Assessing the quality and readability of online content on shockwave therapy for erectile dysfunction

Abstract Introduction In our current technology-driven society, patients and healthcare professionals alike are becoming increasingly reliant on online platforms for disseminating and obtaining health information. Previous research has shown that the quality of information available on the internet about novel medical therapies is generally poor and frequently misleading. Therefore, we hypothesized that online sources regarding novel erectile dysfunction treatment options, such as shockwave therapy, would be fraught with misleading claims and unreliable health information. Objective To evaluate the quality and readability of online health information on shockwave therapy as a treatment for erectile dysfunction. Methods Websites were generated using a Google search of “shockwave therapy for erectile dysfunction” with location filters disabled. Advertisements, scientific research articles, clinical trials, and websites that required subscriptions to access information were excluded from analysis. The websites included were from universities, private clinics, and news media outlets. Readability was analyzed using the Readable software (Readable.com, Horsham, UK). The content quality was graded using the DISCERN tool, a questionnaire that assesses the quality of written information on treatment choices for a health problem. Screening was done independently by 3 reviewers. Statistical analysis was conducted using the Student’s t-test. Results Nine articles that resulted from the Google search had mean readability scores as follows: Flesch-Kincaid grade level (10.8), Gunning-Fog Index (13.67), Coleman-Liau Index (12.74), Simple Measure of Gobbledygook (SMOG) Index (13.33), FORCAST Grade Level (11.33), and Automated Readability Index (11.08). The mean Flesch-Kincaid reading ease index was 46.4, which is difficult. No single article was at the 6th or 8th grade reading level, as recommended by the American Medical Association (AMA) and National Institutes of Health (NIH), respectively. There was no significant difference between the overall website ratings based on the DISCERN instrument (p= 0.565). The articles had a mean DISCERN score of 3.1, which refers to moderate quality (potentially important but not serious shortcomings). Four articles were from websites of private medical practices that each offered shockwave therapy for ED with a mean DISCERN score of 2.1. Five of the nine articles were from universities (n=2) or news sources (n=3) with a significantly higher mean DISCERN score of 4.0 (p<0.001). While the quality of content was significantly poorer, the mean automated readability grade level remained similar (p=0.607). A separate questionnaire was implemented to evaluate website content. Only two websites mentioned radial wave therapy, and both accurately dismissed its efficacy. Five websites mentioned that men with vasculogenic ED are the only candidates that should consider shockwave therapy. Two websites either mentioned the SMSNA statement or recommended that shockwave therapy "should only be used under strict research protocol." Five websites mentioned pricing (mean: $400 per session). Conclusions Overall, the quality of online information on shockwave therapy for ED is adequate. However, while articles from private clinics are just as readable as those from universities or news media, they are significantly more biased and misleading. The current online material may not support patients in making medical decisions and garnering knowledge, necessitating closer collaboration between the sources disseminating information and urologists. Disclosure Yes, this is sponsored by industry/sponsor: National Institutes of Health Grant R01 DK130991, American Cancer Society Clinician Scientist Development Grant. Clarification Industry funding only - investigator initiated and executed study.