Original article Ahmed OH, Sullivan SJ, Schneiders AG, et al. Br J Sports Med (2011). doi:10.1136/bjsm.2010.081620 1 of 9 Accepted 22 March 2011 ABSTRACT Background The internet plays an important role in the dissemination of health information to the general public. Information on orthopaedic sports medicine websites has been shown to be of a varying standard, and to date there has been no evaluation of the overall quality of concussion-related websites. Methods A four-stage methodological sampling technique was used to identify concussion-related websites. Websites were assessed for the presence of a quality standard (the HONcode), their adher- ence to current expert concussion knowledge using a custom-developed concussion checklist (‘CONcheck’), and their readability using the established Flesch Reading Ease (FRE) and Flesch–Kincaid Grade Level (FKGL). Results 43 Websites were identified from the search strategy with the majority (70%) not HONcode certi- fied. A wide distribution of scores was seen for the CONcheck (0–22), FRE (16.3–77.4) and FKGL (6–17.8). Statistical analysis using independent t tests between websites with the HONcode and websites without the HONcode showed no significant differences between the two groups for CONcheck (t 41 =0.571, p=0.571), FRE (t 41 =0.808, p=0.424) and FKGL(t 41 =-0.964, p=0.341) scores. Conclusions The variability in the standard of concussion-related websites highlights the need for sports medicine website providers to consider the delivery, content and readability of information to the public. Recent advances in concussion knowledge 1 2 have been widely disseminated and referenced in the scientific literature. 3 Recommendations from the 2008 Concussion in Sport (CIS) statement 2 highlight the importance of knowledge transfer, 4 which is defi ned in the health setting as ‘the pro- cess of exposing new knowledge to the frontline healthcare provider’. 5 Traditional methods of transferring knowledge face-to-face and through leaflet-based approaches 6 – 8 are now being supple- mented by websites which provide concussion information and advice. 9 10 A major factor in the shift to online knowledge transfer is the continuing expansion of the inter- net into everyday life, with recent studies suggest- ing as many as 61% of American adults regularly look online for health information. 11 The emerg- ing role, and growing acceptance, of the inter- net in sports medicine has led to the creation of numerous websites which offer advice on injury management, 12 13 injury prevention 14 15 and train- ing/rehabilitation programmes. 16 17 Websites for many medical conditions 18 – 20 have been evalu- ated and critiqued in the literature, however to date, there are relatively few studies that have examined the overall quality of sports medicine websites. 21 A recent study by Starman et al (2010) 22 demonstrated ‘a poor overall quality’ of orthopae- dic sports medicine websites, and recommended patient access and use for only well-known web- sites from reputable sources. Online health information has been shown to contain inaccuracies and inconsistencies, 23 24 indicating a need to evaluate the standard of the information provided. 25 26 Three factors cru- cial to the integrity of a website are the infor- mation quality, the content of the information and its readability. The widely-used benchmark for information quality on health websites is the HONcode, 27 created and maintained by the Health on the Net (HON) Foundation to provide a recognised ethical standard. Web publishers can apply to have the HON Foundation evaluate their website, and websites that comply with the HONcode principles are permitted to display the HONcode validation certificate. 28 29 Currently, there is no generic tool for evaluating the content of all health websites. Several condition-specific instruments have been created, 18 19 however, there is no tool which specifically assesses online brain injury or concussion information. The third identified factor relevant to the integrity of a website is its readability, and this is commonly assessed using readability utilities such as the Flesch Reading Ease Score (FRES) and Flesch– Kincaid Grade Level (FKGL). 30 These tools have been primarily utilised for the printed word (including brain injury information leaflets), 31 and have also been used to assess the readability of healthcare websites. 32 33 Numerous organisations, both government and private, provide websites which deliver educa- tional advice and information relating to concus- sive brain injury. 34 – 37 The importance of ensuring the provision of accurate online information is not disputed, however to date, there has been no investigation of the standard of this information in the field of concussion education and manage- ment. The purpose of this study was to evaluate the information quality, content and readability of a range of selected websites providing informa- tion on/related to concussion or sports concussion in particular. 1 Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand 2 Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia Correspondence to Professor S John Sullivan, Centre for Physiotherapy Research, University of Otago, PO Box 56, Dunedin 9054, New Zealand; sjohn.sullivan@otago.ac.nz Concussion information online: evaluation of information quality, content and readability of concussion-related websites Osman H Ahmed, 1 S John Sullivan, 1 Anthony G Schneiders, 1 Paul R McCrory 2 BJSM Online First, published on April 18, 2011 as 10.1136/bjsm.2010.081620 Copyright Article author (or their employer) 2011. 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