used by one patient and another used both AOL and Google. One patient used all three search engines and one patient used Elsevier search engine as well as Google.

Twenty three of the 25 patients said that the internet had given them a better understanding of their condition whereas one patient said that it had not and only one patient said that the information confused him all the more. Twenty two patients said that the information they found on the website appeared reliable to them whereas one patient did not. All but one patient said that they would ask the doctor if they found any conflicting information.

Many studies have been done in orthopaedic patients in North America ^1-3. Beall et al. in 2002 surveyed a community orthopaedic practice for 2 days and looked at both trauma and elective patients and found that 13% of them had browsed the internet for information regarding their complaint¹. Krempac et al found that their survey done in 2002³ found the use of internet by the orthopaedic community increased to 46% compared to their previous report of 20% done 4 years ago¹ suggesting an increase in the utilisation of internet for orthopaedic related information. This is the first study to look at use of internet by new patients attending elective orthopaedic clinic in the U.K. We found no such previous information in the British literature. This study done in a district general hospital shows, that of the 73% with access to internet, about a quarter of them used it to look for information in preparation for their orthopaedic clinic appointment.

Patients are mainly finding material using commercial search engine such as Google and it has been found that such techniques are inefficient and inaccurate⁴. In this situation it would be useful to be in a position to guide patients to specific sites where reliable and relevant information could be found. This could be done on a personal basis by individual surgeons. However surgeons' familiarity with what is available on the net will be variable. Surgeons themselves are likely to require guidance. Perhaps the British Orthopaedic Association (BOA) has a role in this respect. However there is not much data on orthopaedic conditions or procedures that the patient can access on the BOA website. We should consider making it more accessible to patients with basic and reliable information in line with American Academy of Orthopaedic Surgeons website (AAOS).

A quarter of the patients in the current survey used the internet and this number is bound to increase over the coming years³. Recommended sites should be provided after validating their content as part of information to patients. On the BOA website there is clearly a desire to develop information systems for patients. Hopefully if this information becomes more sophisticated, surgeons will have the option of directing patients to this source of reliable and uniform information.

We would like to thank Mrs Margaret Jones, Ms Susan Gray and Mrs Jan Turnbull for their secretarial support.

1. Beall MS, 3rd, Beall MS, Jr., Greenfield ML, Biermann JS. Patient Internet use in a community outpatient orthopaedic practice. Iowa Orthop J 2002;22:103-7.
2. Beall MS, 3rd, Golladay GJ, Greenfield ML, Hensinger RN, Biermann JS. Use of the Internet by pediatric orthopaedic outpatients. J Pediatr Orthop 2002;22-2:261-4.
3. Krempec J, Hall J, Biermann JS. Internet use by patients in orthopaedic surgery. Iowa Orthop J 2003;23:80-2.
4. Bichakjian CK, Schwartz JL, Wang TS, Hall JM, Johnson TM, Biermann JS. Melanoma information on the Internet: often incomplete – a public health opportunity? J Clin Oncol 2002;20-1:134-41.

Articles