Full Text Article Open Access
Citation: Tarantino A, Folath M, Venosa M, Cazzato G, Schettini I, Padua R, et al. Evaluating orthopaedic robotic surgery
information resources: A European web-based study using DISCERN instrument. Jr. med. res. 2023; 6(2):3-5.
Tarantino et al © All rights are reserved. https://doi.org/10.32512/jmr.6.2.2023/3.5
Submit your manuscript: www.jmedicalresearch.com
Background
Orthopedic robotic surgery is having constant development in Italy. It was
implemented in several centres the past decade. This has contributed to
the creation of multiple information online resources regarding this
practice. However, due to the lack of evidence-based resources and the
multiplicity of individual initiatives, the available data is still heterogenous
and non-consensual. The purpose of this study was to rate the quality of
web-written information materials regarding robotic orthopedic surgery in
different European countries websites.
Methods
A Google search using the keyword “orthopedic” ,“robotic” and “surgery"
was performed in Italian for Italy-based websites, Spanish for Spanish-
based websites, English for England-based and French for French-based
websites to analyse the quality of the first fifty records using the DISCERN
instrument.
Results
A total of 270 websites were visited and analysed. Seventy sites were
discarded for duplicate or irrelevant content. Among the 200 examined
sites, 26 belonged to individual surgeons (13%), 49 to private hospitals
(24.5%), 81 to information sites (40.5%), 12 were connected to public
hospitals (6%), 17 to universities (8.5%) and 15 to scientific journals
(7.5%). Thirty-seven-point five percent of materials collected were related
to lucrative companies sites.
According to the DISCERN scale ASSESSMENT, only 35 sites (17.5%) were
scored fair or above (39-50), while the remaining 82.5% were classified
as “poor” or “very poor”.
Conclusions
The quality of information on robotic surgery is low for several countries.
Orthopedic surgeons and hospitals interested in promoting this technique
should refer their patients to valuable resources to improve the quality of
the service according to scientific evidence.
Key words
Orthopaedics; robotic surgery; internet; patient information; DISCERN
instrument.
1:Department of Orthopaedics, Casilino polyclinic,
Rome, Italy.
2:Department of Orthopedics, Al Emadi Hospital,
Doha, Qatar.
3:University of L'Aquila, Abruzzo, Italy.
* Corresponding author
Correspondence to:
Alessio.tarantino1984@gmail.com
Publication data:
Submitted: March 22, 2023
Accepted: September 18, 2023
Online: November 30, 2023
This article was subject to full peer-review.
This is an open access article distributed under the
terms of the Creative Commons Attribution Non-
Commercial License 4.0 (CCBY-NC) allowing to
share and adapt.
Share: copy and redistribute the material in any
medium or format.
Adapt: remix, transform, and build upon the
licensed material.
the work provided must be properly cited and
cannot be used for commercial purpose.
Tarantino Alessio
1,3*
, Folath Mohamad
2
, Venosa Michele
1,3
, Cazzato Gianpiero
1,3
, Schettini Irene
1,3
, Padua Roberto
1,3
, Logroscino Giandomenico
1,3
, Romanini Emilio
1,3
.
Abstract
Original Article
Evaluating orthopedic robotic surgery information resources: A European web-based study using DISCERN instrument.
Evaluating orthopaedic robotic surgery information resources: A European web-based study using DISCERN instrument
Citation: Tarantino A, Folath M, Venosa M, Cazzato G, Schettini I, Padua R, et al. Evaluating orthopaedic robotic surgery
information resources: A European web-based study using DISCERN instrument. Jr. med. res. 2023; 6(2):3-5.
Tarantino et al © All rights are reserved. Submit your manuscript: www.jmedicalresearch.com
Introduction
Orthopedic robotic surgical techniques are constantly progressing
worldwide especially for primary knee and hip arthroplasty [1-3].
Recently a direct web-based information system was developed to
healthcare consumers. The aim of this system implementation is
basically to highlight the potential advantages of the robotic
procedure to the patients. However, web-based information is
rarely peer-reviewed and usually generating confusion [4]. The
lack of the competing interest disclosure and the use of search
engine optimization tools constituted another bias reducing the
scientific integrity of the delivered information [5-7].
The aim of the study was to evaluate objectively the quality of
available written health information regarding robotic orthopedic
surgery in four different languages with a focus on the reliability
and effectiveness.
Among the parameters considered for the reliability of the Italian
web-based information, only three sites provided adequately cited
bibliographic references. Referencing and citation were noted in 17
English sites, 10 Spanish sites and 8 French sites. One Italian, three
Spanish, one French and four English websites detailed at least one
time the advantages of the robotic orthopedic surgery compared
to the conventional surgery technique. Only 11 sites provided
sufficient information about the risks of the procedure and its
specific morbidity. Using the DISCERN instrument, 35 websites
were classified "fair" or above mostly from English literature. A
total of 139 sites were considered “very poor” (table 1).
Table1 : DISCERN scores.
Statistical descriptive analysis showed highest average DISCERN
score for indexed scientific articles and personal surgeon websites.
The lowest average score is recoded by sites of private health
institutions(table2).
Table2: Discern score listed according to written information resources.
4
Results
Among the included 200 websites, 37.5% belonged to the private
healthcare sector and 6% to national public health sector. Health
sciences and medical related websites represented 42% of the total
of studied pages. All sites distribution is detailed in figure 1.
Figure1 :affiliation of the studied websites according to different literature languages.
Italian sites
English sites
Spanish sites
French sites
Very Poor
46
23
33
37
Poor
2
12
7
5
Fair
2
5
4
4
Good
0
2
4
4
Excellent
0
8
2
0
Informational
Private hospital
Scientific articles
Personal
Mean
25.81
23.37
61.64
27.3
Standard error
1.36
1.79
3.64
5.93
Standard deviation
2.72
3.59
5.14
11.86
Sample variance
7.37
12.86
26.45
140.76
Discussion
Searching for medical information on the internet and different
social networks has experienced exponential growth the past years
[8,9]. This has considerably influenced the choice, patients decision
and doctor-patient relationship [10,11]. The implementation of new
surgical technique is widely based on the online resources for the
advertisement of different materials, education and training of the
health practitioners [12].
Evaluating orthopaedic robotic surgery information resources: A European web-based study using DISCERN instrument
Citation: Tarantino A, Folath M, Venosa M, Cazzato G, Schettini I, Padua R, et al. Evaluating orthopaedic robotic surgery
information resources: A European web-based study using DISCERN instrument. Jr. med. res. 2023; 6(2):3-5.
Tarantino et al © All rights are reserved. Submit your manuscript: www.jmedicalresearch.com
References
[1]Bullock EKC, Brown MJ, Clark G, Plant JGA, Blakeney WG. Robotics in Total Hip Arthroplasty:
Current Concepts. J Clin Med. 2022;11:6674.
[2]Stauffer TP, Kim BI, Grant C, Adams SB, Anastasio AT. Robotic Technology in Foot and Ankle
Surgery: A Comprehensive Review. Sensors (Basel). 2023;23:686.
[3]Li C, Wang L, Perka C, Trampuz A. Clinical application of robotic orthopedic surgery: a bibliometric
study. BMC Musculoskelet Disord. 2021;22:968.
[4]Power EGM. Considerations for Effective Communication of Medical Information. Pharmaceut Med.
2023;37:97-101.
[5]Davaris MT, Dowsey MM, Bunzli S, Choong PF. Arthroplasty information on the internet: quality or
quantity? Bone Jt Open. 2020;1:64-73.
[6]Zhang D, Schumacher C, Harris MB. The quality and readability of internet information regarding
clavicle fractures. J Orthop Sci. 2016;21:143-6.
[7]Yermilov I, Chow W, Devgan L, Makary MA, Ko CY. What is the quality of surgery-related
information on the internet? Lessons learned from a standardized evaluation of 10 common
operations. J Am Coll Surg. 2008 ;207:580-6.
[8]Yeung TM, Sacchi M, Mortensen NJ, Spinelli A. Assessment of the Quality of Patient-Orientated
Information on Surgery for Crohn's Disease on the Internet. Dis Colon Rectum. 2015;58:857-61.
[9]Venosa M, Tarantino A, Schettini I, Padua R, Cifone MG, Calvisi V, Romanini E. Stem cells in
orthopedic web information: An Assessment with the DISCERN Tool. Cartilage. 2021 ;13:519S-5S.
[10]Charnock D, Shepperd S, Needham G, Gann R. DISCERN: an instrument for judging the quality
of written consumer health information on treatment choices. J Epidemiol Community Health.
1999;53:105-11.
[11]De Martino I, D'Apolito R, McLawhorn AS, Fehring KA, Sculco PK, Gasparini G. social media for
patients: benefits and drawbacks. Curr Rev Musculoskelet Med. 2017 ;10:141-45.
[12]Shen TS, Driscoll DA, Islam W, Bovonratwet P, Haas SB, Su EP. Modern Internet search analytics
and total joint arthroplasty: What Are Patients Asking and Reading Online? J Arthroplasty.
2021;36:1224-31.
[13]Griffiths SZ, Albana MF, Bianco LD, Pontes MC, Wu ES. Robotic-assisted total knee arthroplasty:
An assessment of content, quality, and readability of available Internet resources. J Arthroplasty.
2021;36:946-52.
[14]Sheridan GA, O'Brien C, Masri BA, Duncan CP, Garbuz DS. Revision total hip arthroplasty: An
analysis of the quality and readability of information on the internet. World J Orthop.2020;11:82-89.
[15] Ali M, Phillips D, Kamson A, Nivar I, Dahl R, Hallock R. Learning Curve of Robotic-Assisted Total
Knee Arthroplasty for Non-Fellowship-Trained Orthopedic Surgeons. Arthroplast Today. 2022;13:194-
198.
[16]Zhang J, Ng N, Scott CEH, Blyth MJG, Haddad FS, Macpherson GJ, Patton JT, Clement ND. Robotic
arm-assisted versus manual unicompartmental knee arthroplasty : a systematic review and meta-
analysis of the MAKO robotic system. Bone Joint J. 2022;104:541-48.
[17]Crozier-Shaw G, Queally JM, Quinlan JF. Metal-on-Metal Total Hip Arthroplasty: Quality of Online
Patient Information. Orthopedics. 2017;40:e262-e268.
[18]Zade RT, Tartaglione JP, Chisena E, Adams CT, DiCaprio MR. The Quality of Online Orthopaedic
Oncology Information. J Am Acad Orthop Surg Glob Res Rev. 2020;4:e19.00181.
[19]Bilgin NC, Kesgin MT, Gucuk S, Ak B. Assessment of internet usage for health-related information
among clients utilizing primary health care services.Niger J Clin Pract. 2019;22:1467-74.
[20] Zhou H, Zhang J, Su J. Internet access, usage and trust among medical professionals in China:
A web-based survey. Int J Nurs Sci. 2020;7:S38-S45.
[21]Peng Y, Yin P, Deng Z, Wang R. Patient-physician interaction and trust in online health
community: The Role of Perceived Usefulness of Health Information and Services. Int J Environ Res
Public Health. 2019;17:139.
[22] Kayani B, Konan S, Ayuob A, Onochie E, Al-Jabri T, Haddad FS. Robotic technology in total knee
arthroplasty: a systematic review. EFORT Open Rev. 2019;4:611-17.
[23] St Mart JP, Goh EL, Shah Z. Robotics in total hip arthroplasty: a review of the evolution,
application and evidence base. EFORT Open Rev. 2020;5:866-73.
[24] Shan Y, Xing Z, Dong Z, Ji M, Wang D, Cao X. Translating and adapting the DISCERN instrument
into a simplified Chinese version and validating its reliability: Development and usability study. J Med
Internet Res. 2023;25:e40733.
[25] Allam A, Schulz PJ, Krauthammer M. Toward automated assessment of health Web page quality
using the DISCERN instrument. J Am Med Inform Assoc. 2017;24:481-87.
5
Regarding major innovative procedures implemented in orthopedic
practice over the past two decades, the presentation of written health
information was usually highlighting the procedure real or presumed
benefits more than its specific risk [13]. That was the example of
computer-assisted arthroplasty, different techniques of partial knee
arthroplasty, hip resurfacing and direct anterior approach [14,15].
Totally robotic or robot-assisted knee orthopedic procedures had quick
implementation. This could be due to simplified online appointment
booking and check-in widely used in most of health facilities proposing
these procedures [16]. More than ninety percent of robotic orthopedic
surgery and robotic surgeons provide more options to facilitate the
access for this health service. However, academic medical journal
websites are presenting medical evidence and did not add to the link
patients-service providers [17].
Up to date, no systems are provided to control the quality of written
medical information on almost all search engines. Available resources
allow only brute presentation of the information with poor editing and
minimally reviewed statements. Among these topics, we noted written
information regarding most of the elective orthopedic procedures such
as knee and hip arthroplasty. An overall higher quality of presentation
were noted in cancer related sites and oncological orthopedics [18,19].
Written information of non-commercial sites was significantly more
reliable than lucrative sites. Confrontation and comparative tools are
usually not available. This give less options to patients in their decision
making [20].
Several studies were performed to assess reliability of the online health
consumer written resources [20,21]. Some non-official independent
organizations such Health on the Net (HON) tried do provide a peer
reviewed assessments testing the impartiality and reliability of the
medical information dissemination. The aim was to provide information
seekers with an objective guidance to the most reliable resources
[22].Only one of the sites included in our analysis was HON certified.
Healthcare practitioners are constantly present and posting written
information on alternative resources such as social media networks.
The written information in this case is delivered as brief communication
for self-promotion and advertisement and rarely detail all sides of the
procedure [23]. The wide variation in the quality of written information
available to patients regarding their conditions best treatment justifies
the need for assessment scales such as “Patient education Materials
Assessment Tool” and “ the suitability assessment of materials for
evaluation of health-related information”. Primary instruments were in
English and only few were translated [24,25].
DISCERN is an instrument for judging the quality of written consumer
health information on treatment choices. It was objective assessment
tool of information regarding several diseases. However, its use was
initially limited to specialists.
Our study might have highlighted the heterogeneity of online health
consumer written information European resources regarding affiliation
of the information delivering websites , the difference of languages
studied, and the bias imposed by the commercial factor.
Conclusions
The implementation of robotics in orthopedic surgery represents an
innovation of indisputable value and an objective potential in future
applications. The best health consumer information resources are the
academic and research journals websites. However, the quality of the
delivered information might not be suitable for the patients due to
sophisticated scientific dialect. The use of DISCERN score is still not
accessible to a large part of health consumers due to English editing
and several variably precepted items. Translation of this instrument in
other languages spoken in Europe and centered patient education on
its use may enhance the assessment accuracy.
Conflict of interest: None