Aims

Total joint replacement (TJR) is a high-cost, high-volume procedure that impacts patients’ quality of life. Informed decisions are important for patients facing TJR. The quality of information provided by websites regarding TJR is highly variable. We aimed to measure the quality of TJR information online.

Background. Internet delivered interventions may provide a route to rapid support for behavioural self-management for low back pain (LBP) that could be widely applied within primary care. Although evidence is emerging that more complex technologies (mobile apps linked to digital wristbands) can have some impact on LBP-related disability, there is a need to determine the effectiveness of highly accessible, web-based support for self-management for LBP. Methods and results. We conducted a multi-centre pragmatic randomised controlled trial, testing ‘SupportBack’, an accessible internet intervention developed specifically for primary care. We aimed to determine the effectiveness of the SupportBack interventions in reducing LBP-related physical disability in primary care patients. Participants were randomised to 1 of 3 arms: 1) Usual care + internet intervention + physiotherapy telephone support, 2) Usual care + internet intervention, 3) Usual care alone. Utilising a repeated measures design, the primary outcome for the trial was disability over 12 months using the Roland Morris Disability Questionnaire (RMDQ) at 6 weeks, 3, 6 and 12 months. Results: 826 were randomised, with follow-up rates: 6 weeks = 83%; 3 months = 72%; 6 months = 70%; 12 months = 79%. Analysis is ongoing, comparing each intervention arm versus usual care alone. The key results will be presented at the conference. Conclusion. We believe this to be the largest trial of it's kind internationally. The trial will extend knowledge regarding the effectiveness of highly accessible internet interventions to support self-management and activity in people with LBP consulting in primary care. Conflicts of interest: No conflicts of interest. Source of funding: NIHR HTA Project number 16/111/78

Background. The internet has revolutionized the way we live our lives. Over 60% of people nationally now have access to the internet. Healthcare is not immune to this phenomenon. We aimed to assess level of access to the internet within our practice population and gauge the level of internet use by these patients and ascertain what characteristics define these individuals. Method. A questionnaire based study. Patients attending a mixture of trauma and elective outpatient clinics in the public and private setting were invited to complete a self-designed questionnaire. Details collected included basic demographics, education level, number of clinic visits, history of surgery, previous clinic satisfaction, body area affected, whether or not they had internet access, health insurance and by what means had they researched their orthopedic complaint. Results. 292 completed the questionnaire (146 M, 146 F). 17 were incomplete and excluded from final analysis. Multiple logistic regression found younger age (O.R. 2.22 in 20–35 age group), possession of health insurance (O.R. 2.65) and higher levels of education (O.R. 8.22 for tertiary education) were all significantly associated with a higher level of access to the internet. Among those with internet access, a second regression analysis showed that a positive history of surgery (O.R. 2.82) and possession of a trade qualification (O.R. 5.15) were the best predictors of internet use to research one's orthopedic condition. Conclusion. Our study showed a level of access comparable with national statistics. It was consistent with previous studies showing younger and better educated had greater access. We believe that this shows there is a niche for increased information provision for those patients who require surgery, but we must be aware access is not available to everyone in the community

Background: There has been an exponential rise in Internet use over recent years with over 11 million homes in the United Kingdom currently having access to the Internet. Previous studies have shown that up to 50% of orthopaedic outpatients have researched their condition on the Internet and that this percentage is dependent upon the condition from which they are suffering. The aim of our study was therefore to assess the prevalence of Internet usage among three groups of orthopaedic outpatients and to further determine how the patients felt their Internet research compared to the information received at consultation. Methods: Data was collected from 150 patients / parents attending three outpatient clinics; 50 consecutive patients attending scoliosis clinic; 50 patients attending paediatric orthopaedic clinic; 50 patients attending back pain clinic. Results: 58% of scoliosis, 22% of general paediatric and 30% of back pain patients had researched their condition on the Internet. 83% of scoliosis, 64% of paediatric and 80% of back pain patients found this information useful. Nearly all patients, however, would trust their doctor more than the Internet. Conclusion: We believe therefore that clinicians need to keep up to date with information available on the Inter-net and provide recommended websites to patients wishing to consolidate their knowledge of their condition

Background:. Internet interventions provide an opportunity to encourage patients with LBP to self-manage and remain active, by tailoring advice and providing evidence-based support for increasing physical activity. This paper reports the development of the ‘SupportBack’ internet intervention, designed for use with usual primary care, as the first stage of a feasibility RCT currently underway comparing: usual primary care alone; usual care plus the internet intervention; usual care plus the internet intervention with physiotherapist telephone support. Methods:. The internet intervention delivers a 6-week, tailored programme focused on graded goal setting, self-monitoring, and provision of tailored feedback to encourage physical activity/exercise increases or maintenance. 22 patients with back pain from primary care took part in ‘think aloud’ interviews, to qualitatively explore the intervention, provide feedback on its relevance and quality and identify any extraneous content or omissions. Results:. Valuable feedback and suggested amendments from patients included individually-tailoring the activity programme, using the individual's current pain or activity level. Patients reported that the goal setting module was helpful, and were content with the range of activities offered by ‘SupportBack’. The majority of patients reported they would accept their GP's recommendation and use a credible internet intervention such as this programme to help improve self-management. Conclusions:. The development of the ‘SupportBack’ internet intervention has worked with patients to create an acceptable online tailored resource to supplement primary care management for patients with low back pain. The intervention is currently being trialled to determine feasibility and the most appropriate way to support its delivery

The objective of this study was to examine patients’ use of the Internet to obtain medical information, their opinions on the quality of medical Web sites and their attitudes towards Internet-based consultations. The study made use of a questionnaire given to 398 patients, aged 10 to 95 years (mean 55 years), visiting the orthopaedic outpatient clinics of a London district general hospital over a 2 week period. The major outcome measures were; 1) the rate of Internet use by patients, 2) the perception of the quality of medical websites, 3) future intentions and attitudes towards internet-based consultations, and 4) concurrence between information obtained from Web sites and advice given by the orthopaedic surgeon in the clinic. Results were considered significant at p< 0.05. The Chi. 2. test was used to compare proportions. Spearman’s correlation coefficients were used to quantify correlation. From 369 respondents (response rate 91%), 55.3% of patients had accessed the Internet. Of these 52.0% had obtained medical information from this source. Access was linearly correlated with age (r. 2. =0.975, p< 0.01) and was also related to social status. Of the 12.3% of patients who had researched their particular orthopaedic condition, 20% reported that the advice received from the surgeon in the clinical contradicted that obtained from the Internet. A total of 37.5% of patients would undergo an Internet-based consultation, whilst a further 25.5% would consider this, depending on the medical condition in question. This is the first detailed UK study examining patient attitude towards Web-based medical learning. Over half of the patients were willing to access the Internet for medical information, with younger patients more likely to undertake this activity. As the commercial advantages of a captive patient population become apparent, there is the potential for inaccurate or misleading information, that has not undergone peer review, to be disseminated over the Internet The increased use of medical Websites by patients raised important issues regarding the need for quality control, which orthopaedic surgeons and their institutions both need to address. This also impacts significantly upon the changing nature of the surgeon-patient relationship

Summary Statement. The purpose is to evaluate the effects of internet usage on new patient referral patterns to identify optimal patient recruitment and communication. Overall, social networking and internet may be an effective way for surgeons to recruit a wider patient population. Introduction. Prior studies in other medical specialties have shown that social networking and internet usage has become an increasingly important means of patient communication and referral. However, this information is lacking in the orthopaedics literature. In this study, we evaluate the means by which new patients arrive at orthopaedic clinics in a major academic center. The purpose is to evaluate the effects of internet or social media usage on new patient referral patterns to identify avenues to optimise patient recruitment and communication. Patients and Methods. New patients were recruited in a major academic orthopaedic clinic to complete a 15-item questionnaire with demographic information, social media use/networking and referral method. Data was collected for all orthopaedic sub-specialties and analyzed accordingly. Statistical analysis was performed. Results. Of the 752 responses, there were 66% female and 34% male responses. Responses were obtained from hand (142), sports medicine (303), foot and ankle (129), joints/tumor (95) and trauma (83) services. Overall, 51% report using social networking sites such as Facebook or Twitter. Of the patients that report not using social network sites, 92% are over the age of 40. Joints/tumor patients most commonly had seen another orthopaedic surgeon prior to their visit (59%) and had prior surgery (42%). Most patients traveled under 60 miles and were referred by their primary care physicians. Between 18–26% of all patients used a physician review website before consultation. The majority of the patients prefer communicating with their physician via the phone(68%) compared to email(32%). Independent associations found that sports medicine patients tend to be higher social networking users (35.9%) relative to other services (9.8–17.9%) and was statistically higher when compared to the joints/tumor service (P<.0001). The multivariate logistic regression model showed that the sports service was generally more likely to have social networking users with the exception of the foot/ankle service), however these differences were not statistically significant. The biggest indicator predicting social media usage in the orthopaedic population was age. The older the patient population, the less likely patients will use social networking sites. Non-doctorate patients were more likely to be social media users compared to doctorate level individuals, but was not statistically significant. Patients that lived from 120 to 180 miles from the hospital were significantly more likely to be social media users, as were patients that did research on their condition prior to their new patient appointment. Discussion and Conclusion. Orthopaedic patients who use social media are more likely to be younger, research their condition prior to their appointment and undergo an average day's travel (120–180 miles) to see a physician. Up to 26% of all patients have seen or used a physician review site prior to their visit. Despite the increased social media usage, most orthopaedic patients still prefer telephone communication with their physicians. Overall, social networking and internet may be an effective way for surgeons to recruit a wider patient population. In an increasingly competitive market, surgeons with younger patient populations (Sports Medicine) will need to utilise social networking and the internet to capture new patient referrals

Patients had traditionally relied on health care professionals for advice and treatment options for most orthopaedic conditions including degenerative lumbar spine disease. However the unprecedented access to heath care information offered by the internet is changing the way how patients gather information and make treatment choices. Aims & Methods: The purpose of this study was to determine the influence of the internet on patients presenting to orthopaedic clinics with degenerative lumbar spine disease and its influence on decision making. A power calculation was done to determine appropriate sample size needed for the study. Questionnaires were handed to willing patients who were attending back clinic for more 6 months and diagnosed to have degenerative lumbar spine disease. Each participant filled a 25 point survey and a total of 105 surveys were collected. Results: Out of the 79% who had access to the internet, 55% accessed it from home which is in comparison to the national statistics of 57%. The rest of 24% access internet at other places. Internet usage was found to be directly proportional to education and earnings with 100% in professionals and then dropping significantly. 80% living in urban areas used internet to access health information. Topics commonly searched include causes (74%), symptoms (70%), treatment/surgical options (82%). Only few people looked at the choice of surgeons (30%) and hospitals (30%) as the practice is mostly NHS based. Around 50% made clinical decisions based on their search. 86% used general search engines like yahoo, google, 14% used sites like med line, NHS. UK. Health professionals had more influence in decision making than internet (80%). Conclusions: Internet is evolving as a powerful source of health information and influencing more an more patients in clinical decision making with a 5% growth in internet usage every year (national statistics)

The purpose of the study was to assess the use of the Internet for medical information, both in the Orthopaedic Outpatient population, and in practicing Orthopaedic Surgeons in New Zealand. To identify any potential sites that may be of use to the patient in gaining reliable information on their orthopaedic problem. 300 questionnaires were distributed to Orthopaedic Outpatient Clinics (Public Trauma, Public Elective, and Private) in Christchurch. Each clinic had 100 questionnaires. A second questionnaire was sent out to all Orthopaedic Surgeons currently practising in New Zealand. A literature search was also performed. Overall 18% of patients use the Internet to look up medical problems. Internet use was highest amongst the younger population. 68% of patients had a computer at home. 52% of patients thought recommended Internet sites would be useful. 91 % of patients stated they used their Doctor as their most common source of healthcare information, with only 5% stating the Internet. 76% of Orthopaedic Surgeons used the Internet for work purposes. 54% thought that the Internet misinformed patients. Only 50% of surgeons had accessed the NZOA web site. The Internet is becoming an increasingly common source of healthcare information for patients and doctors. The NZOA site has huge potential for both surgeons and the public with regard to useful links. At present this site is largely under-utilised

Purpose: To check the accuracy of the Internet-derived medical information. Materials and Method: We tested the validity of randomly chosen Internet-derived statements concerning four common orthopaedics problems. Two-hundred statements were gleaned by two nonmedical persons from 30 chosen websites, after employing a common search engine. Fifty statements were derived on each of four separate topics (knee osteoarthritis, hip osteoarthritis, low back pain, and osteoporosis). Five residents in orthopaedic surgery were then asked, to independently rank the accuracy of these statements using a five point rating scale with 1 being strongly disagree to 5 being strongly agree with the statement. Means were then obtained for each question and ranked on validity with > 4 being very valid, > 3 being somewhat valid and < 3 being invalid. Results: Overall score for the 200 statements was 3.81 with 61% deemed very valid, 20% deemed somewhat valid and 19% deemed invalid. For knee osteoarthritis, the overall score was 3.63 with 63% being very valid, 18% being somewhat valid and 19% being deemed invalid. For hip osteoarthritis, the overall score was 3.75 with 58% being very valid, 21% being somewhat valid and 19% deemed invalid. For low back pain, the overall score was 3.91 with 48% being very valid, 36% being somewhat valid and 16% deemed invalid. For osteoporosis, the overall score was 3.96 with 59% being very valid, 18% being somewhat valid and 23% deemed invalid. Conclusion: Approximately 20% of medical information found on the Internet is misleading and, invalid. Patients and physicians who use the Internet to access health information, should be aware of these inaccuracies and better seek advice from reliable medical web sites of universities

Purpose: To determine the level of promotion of minimally invasive surgery (MIS) & computer assisted orthopaedic surgery (CAOS) in total knee replacement (TKR) through internet sites by BASK members. Methods: We obtained an updated list of active members of BASK in March 2007 and permission from the executive committee to undertake this study. Standard search engines commonly used in our daily lives (viz. Google, Yahoo and Ask.com) were used to search for websites related to each surgeon during Sep–Nov 2007 period. The surgeon’s name, initials and job title thereof were used as keywords in conducting the search. Thus for each surgeon, all websites found were browsed and evaluated for MIS/CAOS and TKR/UKR information. Both direct (surgeon’s personal website/private practice) and indirect (group practice/hospital/university affiliation) information from these websites were reviewed and a standard pre-formed questionnaire proforma was filled in against that particular surgeon. Results: A total of 178 websites were found for 405 members (392 inland + 13 overseas). 2.8% and 4.5% made direct and indirect reference to MIS TKR respectively. The most commonly listed benefits of MIS were quicker recovery, smaller incision and hence lesser pain. Very few specific risks of MIS were outlined by these websites. None of the websites quoted any peer-reviewed publication to support their claims. CAOS was discussed in 1.7% and 2.8% of these sites respectively. Conclusion: Our study suggests that many active members do not have personal websites and these procedures are not commonly promoted by them via the internet. Many of these are often associated indirectly with group practice/institutional affiliation websites which may not necessarily be endorsed the surgeon. Our plan in near future is to monitor the changes in internet dissemination of information and close the audit loop by next year

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

The main objective of our review was to access the inter-net websites providing information on non operative treatment of scoliosis and to assess the evidence for each treatment in the medical literature. Methods: We identified top five search engines at the site . www.searchengines.com. The search term “scoliosis treatment” was entered into each search engine. The websites were reviewed and each search engine produced from 145,354 to 5460,000 results. We identified twenty non operative treatments for scoliosis. We further evaluated and studied these non operative treatments by using each treatment as a search term. The accuracy of these treatments was checked by doing a medical literature review. We used Medline 1950 to November 2008 and Embase 1980 to November 2008. Results: 260 websites were duplicated in the five search engines, 103 websites only mentioned surgical treatment of scoliosis, and 10 websites could not be accessed at the time of the study. We evaluated the remaining 127 websites using the key words “scoliosis treatment” to generate a list of twenty unique non operative scoliosis treatments. These treatments when entered individually into the search engines enabled us to produce a list of these treatments in decreasing order of frequency. This was based on the number of results that each treatment generated. These treatments were then entered for search in Medline and Embase, only 45% (9/20) of these treatments were found to have been described in the medical literature. Conclusion: Our study did reveal that information on non operative treatment of scoliosis leaves much to be desired. Based on this study we recommend that it is the duty of the treating surgeon to warn the patients of the potential danger of misinformation that is abundant on the internet. Ethics approval: None. Interest Statement: None

Introduction

The use of osseointegrated limb replacement prostheses for amputees are rapidly growing in popularity due to the many benefits over conventional sockets. Many institutions worldwide are beginning to provide this surgical option to their patients and are advertising the service online. The aim of this study was to assess the quality and reading level of related information available online.

Aims. While internet search engines have been the primary information source for patients’ questions, artificial intelligence large language models like ChatGPT are trending towards becoming the new primary source. The purpose of this study was to determine if ChatGPT can answer patient questions about total hip (THA) and knee arthroplasty (TKA) with consistent accuracy, comprehensiveness, and easy readability. Methods. We posed the 20 most Google-searched questions about THA and TKA, plus ten additional postoperative questions, to ChatGPT. Each question was asked twice to evaluate for consistency in quality. Following each response, we responded with, “Please explain so it is easier to understand,” to evaluate ChatGPT’s ability to reduce response reading grade level, measured as Flesch-Kincaid Grade Level (FKGL). Five resident physicians rated the 120 responses on 1 to 5 accuracy and comprehensiveness scales. Additionally, they answered a “yes” or “no” question regarding acceptability. Mean scores were calculated for each question, and responses were deemed acceptable if ≥ four raters answered “yes.”. Results. The mean accuracy and comprehensiveness scores were 4.26 (95% confidence interval (CI) 4.19 to 4.33) and 3.79 (95% CI 3.69 to 3.89), respectively. Out of all the responses, 59.2% (71/120; 95% CI 50.0% to 67.7%) were acceptable. ChatGPT was consistent when asked the same question twice, giving no significant difference in accuracy (t = 0.821; p = 0.415), comprehensiveness (t = 1.387; p = 0.171), acceptability (χ. 2. = 1.832; p = 0.176), and FKGL (t = 0.264; p = 0.793). There was a significantly lower FKGL (t = 2.204; p = 0.029) for easier responses (11.14; 95% CI 10.57 to 11.71) than original responses (12.15; 95% CI 11.45 to 12.85). Conclusion. ChatGPT answered THA and TKA patient questions with accuracy comparable to previous reports of websites, with adequate comprehensiveness, but with limited acceptability as the sole information source. ChatGPT has potential for answering patient questions about THA and TKA, but needs improvement. Cite this article: Bone Jt Open 2024;5(2):139–146

Aims. This study assesses patient barriers to successful telemedicine care in orthopaedic practices in a large academic practice in the COVID-19 era. Methods. In all, 381 patients scheduled for telemedicine visits with three orthopaedic surgeons in a large academic practice from 1 April 2020 to 12 June 2020 were asked to participate in a telephone survey using a standardized Institutional Review Board-approved script. An unsuccessful telemedicine visit was defined as patient-reported difficulty of use or reported dissatisfaction with teleconferencing. Patient barriers were defined as explicitly reported barriers of unsatisfactory visit using a process-based satisfaction metric. Statistical analyses were conducted using analysis of variances (ANOVAs), ranked ANOVAs, post-hoc pairwise testing, and chi-squared independent analysis with 95% confidence interval. Results. The survey response rate was 39.9% (n = 152). The mean age of patients was 51.1 years (17 to 85), and 55 patients (38%) were male. Of 146 respondents with completion of survey, 27 (18.5%) reported a barrier to completing their telemedicine visit. The majority of patients were satisfied with using telemedicine for their orthopaedic appointment (88.8%), and found the experience to be easy (86.6%). Patient-reported barriers included lack of proper equipment/internet connection (n = 13; 8.6%), scheduling difficulty (n = 2; 1.3%), difficulty following directions (n = 10; 6.6%), and patient-reported discomfort (n = 2; 1.3%). Barriers based on patient characteristics were age > 61 years, non-English primary language, inexperience with video conferencing, and unwillingness to try telemedicine prior to COVID-19. Conclusion. The barriers identified in this study could be used to screen patients who would potentially have an unsuccessful telemedicine visit, allowing practices to provide assistance to patients to reduce the risk of an unsuccessful visit. Cite this article: Bone Jt Open 2021;2(9):745–751

Congenital talipes equinovarus (CTEV), also known as club foot or talipes is a common congenital disorder. Parents are using the Internet more and more as a source of information about health care. Unfortunately, the quality of health care information on the Internet varies. This study looked at information available to parents using two instruments for judging the equality of information on the internet. The top five search engines were searched on Google. Three of these were also included in the top 50 sites in Ireland so these 3 sites were used. The phrases CTEV and club foot were searched from all 3 platforms. Websites were then scrutinized using the HON code and the DISCERN tool. 54 organic sites were found for the 3 search engines using the key word club foot. For the key word CTEV 55 matches were returned for the three search engines. 4 websites displayed the HON code. Using the discern tool CTEV websites had a mean score of 60 with a standard deviation of 17. While club foot had a mean score of 56.8 with a standard deviation of 13. Max score 80. Large volumes of information are available to parents on the Internet. Often parents find comfort in sharing experiences and feel empowered by learning about their children's illnesses. However, information provided on the interned can also be ambiguous and disingenuous. Practitioners should be aware of a number of key websites that parents can be directed towards

This randomised methodological study sought to test the reliability of an Internet questionnaire and investigate the differences in response rates between traditional pen-and-paper questionnaires and Internet questionnaires for measuring patient-reported outcome after total hip arthroplasty (THA) surgery. From the Swedish Hip Arthroplasty Register, 2 400 patients were chosen at random but stratified by age, sex and diagnosis for inclusion in a four-year follow-up using the health-related quality of life (HRQoL) tool EQ-5D and visual analogue scales for pain and satisfaction. The patients were randomized to answer the follow-up model protocol either via a password-protected Internet questionnaire or via a mailed pen-and-paper questionnaire. A reliability test for the Internet follow-up instrument showed adequate correlation. However, the Internet group and the pen-and-paper group differed significantly (p<0.001) with a 92% response rate in the latter and 49% in the former. Adjusted to the normal age distribution of the THA population, the Internet response rate was 34%. The patient-administered Internet questionnaire alone does not give a sufficient response rate in the THA population to replace the pen-and-paper questionnaire. However, the system is reliable and could be used for measuring patient- reported outcome if supplemented with traditional pen-and-paper questionnaires for Internet non-respondents. It is expected that this answer procedure will soon predominate in view of the general development of Internet functions. Register work may then become less resource-consuming and the results may be analysed in real time

Introduction. Pre-operative patient education prior to hip and knee arthroplasty is thought to be beneficial for patients in general, although the clinical effect is unproven. Pre-operative education is now standard practice in many orthopaedic units, including our own. Anecdotally, we found patients in the private sector to be more satisfied with their education than those in the public sector, despite very similar education programs. We set out to investigate this observation and establish whether there were differences in the perception of educational quality between these groups. Methods. After appropriate power calculation, 60 patients in each group (120 total) were interviewed after hip or knee arthroplasty. Satisfaction with education was assessed on a simple 5 point scale and demographic data including internet access was obtained, as well as Short-Form 12 (SF-12) data to establish physical and mental function. The education program in each group was similar, with written material provided and verbal education given at a single pre-operative session. This included specialist nursing and physiotherapy input. Results were analysed with the chi2 test, Mann-Whitney U test and logistic regression as appropriate, with significance at P<0.05. Results. Overall, there was a high level of satisfaction in both groups but patients in the private sector were significantly more satisfied with their pre-operative education. Significant differences were identified between the groups in provision of written information, provision of internet resources, access to the internet, attendance at education sessions and the mental component score of the SF-12. Logistic regression modelling showed that factors influencing satisfaction rates were interdependent. The relationship between lower SF-12 mental component scores and lower satisfaction rates was linear. Conclusion. Private patients are more satisfied with their pre-operative education than public patients, a disparity which may be due to several demographic and educational factors including lower SF-12 mental component scores. The relationships between these factors are complex and not independent. Satisfaction in the public sector may be improved by improving attendance rates at education sessions. However, public patients may not benefit from advances in education that rely on internet access or computer use. Although the use of the internet and computers in general is gaining support, it may not be as beneficial to patients in the public sector as the private sector. This has implications for service provision and planning in arthroplasty units

Reverse shoulder arthroplasty (RSA) is increasingly performed recently. The patients seeking internet as a source of information may get misleading and a false sense of expectation. This study aimed at analysing patient information on internet and establish list of available quality websites to safely recommend to the patients. The study analysed 310 websites from 10 top search engines exploring the quality of patient information using an assessment tool. Search engines used were metasearch (Metacrawlers and Mamma), general search (Google, Altavista, Yahoo, MSN, AOL, Lycos) and health search engines (Medhunt and Excite Health). The study was undertaken by two independent researcher over a four-week period in November 2011. Each Website was evaluated according to RSA-specific content using a point value system with shoulder disease and surgery specific key words on an ordinal scale. Adequacy of the content was analysed in regard with description of diagnosis, procedure, alternate options, postoperative protocol, complications and prognosis. Excluding the repetitions 104 websites were analysed for accessibility, relevance, authenticity, adequacy of patient information and accountability. The median time since update was 12 months. More than 90% of the websites were found to be of poor quality. Only 25% sites targeted mainly people with shoulder problems. 8% of websites were from non profit organisations. Most of these websites were promoting either their service 80 (76%) or some product 12 (11%). The strength of association between two reviewers was very high (r = 0.899). Intra-rater reliability was significant (r = 0.955) with p level < 0.01. The reading level of most of websites were too high for average consumers. There is need for government organizations and professional societies to regulate the information provided by Internet. Until long-term data are available, patients should be warned when using the Internet as a source for health care information