Concussion information online: evaluation of information
quality, content and readability of concussion-related websites

Ahmed OH., Sullivan SJ., Schneiders
AG., McCrory RP. British Journal of Sports Medicine, 2012;46: 675-683.

A lot of people are using the internet
to gather health information; however, not all websites are up to date with the
latest accurate information. Despite the increased attention on concussion the
quality of information online regarding concussions is unclear. Therefore, the purpose
of this study was to evaluate concussion websites for information quality,
content and readability. The website search included 6 Google searches (taking
the top 10 sites on each), concussion expert suggested websites (e.g., Mayo
Clinic), websites hosted by international sporting federation (e.g., FIFA), and
an industry sampling (e.g., ImPACT). Forty-three websites were included in this
study. Information quality was assessed by the inclusion of the HONcode logo
on the website. A concussion expert research team created a new 11-item
concussion information checklist (CONcheck) to evaluate information
content.  The checklist, based on
information in the 2008
Concussion in Sport Statement
included information regarding the mechanism, signs and symptoms, where to go
for medical counsel, and return-to-play measures. Readability was assessed
using the Flesch-Kincaide Grade Level (FKGL) and Flesch Reading Ease
(FRES). The current study found that 30% (13/43) of websites had the Honcode logo. There were no difference
between the HONcode and non HONcode websites and their CONcheck,
FKGL, or FRES scores. Six websites achieved the maximum CONcheck score (20
points) and 7 websites scored the lowest score (0 points). Seventeen websites
gave 1 to 5 pieces of inaccurate information (e.g., You are allowed to return
to play if symptoms resolve in 15 minutes). Over 70% of the websites accurately
reported that loss of consciousness is NOT an essential factor for diagnosis of
a concussion and an individual with concussion may have one or more of the
following symptoms, physical signs, impaired brain function or abnormal
behavior. Six out of 11 CONcheck items were commonly inaccurate, incomplete, or
missing on more than 50% of the websites. The readability scores indicated that
many sites were written for readers at a high school reading level or higher
(FRES ranged from 16.3 to 77.4 and FKGL ranged from 6 to 17.8).

People may be supplementing traditional
face-to-face discussions and pamphlets with websites that provide concussion
information and advice. However, many websites’ are not up to date, and may
contain numerous inaccuracies. This study indicated that the HONcode should not be the only quality check
of a website. The HONcode is not an
award system to rate the quality of information, which may have been the reason
that there were no differences in content and readability between sites with
and without the HONcode. In contrast
to the HONcode, the CONcheck
instrument was created specifically to evaluate the content of concussion
websites and the authors found that many of the problems were with the
return-to-play guidelines and when to seek medical attention. This is
particularly troubling since seeking medical counsel following a concussion is
an essential aspect of the concussion management protocol. It is important to
note that the CONcheck may require further validation to confirm that the
instrument is not missing information and reproducible among multiple users. Beyond
inaccuracies and missing information, the readability data suggested that the
existing concussion information may be worded in a manner where the majority of
the general population would not be able to comprehend and utilize the
information. This study demonstrated that the overall quality of concussion
websites is highly varied, and that steps need to be taken to ensure that the
information is distributed in a manner that will ensure accuracy and
readability. Do you use websites to gather concussion information? What
websites do you use?

by: Jane McDevitt MS, ATC, CSCS
by: Jeffrey Driban

Related Posts:

Ahmed OH, Sullivan SJ, Schneiders AG, & McCrory PR (2012). Concussion information online: evaluation of information quality, content and readability of concussion-related websites. British journal of sports medicine, 46 (9), 675-83 PMID: 21504964