title: Online resources for shoulder instability: what are patients reading?
abstract: BACKGROUND
  Evaluations of the medical literature suggest that many online sites provide poor-quality information. The purpose of our study was to investigate the value of online resources for patient education about shoulder instability.
  
  
  METHODS
  Three search terms ("shoulder instability," "loose shoulder," and "shoulder dislocation") were entered into three Internet search engines. Three orthopaedic residents independently gauged the quality and accuracy of the information with use of a set of predetermined scoring criteria, in addition to noting whether or not four potential surgery options were mentioned. The readability of the web sites was evaluated with use of the Flesch-Kincaid score.
  
  
  RESULTS
  Eighty-two unique web sites were evaluated. Quality and accuracy were significantly higher with use of the term "shoulder instability" compared with the term "loose shoulder" (quality, p < 0.001; accuracy, p = 0.001). However, the reading level was significantly more advanced for the "shoulder instability" web sites (p < 0.001). Quality was significantly higher on web sites with reading levels above the eighth grade level (p = 0.001) (88% of web sites). Only twenty-three sites (28%) mentioned surgical options for shoulder instability, and of these, only eight mentioned thermal capsulorrhaphy as a primary treatment.
  
  
  CONCLUSIONS
  Online information regarding shoulder instability is often inaccurate and/or at an inappropriately high reading level. The quality of information is highly dependent on the specific search term used. Clinicians need to be aware of the information that is available online and should help direct patients to proper sites and guide Internet search terms.
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for G.H. Garcia: GarciaGr@hss.edu.
authors.forename: Grant H
authors.initials: GH
authors.lastname: Garcia
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for G.H. Garcia: GarciaGr@hss.edu.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Taylor
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for G.H. Garcia: GarciaGr@hss.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Dy
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for G.H. Garcia: GarciaGr@hss.edu.
authors.forename: Alexander
authors.initials: A
authors.lastname: Christ
authors.affiliation: University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555.
authors.forename: Ronak M
authors.initials: RM
authors.lastname: Patel
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, 333 Earle Ovington Boulevard, Suite 106, Uniondale, NY 11553.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Dines
mesh_terms: D006801:Humans; D020407:Internet; D007593:Joint Instability; D010353:Patient Education as Topic; D012783:Shoulder Dislocation; D012785:Shoulder Joint