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Evaluation of the Quality, Accuracy, and Readability of Online Resources for Dupuytren's Disease: Are They Reliable Resources for Patient Education
Jason H Ghodasra, MD, MSCI; Andrew R Jensen, MD, MBE; Ajay N Gurbani, MD; Vishal V Hegde, MD; Kent T Yamaguchi, MD; Casimir L Dowd, MD
David Geffen School of Medicine at UCLA, Los Angeles, CA

Introduction: The degree to which patients are informed by available educational materials is highly dependent upon the quality, readability, and accuracy of the provided information. With the growing utilization of the Internet, more patients are searching online to learn about their condition. The purpose of this study was to critically evaluate readily available Internet resources for Dupuytren's disease.
Methods: Using three standard Internet search engines, we performed a comprehensive evaluation of the first 50 websites that discussed Dupuytren's. The website's affiliation was identified, and the quality and accuracy of online information were independently evaluated by three reviewers using predetermined scoring criteria based upon current evidence-based recommendations (Table 1). The readability of available resources was evaluated using the Flesch-Kincaid (FK) grade score.
Results: A total of 53 unique websites were identified and evaluated (Figure 1). The average quality and accuracy of the websites was 14.0 3.5 (out of maximum 25) and 11.4 1.0 (out of maximum 12), respectively. The average FK grade level was 10.9 1.5, which is several grades higher than the recommended 8th grade level for general patient education material. Eighty-three percent (44/53) of websites were authored by physicians, and 19% (10/53) contained commercial bias. Mean quality and accuracy ratings were significantly greater in websites authored by physicians (14.5 3.0 vs. 11.7 4.3, p=0.03 and 11.5 0.90 vs. 10.7 1.3, p=0.02, respectively). In addition, mean quality ratings were significantly greater in websites without commercial bias (14.7 3.2 vs. 11.2 2.9, p<0.01). Although 77% (41/53) of online resources discussed palmar fasciectomy and collagenase injections, only 30% (16/53) and 21% (11/53) mentioned the risks or complications of these treatment options, respectively.
Conclusion: The quality of online patient resources for Dupuytren's disease is poor, and the information overestimates the reading ability of the general population. Additionally, the majority of these websites discuss treatment options without reporting their risks, which may fail to provide appropriate patient understanding and treatment expectations. In the absence of quality control on the Internet, physicians should help guide patients towards high quality, accurate, and readable online patient education material.
Table 1 Quality scoring criteriaFigure 1 Study flow diagram


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