PATIENT CONCERNS ABOUT TOTAL JOINT REPLACEMENT IN EUROPE STUDIED BY INTERNET SEARCH TERM ANALYSIS

Abstract

Introduction: Issues regarding total joint replacement (TJR) are perceived differently between patients and doctors and this may lead to patients being unsatisfied about their consultation or even their procedure as questions were not satisfactorily answered. However, even in a research setting, the real patient concerns are difficult to capture as questionnaires bias the answers to the expectations of the researchers and free interviews require too large numbers for monitoring purposes.

Internet keyword search is an indicator of true patient interest as searches are entered in privacy. It is now technologically possible to monitor search term frequency over time, per region and identify the most frequent related searches.

It is the aim of this study to identify the most popular and fastest rising search terms regarding TJR in Europe by studying internet search history.

Methods: Keywords regarding TJR were analysed in Google Insight, a new application which allows the history of search term frequency (relative popularity to a maximum of 100) to be tracked for any time period since 2004. The 10 most frequently searched related terms are evaluated as well as the fastest growing searches regarding the subject in comparison to the previous year. Keywords analysed were: hip replacement and knee replacement (in UK and USA) and their language equivalents in German, French, Spanish, Dutch and Polish to compare national differences.

Results: In the non-English speaking countries, the top 10 search terms are mostly variants of the original keyword (e.g. total hip surgery instead of replacement). The most popular non-synonymous terms relate to the post-op care such as recovery, rehabilitation or physiotherapy. Their prevalence is higher with knee than hip replacement. No top or fastest growing search term referred to pain, complications or longevity. Only rarely implant type related searches are popular in non-English speaking countries (Spain: hip resurfacing, NL: hemi-knee). Also in the UK and USA searches regarding aftercare are most popular but TJR pain is on the rise, especially with knees. In the UK rising search interests includes NHS issues and two product names (Oxford knee, Birmingham hip). In the USA, search focus is even more specific including most major company names plus cost issues.

Discussion: Internet keyword search history seems a promising tool to monitor and analyse public interest in issues of health care provision across nations. In the context of TJR, a dominant and rising interest was found in recovery issues. It appears beneficial to increase the availability and quality of such information (e.g. instructional videos of rehab exercises). Trends towards patient marketing and cost are still weak in Europe. Professional societies or health care providers may try to steer such interest towards objective information sources.