ABSTRACT

Objective:

The aim of the present study was to assess the quality, reliability and educational value of health-related information videos about lateral epicondylitis on YouTube.

Method:

The study conducted a search on YouTube on April 1, 2021 using the search term ‘‘lateral epicondylitis’’. Based on relevance to this keyword, the first 50 videos were recorded for assessment. The videos were assessed by two orthopedic surgeons. Video length in seconds, view counts, number of likes, number of dislikes, video category (animation or not), video content, days since upload, and source of upload (uploader) were recorded. All videos were analyzed for length, view counts, number of likes and source of upload. Quality of the videos was assessed using the global quality score (GQS) (score range: 0-4), Journal of the American Medical Association (JAMA) score (0-5), and DISCERN (15-75) score. The data were statistically analyzed according to these scoring systems.

Results:

Like rate had no significant correlation with GQS, DISCERN, and JAMA scores. There was a significant positive correlation between view rate and GQS scores (p=0.038). View rate had no significant correlation with DISCERN (p=0.453) and JAMA scores (p=0.946). There was a significant positive correlation between video power index and GQS scores (p=0.036). Video power index had no significant correlation with DISCERN (p=0.442) and JAMA scores (p=0.938). According to the source of upload, there was a significant difference in JAMA and DISCERN scores between physicians and non-physicians. GQS did not significantly differ (p=0.15) according to the source of upload.

Conclusion:

The analysis of the first 50 videos relevant to lateral epicondylitis on YouTube revealed that videos were uploaded mainly by healthcare professionals. Overall, the 50 videos had an average level of adequacy.

Keywords: Lateral epicondylitis, social media, YouTube

Introduction

The Internet has become the most practical and quickest way to access information in the last three decades. In parallel with the popularity of the Internet, many people utilize the Internet or social media as the first source of information especially before medical procedures to be performed during the pandemic or to learn the details of their diseases. The video-sharing site most commonly used to explain medical conditions and medical procedures is YouTube.

There are currently over 2 billion active YouTube users. Almost 70% of video viewers watch videos on mobile devices (1). Patients often try to gather information about their diseases by watching YouTube videos (2-4). These patients also include those with extremity disorders. In particular, patients with lateral epicondylitis, which is resistant to medical and conservative therapy, go through a more comprehensive search over time. Patients can increase their anxiety levels by constantly thinking about the worst and referring to the most negative examples based on the videos they watch.

Kunst et al. (5) concluded in their study, conducted in 2002, that health-related websites had not been improved enough and had inadequate information. In order for patients to access accurate information, videos need to have a high-quality content about health-related information. However, although accessed by everyone, the utility and accuracy of the information obtained over the Internet is controversial (5).

Since being founded in 2005, YouTube has 30 million daily and 2 billion monthly active users (6). From this point of view, YouTube is a site with visual browsing on almost every topic, including health-related subjects. However, YouTube is a video site established for entertainment or social purposes rather than educational or academic videos.

Although patients utilize the Internet or YouTube to search their medical conditions, only 18% discuss this online search with their clinicians (7). In addition, 75% of chronic patients make online search to reach a final decision just before treatment (8). Despite all, the Internet still does not have an effective control mechanism for health education.

Lateral epicondylitis is a common medical condition seen in orthopedics and physical therapy outpatient clinics. We conducted this study to establish the extent of accurate information obtained by our patients about this condition through online search. Lateral epicondylitis patients, particularly those who work in the heavy industry, are under significant stress to maintain their active work lives. In the literature, orthopedic and physical therapy studies evaluating the quality and specificity of YouTube videos are limited in number. These studies are about scoliosis, bone tumors, arthritis of the hip, and anterior cruciate ligament tear in particular (3,9-12). There is a lack of studies on lateral epicondylitis.

The aim of the present study was to assess the quality, reliability and educational value of health-related information videos about lateral epicondylitis on YouTube.

Materials and Methods

YouTube search

In this study, a search was performed on YouTube on April 1, 2021, using the search term ‘‘lateral epicondylitis’’. Based on the relevance to this keyword, the first 50 videos were recorded for assessment (Table 1). This was considered an appropriate method for video selection because this was an accepted assessment method in other peer-reviewed literature on orthopedic surgery (9). Only videos in English language were included in the study. Videos with information unrelated to lateral epicondylitis, those in non-English languages, those for advertising purposes, and those with only audio were excluded. This study does not contain any human or animal resources, ethical approval was not needed for this study. Patient information was not used in the study. Therefore, the patient consent document was not obtained.

Table 1

The videos were watched independently by two orthopedists. Video length in seconds, view counts, number of likes, number of dislikes, video category (animation or not), video content, days since upload, and source of upload (uploader) were recorded. The source of upload was classified as patient experience, physician, physiotherapist and health website. The video content was categorized as surgical technique, disease-specific assessment, exercise training, and advertisement. For each video, a video power index (VPI) (like ratio × view ratio/100), a view ratio (number of views/days), and a like ratio [like×100/(like + dislike)] were calculated. We used these measurements in our study since they were used in previous studies published in previous peer-reviewed journals (13).

Assessment of video reliability and educational content

Videos were independently scored by two orthopedists according to content, global quality score (GQS), Journal of the American Medical Association (JAMA) score, and DISCERN score (14-16). The videos were watched separately by two orthopedists and then their scores were added up and divided by two, yielding the average GQS, DISCERN, and JAMA scores (Figure 1).

Figure 1

The JAMA scoring system is a non-specific and objective tool for online videos and resources. It consists of 4 individual criteria. Each criterion is scored 1 point and the total score ranges from 0 to 4 points. A score of 4 indicates high reliability and accuracy for the online source, while a score of 0 indicates poor source reliability and accuracy (Table 2).

Table 2

Non-specific educational content quality was assessed using the GQS. The GQS assesses the educational value of video content based on 5 criteria. The source is given 1 point for each of the present criteria. A score of 5 indicates the highest quality of education (Table 3).

Table 3

The DISCERN score generally assesses the video content for integrity, purpose and relevance, objectivity, accuracy of therapeutic options, and the availability of alternative therapeutic options. It is a test consisting of 15 items. Each item is scored from 1 to 5. A score of 63-75 is considered as excellent, 51-62 as good, 39-50 as fair, 28-38 as poor, and <28 as very poor (Table 4).

Table 4

In the study, the VPI, view ratio and like ratio were calculated using respective formulas. The formula used to calculate the view ratio and like ratio were as follows: (number of views/days) and [likex100/(like + dislike)], respectively. The formula used to calculate the VPI was as follows: (like ratio*view ratio/100) (9,13).

Statistical Analysis

Statistical analysis was performed using SPSS 25.0 for Windows 10 software. The independent samples t-test was used to analyze the difference in mean scores between two groups. Correlations among continuous variables were examined using the Pearson’s correlation test. The study was conducted at 95% confidence interval.

Results

All results are summarized in Tables 5,6,7. All analyzed data, mean values, standard deviation and ranges are explained in Table 5. Three (6%) videos included animation, 22 (44%) videos physicians, 10 (20%) videos health websites, 13 (26%) videos physiotherapists, 1 (2%) video commercial product company, 3 (6%) videos academic content, and 1 (2%) video included a patient’s own experience. Regarding video contents, there were 22 (44%) clinical (disease-related) videos, 11 exercise (22%) training videos, 2 (4%) advertisement videos, 11 (22%) disease-specific information videos, 3 (6%) surgical technique and approach videos, and 1 (2%) patient experience video.

Table 5

Table 6

Table 7

According to the Pearson’s correlation test, like ratio was not statistically significantly correlated with GQS (p=0.772), DISCERN (p=0.713), and JAMA (p=0.486) scores. There was a significant positive correlation between view ratio and GQS scores (p=0.038). View ratio had no significant correlation with DISCERN (p=0.453) and JAMA scores (p=0.946). There was a significant positive correlation between view ratio and GQS scores (p=0.036). View ratio had no significant correlation with DISCERN (p=0.442) and JAMA scores (p=0.938).

When sources of upload were classified as physician and non-physician (academic content, commercial product companies, medical content and animation, physiotherapist, physical training or athletic trainer (non-physiotherapist), patient), there was a significant difference in JAMA and DISCERN scores between physicians and non-physicians. GQS did not significantly differ (p=0.15) according to the source of upload. According to this result, the GQS score did not differ between physician and non-physician uploaders. There was a significant difference in JAMA scores (p<0.05) between the sources of upload. There was a significant difference in JAMA scores in favor of physicians between videos uploaded by physicians and by non-physicians. There was a significant difference in DISCERN scores (p<0.05) between the sources of upload. There was a significant difference in DISCERN scores in favor of physicians between videos uploaded by physicians and by non-physicians (Table 7).

There was no significant difference in view ratios (p>0.05) between the sources of upload (physicians and non-physicians). According to this result, the view ratios did not differ between physician and non-physician uploaders. There was no significant difference in like ratios (p>0.05) between the sources of upload (physicians and non-physicians). According to this result, the like ratios did not differ between physician and non-physician uploaders (Table 7).

Discussion

This is the first study to focus on lateral epicondylitis and provide information on the effects of video content quality on patients. The first focus of the study was to discuss how well lateral epicondylitis was explained on YouTube and the quality of video content.

Most of the videos were produced by healthcare professionals in our study. Although the literature review showed that video uploads by patients were not to be underestimated, our study found that videos were mainly uploaded by healthcare professionals.

The mean video length was 5.67 min in our study, while previous studies reported a length of 6.17-16.18 min (3-9-17-18).

The statistical assessments did not reveal any statistically significant relationship among like ratios and GQS, DISCERN and JAMA scores. This finding suggests that video likes by video viewers are not related to video content quality and originality. However, GQS scores were found to have a significant positive correlation with view ratio and VPI (Table 6). The GQS assesses non-specific educational content quality. Obviously, view ratio increases with increasing content, specific information and quality useful for patients. However, DISCERN and JAMA scores were not correlated with like ratio, view ratio and VPI. DISCERN and JAMA scores, which provide more academic and professional information flow, did not attract the attention of video viewers. However, other studies established more likes in low quality videos (19,20).

Our study established statistically significant differences between physician and non-physician uploaders. No significant difference was found in GQS scores and like ratios between physician and non-physician uploaders; however, there was a significant difference in JAMA and DISCERN scores between physician and non-physician uploaders in favor of physicians. Physician uploaders were more successful in describing the current medical condition, explaining the treatments and complications in detail, and questioning the reliability of their resources. However, there was no difference in the like and view ratios, which are the causes of trends on YouTube, between videos uploaded by physicians and non-physicians. However, the review of literature did not identify any significant correlation between videos by uploaders and video quality (20,21).

In their study on bone tumors and YouTube contents, Sezgin and Erman (9) reported the mean GQS, JAMA and DISCERN scores as 2.22 (1-4), 2.12 (1-3), and 33.48 (17-66), respectively. In this study, the average JAMA, GQS and DISCERN scores, which were used to assess various aspects of the videos such as content, appropriateness of treatment, quality, accuracy and reliability, were 3.06, 1.96, and 43.94, respectively. Considering these findings, the video quality in our study was average.

The most important limitation of the study was that the first 50 videos were watched and assessed. However, previous studies were also found to conduct a similar assessment (22,23). Another limitation of the study was that the assessment was made by two orthopedists. Another limitation is that YouTube search ranking varies across countries. However, we found that the most relevant video ranking remained same when the country was changed using proxy networks. Another limitation of the study is that lateral epicondylitis is also referred to as tennis elbow at the same time. In the study, lateral epicondylitis was used instead of tennis elbow as a search word. Tennis elbow search term is a disease that is mostly used by the public. However, lateral epicondylitis is a more scientific and medical term than tennis elbow. However, when the literature is searched, YouTube reviews with the search term tennis elbow have not been done before. Moreover, the search term of tennis elbow and YouTube videos have not been examined in the literature before.

Conclusion

In conclusion, the Internet and YouTube are the first sources that people refer to about health as is every topic in the 21st century. The analysis of the first 50 videos relevant to lateral epicondylitis on YouTube revealed that videos were uploaded mainly by healthcare professionals. Overall, the 50 videos had an average level of adequacy in terms of quality and content. We believe that this study revealed the extent of accurate information obtained on YouTube videos by patients with lateral epicondylitis and the quality standards of the videos watched from the perspective of healthcare professionals.

Ethics

Ethics Committee Approval: This study does not contain any human or animal resources, ethical approval was not needed for this study.

Informed Consent: Patient information was not used in the study. Therefore, the patient consent document was not obtained.

Peer-review: Externally peer-reviewed.

Authorship Contributions

Concept: M.A., A.M., Design: M.A., A.M., Data Collection or Processing: M.A., A.M., Analysis or Interpretation: M.A., A.M., Writing: M.A.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study received no financial support.

References

Statics for youtube. Available from: https://www.youtube.com/intl/en-GB/about/press/

Drozd B, Couvillon E, Suarez A. Medical YouTube videos and methods of evaluation: literature review. JMIR Med Educ 2018;4(1):e3.

Staunton PF, Baker JF, Green J, Devitt A. Online curves: a quality analysis of scoliosis videos on YouTube. Spine (Phila Pa 1976) 2015;40(23):1857-1861.

Powell J, Inglis N, Ronnie J, Large S. The characteristics and motivations of online health information seekers: cross-sectional survey and qualitative interview study. J Med Internet Res 2011;13(1):e20.

Kunst H, Groot D, Latthe MP, Latthe M, Khan KS. Accuracy of information on apparently credible websites: survey of five common health topics. BMJ 2002;324(7337):581-582.

YouTube by the Numbers: Stats, Demographics & Fun Facts. Last Accesed Date: 20.10.2020. Available from: https://www.omnicoreagency.com/youtube-statistics

Ayeni OR, Chan K, Al-Asiri J, Chien T, Sprague S, Liew S, et al. Sources and quality of literature addressing femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc 2013;21(2):415-419.

Perrin A. Americans’ Internet Access: 2000-2015, Vol. 2019. Pew Internet and American Life Project. Washington, DC: Pew Research Center, 2015.

Sezgin BT, Erman ÖS. Assessment of the Quality and Reliability of the Information on Bone Tumor on Youtube. Bagcilar Med Bull 2020;5(3):133-137.

Cassidy JT, Fitzgerald E, Cassidy ES, Cleary M, Byrne DP, Devitt BM, et al. YouTube provides poor information regarding anterior cruciate ligament injury and reconstruction. Knee Surg Sports Traumatol Arthrosc 2018;26(3):840-845.

MacLeod MG, Hoppe DJ, Simunovic N, Bhandari M, Philippon MJ, Ayeni OR. YouTube as an information source for femoroacetabular impingement: a systematic review of video content. Arthroscopy 2015;31(1):136-142.

Fischer J, Geurts J, Valderrabano V, Hügle T. Educational quality of YouTube videos on knee arthrocentesis. J Clin Rheumatol 2013;19(7):373-376.

Erdem MN, Karaca S. Evaluating the accuracy and quality of the information in kyphosis videos shared on YouTube. Spine (Phila Pa 1976) 2018;43(22):E1334-E1339.

AbouZahr C, Boerma T. Health information systems: The foundations of public health. Bull World Health Organ 2005;83(8):578-583.

Silberg WM, Lundberg GD, Musacchio RA. Assessing, controlling and assuring the quality of medical information on the Internet: caveant lector et vieworeLet the reader and viewer beware. JAMA 1997;277(15):1244-1245.

Charnock D, Shepperd S, Needham G, Gann R. DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health 1999;53(2):105-111.

Madathil KC, Rivera-Rodriguez AJ, Greenstein JS, Gramopadhye AK. Healthcare information on YouTube: a systematic review. Health Informatics J 2015;21(3):173-194.

Gokcen HB, Gumussuyu G. A quality analysis of disc herniation videos on YouTube. World Neurosurg 2019:S1878-8750(19)30243-30246. doi: 10.1016/j.wneu.2019.01.146. (Epub ahead of print)

Kumar N, Pandey A, Venkatraman A, Garg N. Are video sharing web sites a useful source of information on hypertension? J Am Soc Hypertens 2014;8(7):481-490.

Lee JS, Seo HS, Hong TH. YouTube as a source of patient information on gallstone disease. World J Gastroenterol 2014;20(14):4066-4070.

Tonyali S. YouTube: A good source for retrograde intrarenal surgery? Invest Clin Urol 2021;62(2):180-185.

Morahan-Martin JM. How internet users find, evaluate, and use online health information: a cross-cultural review. Cyberpsychol Behav 2004;7(5):497-510.

Kucukakkas O, Atar E, Berberoglu AH, Karaman CA, Korkmaz MB. YouTube as an information source for intra-articuler knee injection. Ann Med Res 2019;26(5)918-923.

Assessment of Lateral Epicondylitis Videos on YouTube