Abstract
Background
YouTube is now becoming important for people as a source of health related information. The aim of the present study was to assess the educational quality of YouTube videos related to Total hip replacement.
Methods
A search on YouTube for the term “Total hip replacement” was performed. Data from 47 most relevant videos were collected. Quality assessment checklists with a scale of 0–10 points were developed to evaluate the video content. Videos were grouped into poor quality (grade 0–3), acceptable quality (grade 4–7), and excellent quality (grade 8–10).
Results
91% of videos were of poor educational quality (43/47), 9% were of acceptable quality (4/47) and none of the videos were of excellent quality. Common missing information was regarding non-operative treatment options and types of bearing surfaces.
Conclusions
Videos regarding total hip replacement are frequently viewed on YouTube which is an unreliable educational source for patients, so it is important that surgeons should have knowledge about the available content so as to direct our patients to a suitable source. Also, surgeons should upload more informative videos that can be understood by patients which will be beneficial in providing information and education regarding Total Hip Replacement.
Keywords: YouTube, Total hip replacement, Video
1. Introduction
Total hip replacement (THR) is the treatment of choice for end-stage hip arthritis.1 The Internet now becomes a chief source for medical information.2 There is plenty of information about THR on the internet in the form of videos. YouTube videos have a greater impact on the patient-doctor relationship and also effect treatment compliance. YouTube Videos generally do not go through a review process, lack of information, and truth and not be regularly updated, thus making the quality questionable.4 The aim of the present study was to assess the educational quality of YouTube videos related to THR.
2. Material and methods
A YouTube search was done on 15 January 2020 for THR related videos by using the following search terms: Total hip replacement, Total hip arthroplasty, THR, Hip replacement. The search was done via a web browser without any saved history or “cookies”. For search terms, the first three pages of videos were included in the analysis supposing that users would not access videos beyond the third page, and also the search results became non-specific. Exclusion criteria were videos, not related to THR, duplicated videos, videos with no audio or captions. Data collected were video title, Universal Resource Locator (URL), total views, duration (minutes), publication date, number of likes, dislikes, and comments.
Initially, 126 videos were there, 79 were disqualified as they did not meet the inclusion criteria. 47 videos were included in the present study. The videos were assessed for educational quality regarding THR, through a checklist modified from the work of Koller and Wong et al.3,5 (Table 1). The modified checklist has a scale from 0 to 10. Videos were characterized by the type of video as either educational, surgical technique, news, advertisement, or others and were also segregated by their publisher: physician/hospital, non-physician, patient, or others.
Table 1.
Hip arthroplasty video score checklist.
| 1) Preoperative education | |
| a) Discussion of preoperative preparation | 1 point |
| b) Discussion of concept of hip arthroplasty | 1 point |
| c) Discussion of non-operative options | 1 point |
| 2) Surgical | |
| a) Discussion of Bearing surface (MoP, CoC, MoM, CoP) | 1 point |
| b) Approach to hip (anterior, anterolateral, lateral, posterior) | 1point |
| c) Restoration of hip biomechanics (offset, leg length) | 1 point |
| 3) Post surgical | |
| a) Discussion of post-operative mobilisation/physiotherapy | 1 point |
| b) Discussion on functional outcome | 1 point |
| c) Discussion on possible complication including (nerve injury for Vessel injury, periprosthetic fracture, Dislocation, implant failure Venous thromboembolism) | 0.5 points each maximum of 2 points |
Mop- Metal- on -polyethylene,CoC- ceramic –on – ceramic, MoM –Metal –on –Metal, CoP – Ceramic –on - polyethylene.
Videos were categorized according to educational quality as either poor (grade 0–3), acceptable (grade 4–7), and excellent (grade 8–10). All the scoring was done by the author 1. For intra-observer reliabilities, grading was performed on two occasions, after six weeks the same videos (47) were assessed again by the same author and scoring was compare with the previous score. Institutional review board approval was not required for the present study.
3. Results
A total of 47 videos were assessed. The mean duration was 1.3 min, the number of views per video was 1, 22,622, with a total view count of 5,76,3278. The average number of “likes”, “dislikes, and comments per video was 404, 35, and 26 respectively. In terms of the educational content of videos, 91% (43/47) were of poor quality, 9% acceptable quality (4/47) and none of the videos were of excellent quality (Fig. 1). The origins of videos were as follows: 55% non-physician, 19% physicians/hospital, 21% of videos were by patients, and 4% by others. Regarding the type of videos, 44% educational, 27% related to surgical technique and 21% were industry-sponsored advertisements. The most frequently discussed topics were approach to hip (15%) and discussion of postoperative mobilization/physiotherapy (15%). Discussion on non-operative options (2%) and bearing surface (4%) was the least commonly discussed topics.
Fig. 1.
Scoring of videos regarding total hip replacement.
On comparing both scores of all the videos which were taken 6 weeks apart, it was seen that there was no significant difference between them (p < 0.05).
4. Discussion
The present study showed that videos available on YouTube are an unreliable source of education for patients.
Information based on video is going to grow within subsequent years.6 Video-based information has an effect on the doctor-patient relationship, and 38% of doctors believe that the patient visit becomes less efficient if patients watch these videos before visit.7 In a Study by Koller et al3, 133 videos were assessed of hip arthritis, which showed that 84% were of poor, 14% of moderate and only 2% were of excellent quality. Another study by MacLeod et al8, of 52 videos on quality of information regarding femoroacetabular impingement and found that 53.8% were somewhat useful, 21.1% as moderately useful, 19.2% as not useful, and none were excellent.
In this study, we found that the total number of views, comments, “likes” and “dislikes” did not affect the score of videos.
The topics that are less commonly discussed in YouTube videos may help surgeons in counselling their patients. In the present study, discussion regarding non-operative (2%) and bearing surface (4%) was the least commonly discussed topics. Wong M et al5, did a study on 50 videos discussing knee arthroplasty and found that nonoperative options and implant duration were seen in only 10% videos discussing total knee arthroplasty.
This study will help the surgeons to counsel patients regarding the limitations of using YouTube as an information source for THR.
Limitations of the present study are the scoring checklist used in this study which is modified from the works of Wong M et al5 This study was limited to YouTube videos and we did not review other video sites that may have better educational quality videos. Search on YouTube may change depending on geographic location, history, or other reasons so this might have affected the videos. The other limitation of our study is the small sample size.
5. Conclusions
Videos regarding total hip replacement are frequently viewed on YouTube which is an unreliable educational source for patients, so it is important that surgeons should have knowledge about the available content so as to direct our patients to a suitable source. Also, surgeons should upload more informative videos that can be understood by patients which will be beneficial in providing information and education regarding Total Hip Replacement.
Source of funding
None.
Declaration of competing interest
The authors do not have any conflict of interests.
Contributor Information
Amit Kumar Yadav, Email: amit_aur09@yahoo.com.
G.S. Prasanna Kumar, Email: prasannakumargs5@gmail.com.
Vikram Khanna, Email: 86.khanna@gmail.com.
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