CORR Insights®: Most YouTube Videos About Carpal Tunnel Syndrome Have the Potential to Reinforce Misconceptions

Where Are We Now?

The internet is an unvetted source of medical information, but also of misinformation and disinformation [9]. Most studies on the accuracy of medical content available on the internet show wide variability in accuracy of information as well as misleading and harmful statements [2, 3, 9, 10], which can cause patients to mistrust the recommendations made by their medical providers. And yet, many patients use the internet as their primary source of medical information; in fact, research suggests that the strength of the relationship with the patient’s medical provider is inversely correlated with the patient’s usage of the internet for decision making [8]. With declining reimbursement for patient visits, increased emphasis on documentation in the electronic medical record resulting in shorter face time with patients, and a heavier reliance on telemedicine, the quality of doctor-patient relationships is eroding. This opens a gap that patients fill by turning to “Dr. Google” for medical answers instead of trusting their providers, which could lead to healthcare decisions based on misinformation.

In my opinion, there is too much medical information on the internet that is provided by clinicians and institutions who use the platform as an advertisement to gain referrals, increase market share, and expand their brand. That may be good for business, but it does little for patients. These professional websites that double as marketing tools for providers offer information on a broad range of topics to show their expertise. While the pretense is educational, they often end by prompting the user to schedule an appointment. Since the emphasis on these presentations is marketing, most of the information may be generally correct but not be entirely accurate and may propagate some misconceptions that could lead patients to make unhealthy choices. In addition, some clinicians may advertise their unique treatment as the “best” even if it lacks evidence at the expense of what would be considered current standard of care. This provides further confusion to patients when it is unclear whether these proposed treatments have any scientific basis and are unable to properly evaluate the peer-reviewed evidence base.

In their study in this month’s Clinical Orthopaedics and Related Research®, Goyal et al. [5] evaluated 60 YouTube videos related to the cause, diagnosis, and/or treatment of carpal tunnel syndrome. The authors then noted the potential of these videos to reinforce misinformation or their ability to reorient viewers toward better information by dispelling popular misconceptions. Nearly half of the videos were provided by reputable organizations, but 78% of the videos provided at least one statement that reinforced a misconception related to carpal tunnel syndrome, with an average of two misconceptions per video. These videos averaged nearly 20,000 views, and the video with the most views garnered more than 85,000. Unfortunately, greater popularity was not correlated with fewer misconceptions, displacing the notion that more frequently visited videos could indicate “better” or more accurate information. Some 38% of sites stated that carpal tunnel syndrome was caused by hand overuse, and 37% declared that splints were disease modifying; no robust evidence supports those types of claims. Certainly, most clinicians use splints or steroid injections to manage symptoms early in the disease process, but these interventions are not expected to cure carpal tunnel syndrome. This may seem like semantics, but the authors [5] make the point that clinicians need to be particularly sensitive to propagating misinformation in order to decrease catastrophic thinking and facilitate better decision-making among patients with carpal tunnel syndrome. For example, if our patients believe that repetitive activity is a cause of pain from carpal tunnel syndrome, some patients may be prone to “worst-case thinking and kinesiophobia” [5] and use this misinformation to avoid activity, which needlessly diminishes their capability.

Where Do We Need To Go?

Overall, clinicians need to be aware of their potential role in reinforcing misinformation related to carpal tunnel syndrome and all musculoskeletal diseases. We don’t always fully discuss the problem, etiology, and treatment of an injury. Many times, we assume that if patients don’t ask questions, they are satisfied with the visit. But considering that office visits are often short, they have little time to assimilate the information. In addition, it has been shown that patients forget over 80% of the information verbally communicated in the office [6], and their ability to process information and ask immediate questions may be limited, especially in those with less medical or educational backgrounds. This also likely leads patients to later refer to the internet to improve their understanding of the injury.

Physicians need to assume that patients will look for additional information after they leave the office, and so it is our job to provide good sources of information that we know to be both accurate and current. To do this, we also need to determine the best educational platform for patients of different ages, genders, and socioeconomic status. Future research needs to focus on whether we need different sources of information for different patients.

How Do We Get There?

To minimize the clinician’s role in reinforcing misinformation, we need to address common misconceptions and lesson their propagation. For example, when a patient presents with symptoms similar to carpal tunnel syndrome and then attributes the pain to their typing, we should gently educate them about how light repetitive activities are not a cause of carpal tunnel syndrome, although symptoms may be experienced during those activities. Too often, it is easier to ignore that statement by the patient and move on to the treatment without addressing the misconception. Even if our patients receive appropriate carpal tunnel release, they may still be anxious about further recurrence with continued typing, even though this was not the original source. The supplemental educational brochures we provide or the websites we direct them to should correlate with the information offered in the office. Even though patients may not ask for more information, we should be proactive in directing them to sites with the best information.

Future studies should compare the efficacy of old-fashioned brochures provided to patients in the office versus reputable websites. We could also compare both approaches to video content provided in the office during the scheduling of surgery for carpal tunnel syndrome. There are certainly pros and cons to each of these. Although a brochure ensures that the patient received the information that we want them to view, it still requires the clinician to either develop or review the information for accuracy. Providing a video instruction in the office also ensures that the patient receives approved information, but it’s more expensive to develop, takes up more time in the office, and does not leave the patient with a source to refer back to when thinking of later questions. Direction to a website is the most efficient for the clinician, but requires more steps for the patient to review the content, which may result in less patients to view that clinician-directed site.

Future studies must address attention to socioeconomic status, educational background, race, and gender [1, 4, 7], since the best approach for educating patients may vary with those factors. There may not be a one-size-fits-all answer for all groups. Older patients or those of lower socioeconomic status may prefer a written brochure they carry out with them. More educated patients that are routinely on the internet and have been brought up using medical websites for their source of information may prefer this direction. Outcome measures could include how well patients understood their disease entity and what information was most influential as they decided on a treatment.

Patients scanning the internet for general education on their problem have a difficult time deciphering standard treatment from newer unproven treatments. Our medical societies should encourage disclaimers, review current websites, and also be a source of preferred websites for patients to view.