Mechanisms for Quality Assurance of Orthopaedic Webpages

For webpages there are at least three levels of quality assessment that may be desirable. The first would be provenance, the second content coverage and the third the quality of that coverage. The "provenance" quality is most easily assessed. Silberg et al. (1997) ¹ proposed the four criteria of authorship, disclosure, attribution and currency. While these are important, it remains true that a site could satisfy all these criteria and still be misleading or inadequate. Clough & Oliver (2002) ² proposed that orthopaedic patient information pages on the Internet should cover a set of topics relating to the condition, nonoperative treatment, and operative management. However, even if those topics are covered, there is no certainty that they are covered well. Informatics faces a huge task defining and assessing quality. It will involve the creation of standards, the assessment of pages against those standards and some form of "enforcement" of those standards. An intriguing finding comes from a study of patient information on carpal tunnel syndrome ³ . Fricke et al found that "indicators that make use of the invisible link structure of the Internet are more reliable guides to accurate information". This suggestion that better pages received more links should be further studied and implies an inherent quality mechanism in the Internet.
Some form of central directory of orthopaedic information would seem to be essential to any quality control mechanism. If a listing on the directory became a desirable promotion of traffic to the site (i.e. readership), then the directory itself would be in a position to suggest standards.

Footnotes
Ref	Notes
1	Silberg WM, Lundberg GD, Musacchio RA, 1997. "Assessing, controlling, and assuring the quality of medical information on the Internet: Caveant lector et viewor--Let the reader and viewer beware." JAMA 277 (15): 1244-5 [PubMed]
2	Clough JF, Oliver CW, 2002. "Orthopaedics, networks and computers." J Bone Joint Surg Br 84 (4): 481-5 [PubMed]
3	Frické M, Fallis D, Jones M, Luszko GM, 2005. "Consumer health information on the Internet about carpal tunnel syndrome: indicators of accuracy." Am J Med 118 (2): 168-74 [PubMed] Abstract: PURPOSE: To identify indicators of accuracy for consumer health information on the Internet. METHODS: Several popular search engines were used to find websites on carpal tunnel syndrome. The accuracy and completeness of these sites were determined by orthopedic surgeons. It also was noted whether proposed indicators of accuracy were present. The correlation between proposed indicators of accuracy and the actual accuracy of the sites was calculated. RESULTS: A total of 116 websites and 29 candidate indicators were examined. A high Google toolbar rating of the main page of a site, many inlinks to the main page of a site, and an unbiased presentation of information on carpal tunnel syndrome were considered genuine indicators of accuracy. Many proposed indicators taken from published guidelines did not indicate accuracy (e.g., the author or sponsor having medical credentials). CONCLUSION: There are genuine indicators of the accuracy of health information on the Internet. Determining these indicators, and informing providers and consumers of health information about them, would be useful for public health care. Published guidelines have proposed many indicators that are obvious to unaided observation by the consumer. However, indicators that make use of the invisible link structure of the Internet are more reliable guides to accurate information on carpal tunnel syndrome.

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