The World Wide Web and clinical practice : do sports and musculoskeletal physiotherapists recommend Internet resources to their patients?

Background: With rapid advancement in technology, a plethora of health information is now available on the Internet. However, the quality and accuracy of this information is highly variable. Consequently, this could pose a potential risk to patients where online information may lead to incorrect self-diagnosis and self-management. It is therefore a responsibility of physiotherapists, who are at a vantage point as primary practitioners, to direct patients towards trustworthy Internet resources. By recommending specific websites to patients, physiotherapists can help to alleviate concerns about patients accessing poor quality information, thus performing the role of ‘e-gatekeepers’ of information. Nonetheless, little is known about whether physiotherapists do so. Purpose: To investigate whether physiotherapists recommend Internet resources to their patients; to explore the factors that influence their recommendation practices and to determine the criteria used to discern the quality of the information they recommend .Methods: A cross-sectional web-based survey incorporating key survey design principles. Study participants were recruited from the membership of Sports Physiotherapy New Zealand (SPNZ), a special interest group of Physiotherapy New Zealand. A customized questionnaire was designed and sent via email to all registered members of SPNZ as a web link embedded into an invitation to participate. Results: Of the 609 members of SPNZ, 130 responded (21.4% response rate), with 115 completing the survey. The majority of participants were females (60.9%, 70/115), worked in private practice (88.7%, 102/115) and reported having postgraduate qualifications (72.2%, 83/115). The majority were frequent users of Facebook (70.4%, 81/115) and journal websites (66.1%, 76/115) and most reported accessing health resources on the Internet ‘sometimes’ (47.8%, 55/115) or ‘very often’ (40.0%, 46/115). Two thirds (75/115) of the participants recommended Internet resources to patients, mostly for educational purposes (93.3%, 70/75) and to demonstrate an exercise or treatment technique (65.3%, 49/75). Those (34.8%, 40/115) who did not recommend Internet resources felt that patients might misinterpret the Internet content (65.0%, 26/40), preferred to personally discuss issues with patients (65.0%, 26/40), or were concerned about unreliable, inaccurate or biased Internet content (55.0%, 22/40). The three most important criteria used to discern the quality of the information recommended were; accuracy of content, up-to-date information and ease of understanding.Conclusion(s): The majority (65.2%) of the physiotherapists surveyed recommended Internet resources to their patients. This suggests the need for physiotherapists to be attuned to web content pertaining to the needs of their patients and key conditions. Furthermore, there is a need for physiotherapists to be able to evaluate the quality of the information they recommend to their patients.Implications: This study suggests the need for accurate quality appraisal of physiotherapy information on the Internet. This includes the use of quality assessment tools and the background knowledge of physiotherapists to determine what is suitable to recommend to their patients. Therefore, the development of educational programs and/or the provision of CPD training incorporating these aspects are essential to help physiotherapists source good quality Internet resources. Such initiatives will equip physiotherapists to take on the role of ‘e-gatekeepers’ for their patients and play an integral part in the e-health community.