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Quality Assessment of Online Resources for Thoracic Outlet Syndrome Patients

  • Wesley Clothier
    Affiliations
    Division of Vascular and Endovascular Surgery, University of Texas Health at San Antonio, San Antonio, TX

    Department of Surgery, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX
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  • John A. Treffalls
    Affiliations
    Division of Vascular and Endovascular Surgery, University of Texas Health at San Antonio, San Antonio, TX

    Department of Surgery, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX
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  • Preston H. Tolbert
    Affiliations
    Division of Vascular and Endovascular Surgery, University of Texas Health at San Antonio, San Antonio, TX

    Department of Surgery, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX
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  • Zach Harbin
    Affiliations
    Division of Vascular and Endovascular Surgery, University of Texas Health at San Antonio, San Antonio, TX

    Department of Surgery, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX
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  • Qi Yan
    Affiliations
    Division of Vascular and Endovascular Surgery, University of Texas Health at San Antonio, San Antonio, TX

    South Texas Center for Vascular Care, South Texas Medical Center, San Antonio, TX
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  • Mark G. Davies
    Correspondence
    Correspondence to: Mark G. Davies, MD, PhD, MBA, Division of Vascular and Endovascular Surgery, South Texas Center for Vascular Care, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MC7741, San Antonio, TX 78229, USA
    Affiliations
    Division of Vascular and Endovascular Surgery, University of Texas Health at San Antonio, San Antonio, TX

    Department of Surgery, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX
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Published:April 21, 2022DOI:https://doi.org/10.1016/j.avsg.2022.04.009

      Background

      The internet has become a leading resource for patients, to research information about their medical conditions. Access to inaccurate information can lead to miscommunication, poor patient satisfaction and effect shared decision-making with the provider. This study seeks to evaluate the quality and readability of patient resources that appear in the top search results for Thoracic Outlet Syndrome (TOS).

      Methods

      Searches were performed for “TOS” and “Thoracic Outlet Syndrome” on the search engines Google ©, Yahoo ©, and Bing©, and on the meta-search platforms Yippy© and Dogpile©. Websites were screened for exclusion and evaluated by 2 reviewers for accountability, interactivity, structure/organization, and content. Exclusion criteria included duplications, no original content on TOS, resources not intended for patients, foreign language, and inaccessible websites. Reviewers came to a consensus on scoring discrepancies. Four indices were used to evaluate readability. Statistical analysis was performed using the Rstudio with ANOVA.

      Results

      In total, 44 websites met inclusion criteria. There were 25 hospital/healthcare organization websites (57%), 11 open access (25%), 5 government agency (11%), 2 professional medical society (5%), and 1 industry sponsored (2%). Median scores were 5.00 out of 16.00 for Accountability (interquartile range IQR: 1.50–8.75), 1.50 out of 5.00 for Interactivity (IQR:1.50–1.50), 3.00 out of 4.00 for Structure/Organization (IQR: 2.00–3.13), 10.00 out of 25.00 for Content (IQR: 7.90–12.63) and 20.25 out of 50.00 for Total Score (IQR: 16.73–27.75). Websites performed well-describing TOS with 98% of websites providing a definition, 90% providing an etiology, 93% providing description or images of the anatomy, 98% providing symptoms of neurogenic TOS, 93% providing symptoms of venous TOS, and 93% providing symptoms of arterial TOS. Physical therapy was the most discussed treatment option (91%) followed by decompression surgery (86%), thrombolysis (41%), vascular repair (39%), interscalene injections (18%), and embolectomy (11%). There was no significant difference across website types for any category other than accountability where Open Access scored the highest (Table II). Readability was difficult with median Flesch Reading Ease formula score correlating to a college level (IQR: 10th–12th grade-college), median Flesch-Kincaid Grade Level of 10 (IQR: 9th−12th grade), median Standardized Measure of Gobbledygook (SMOG) grade of 10 (IQR: 9th–11th grade), and median Dale-Chall Readability Formula Score correlating to 11th–12th grade (IQR: 11th to 12th–college grade level). There was no significant difference between website types for readability.

      Conclusions

      The top web results for TOS have varying degrees of quality with a clear gap in certain areas of information. While websites performed well-explaining the disease, they lacked discussion of the full scope of treatment that may be offered. In addition, readability was poor across all website types which will not help patients’ understanding of their condition. Providers should take into account the variability in websites when entering into shared decision-making discussions with patients.
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