Advertisement

Online Information About the Effectiveness of Shoulder Surgery Is Not Based on the Best Available Evidence: A Content Analysis

      Highlights

      • Most online information about shoulder surgery is not evidence based.
      • Few webpages accurately portray the best available evidence for surgery.
      • Few webpages mention the possible harms of surgery and to avoid surgery if possible.
      • Most webpages mentioned alternatives to surgery and to delay surgery if possible.

      Abstract

      Objective

      To summarize the proportion of consumer webpages on subacromial decompression and rotator cuff repair surgery that make an accurate portrayal of the evidence for these operations (primary outcome), mention the benefits and harms of surgery, outline alternatives to surgery, and make various surgical recommendations.

      Design

      Content analysis.

      Setting

      Online consumer information about subacromial decompression and rotator cuff repair surgery. Webpages were identified through (1) Google searches using terms synonymous with “shoulder pain” and “shoulder surgery” and searching “orthopedic surgeon” linked to each Australian capital city and (2) websites of relevant professional associations (eg, Australian Orthopaedic Association). Two reviewers independently identified webpages and extracted data.

      Participants

      Not applicable.

      Interventions

      Not applicable.

      Main Outcome Measures

      Whether the webpage made an accurate portrayal of the evidence for subacromial decompression or rotator cuff repair surgery (primary outcome), mentioned benefits and harms of surgery, outlined alternatives to surgery, and made various surgical recommendations (eg, delay surgery). Outcome data were summarized using counts and percentages.

      Results

      A total of 155 webpages were analyzed (n=89 on subacromial decompression, n=90 on rotator cuff repair, n=24 on both). Only 18% (n=16) and 4% (n=4) of webpages made an accurate portrayal of the evidence for subacromial decompression and rotator cuff repair surgery, respectively. For subacromial decompression and rotator cuff repair, respectively, 85% (n=76) and 80% (n=72) of webpages mentioned benefits, 38% (n=34) and 47% (n=42) mentioned harms, 94% (n=84) and 92% (n=83) provided alternatives to surgery, and 63% (n=56) and 62% (n=56) recommended delayed surgery (the most common recommendation).

      Conclusions

      Most online information about subacromial decompression and rotator cuff repair surgery does not accurately portray the best available evidence for surgery and may be inadequate to inform patient decision making.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Britt H
        • Miller GC
        • Henderson J
        • et al.
        General practice activity in Australia 2015-16.
        Sydney University Press, Sydney2016
        • Whittle S
        • Buchbinder R
        In the clinic. Rotator cuff disease.
        Ann Intern Med. 2015; 162: ITC1-IT15
        • Jones T
        • Carr AJ
        • Beard D
        • et al.
        Longitudinal study of use and cost of subacromial decompression surgery: the need for effective evaluation of surgical procedures to prevent overtreatment and wasted resources.
        BMJ Open. 2019; 9e030229
        • Karjalainen TV
        • Jain NB
        • Page CM
        • et al.
        Subacromial decompression surgery for rotator cuff disease.
        Cochrane Database Syst Rev. 2019; 1CD005619
        • Karjalainen TV
        • Jain NB
        • Heikkinen J
        • Johnston RV
        • Page CM
        • Buchbinder R
        Surgery for rotator cuff tears.
        Cochrane Database Syst Rev. 2019; 12CD013502
        • Judge A
        • Murphy RJ
        • Maxwell R
        • Arden NK
        • Carr AJ
        Temporal trends and geographical variation in the use of subacromial decompression and rotator cuff repair of the shoulder in England.
        Bone Joint J. 2014; 96-B: 70-74
        • Paloneva J
        • Lepola V
        • Äärimaa V
        • Joukainen A
        • Ylinen J
        • Mattila VM
        Increasing incidence of rotator cuff repairs—a nationwide registry study in Finland.
        BMC Musculoskelet Disord. 2015; 16: 189
        • Zhang AL
        • Montgomery SR
        • Ngo SS
        • Hame SL
        • Wang JC
        • Gamradt SC
        Analysis of rotator cuff repair trends in a large private insurance population.
        Arthroscopy. 2013; 29: 623-629
      1. Medicare. Medicare item reports 2000/2001 to 2018/19. Available at: http://medicarestatistics.humanservices.gov.au/statistics/mbs_item.jsp. Accessed August 25, 2020.

        • Colvin AC
        • Egorova N
        • Harrison AK
        • Moskowitz A
        • Flatow EL
        National trends in rotator cuff repair.
        J Bone Joint Surg Am. 2012; 94: 227-233
        • Thorpe A
        • Hurworth M
        • O'Sullivan P
        • Mitchell T
        • Smith A
        Rising trends in surgery for rotator cuff disease in Western Australia.
        ANZ J Surg. 2016; 86: 801-804
        • Hajjaj FM
        • Salek MS
        • Basra MK
        • Finlay AY
        Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice.
        J R Soc Med. 2010; 103: 178-187
        • Fraval A
        • Ming Chong Y
        • Holcdorf D
        • Plunkett V
        • Tran P
        Internet use by orthopaedic outpatients - current trends and practices.
        Australas Med J. 2012; 5: 633-638
        • Ferreira G
        • Traeger AC
        • Machado G
        • O'Keeffe M
        • Maher CG
        Credibility, accuracy, and comprehensiveness of internet-based information about low back pain: a systematic review.
        J Med Internet Res. 2019; 21: e13357
        • Buchbinder R
        • Bourne A
        Content analysis of consumer information about knee arthroscopy in Australia.
        ANZ J Surg. 2018; 88: 346-353
      2. Statcounter GlobalStats. Search engine market share Australia Dec 2018 - Dec 2019. Available at: https://gs.statcounter.com/search-engine-market-share/all/australia. Accessed January 28, 2020.

      3. SISTRIX. Why (almost) everything you knew about Google CTR is no longer valid. Available at: https://www.sistrix.com/blog/why-almost-everything-you-knew-about-google-ctr-is-no-longer-valid/. Accessed September 23, 2020.

        • Saini V
        • Garcia-Armesto S
        • Klemperer D
        • et al.
        Drivers of poor medical care.
        Lancet. 2017; 390: 178-190
        • Stacey D
        • Légaré F
        • Lewis K
        • et al.
        Decision aids for people facing health treatment or screening decisions.
        Cochrane Database Syst Rev. 2017; 4CD001431
        • Zadro JR
        • Traeger AC
        • Décary S
        • O'Keeffe M
        Problem with patient decision aids.
        BMJ Evid Based Med. 2020; (May 21. [Epub ahead of print])
        • Page MJ
        • Green S
        • McBain B
        • et al.
        Manual therapy and exercise for rotator cuff disease.
        Cochrane Database Syst Rev. 2016; 6CD012224
        • Page MJ
        • Green S
        • Mrocki MA
        • et al.
        Electrotherapy modalities for rotator cuff disease.
        Cochrane Database Syst Rev. 2016; 6CD012225
        • Brox JI
        • Staff PH
        • Ljunggren AE
        • Brevik JI
        Arthroscopic surgery compared with supervised exercises in patients with rotator cuff disease (stage II impingement syndrome).
        BMJ. 1993; 307: 899-903
        • Beard DJ
        • Rees JL
        • Cook JA
        • et al.
        Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial.
        Lancet. 2018; 391: 329-338
        • Moosmayer S
        • Lund G
        • Seljom U
        • et al.
        Comparison between surgery and physiotherapy in the treatment of small and medium-sized tears of the rotator cuff: a randomised controlled study of 103 patients with one-year follow-up.
        J Bone Joint Surg Br. 2010; 92: 83-91