1171117
FAOXXX10.1177/24730114231171117Foot & Ankle OrthopaedicsAnastasio et al
research-article2023
Article
A New Trend in Social Media and Medicine:
The Poor Quality of Videos Related to
Ankle Sprain Exercises on TikTok
Foot & Ankle Orthopaedics
2023, Vol. 8(2) 1–8
© The Author(s) 2023
https://doi.org/10.1177/24730114231171117
DOI: 10.1177/24730114231171117
journals.sagepub.com/home/fao
Albert T. Anastasio, MD1, Troy Q. Tabarestani, BA2, Kian Bagheri, BA3 ,
Mikhail A. Bethell, MS2 , Isabel Prado, MS2, Joshua R. Taylor, BS2,
and Samuel B. Adams, MD1
Abstract
Background: Social media platforms, like TikTok, have become popular options for the distribution of health care
information. Because of the lack of scientific oversight, the quality of health care–related videos has become a focus of
the current literature. However, orthopaedic surgery has lagged behind other fields in acknowledging the widespread
utilization of TikTok videos for medical information consumption. This study aims to assess the quality and educational
benefits of ankle sprain–related TikTok videos.
Methods: TikTok was queried using the hashtag “#anklesprainexercises.” One hundred videos were included after
applying the exclusion criteria. The number of views, likes, shares, comments, and favorites was recorded. The content
was graded using DISCERN (a well-validated informational analysis tool) and ASEES (a self-designed tool for exercise
evaluation). We hypothesized that information on TikTok related to ankle sprain exercises would be poor in quality.
Results: The total number of views of the 100 videos was 6 483 412, with a median of 5377.5 (IQR = 1074-20 275). The
videos collectively received 385 847 likes, 3642 comments, 55 574 favorites, and 14 918 shares with a median of 267.5
(IQR = 41.5-1678.0), 4.0 (IQR = 0.0-23.0), 42.0 (IQR = 4.8-264.5), and 13.0 (IQR = 1.8-67.8), respectively. General users had a
higher percentage of their videos graded as “very poor” (61.8%) in comparison to the number of videos uploaded by health
care professionals deemed “very poor” (34.4%). Neither general user nor health care professionals had videos graded as
“good” or “excellent.” There were significant differences between the 2 groups for DISCERN 1, 3, and ASSES scores.
Conclusion: Although TikTok is a powerful tool for information distribution, the educational value of the videos related
to ankle sprain injury exercises was poor. With only 2% of videos receiving a grade of “fair,” and no videos reaching a score
of “good” or “excellent,” health care professionals should be aware of the low-quality content easily accessible on TikTok.
Level of Evidence: Level III, cross-sectional study.
Keywords: TikTok, ankle sprain, social media, health care, education, ankle sprain exercises, ankle sprain rehabilitation
Introduction
Ankle sprains involving the lateral ligamentous complex
account for 80% of all ankle injuries and usually occur when
the ankle is in an inverted and plantar flexed position. With
regard to etiology, Vuurberg et al39 determined that roughly
40% of all traumatic ankle injuries occur during athletic participation. Doherty et al12 reported that up to 70% of patients
reported persistent residual symptoms and injury recurrence
after ankle sprain. It is estimated that proper proprioceptive
1
Department of Orthopedic Surgery, Duke University Hospital, Durham,
NC, USA
2
Duke University School of Medicine, Durham, NC, USA
3
Campbell University School of Osteopathic Medicine, Lillington, NC,
USA
Corresponding Author:
Albert T. Anastasio, MD, Department of Orthopedic Surgery, Duke
University Hospital, 200 Trent Drive, Durham, NC 27710, USA.
Email: albert.anastasio@duke.edu
Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons AttributionNonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction
and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages
(https://us.sagepub.com/en-us/nam/open-access-at-sage).
2
rehabilitation reduces the risk of recurrent ankle sprain by
36%.23,30 Proprioceptive training can vary widely, but examples include exercises such as single leg stand with the eyes
closed, balancing on a wobble board, and balancing on a
single leg while catching a ball.30 The negative implications
of inadequate proprioceptive rehabilitation may include
repetitive injury to the ankle joint and the development of
chronic ankle instability. Therefore, successful treatment of
ankle sprains involves an accurate diagnosis and rigorous,
proprioceptive rehabilitation.11
During the last decade, social media has risen in use to
become a chief form of information dissemination. TikTok
is a social media platform that was released for use in 2017.
Users can share and watch short-form videos that range
from 15 seconds to 10 minutes long. Users are also able to
“like” and “comment” on videos, enhancing the ability of
the platform’s algorithms to create unique content based on
each user’s interests. TikTok reaches a massive audience,
and the platform had more than 1.6 billion users and 2.6
billion downloads worldwide at the end of 2021.16
The use of online platforms for dissemination of medical
information drastically increased in response to the COVID19 pandemic as a surrogate for person-to-person visits.13,27
For example, prior to the pandemic, only 2% of physical
therapy providers in the United States reported providing
telehealth services. By July 2020, this number increased to
47%.14 TikTok has also emerged as a distribution platform
for medical information, and contains videos pertaining to a
wide variety of other medical conditions.6,21,33 Highly prolific users with large followings known as “influencers” can
have a tremendous impact on the information transmitted
through these platforms, and their videos can reach a huge
audience.36 However, many health care professionals question the quality of information presented on TikTok,2,37,41
and others note that health care–related posts on TikTok
often contain no references and lack oversight from recognized health authorities.13
The orthopaedic surgery literature lags behind other
medical fields in acknowledging and analyzing the growing
body of TikTok videos that contain medical information.
Other areas of medicine including endocrinology,21 obstetrics and gynecology,40 and urology41 have addressed the
growing body of information available on TikTok related to
their specialties. Especially for common orthopaedic conditions that are relevant to younger populations such as ankle
sprain, TikTok may be consulted prior to or in lieu of seeking expert consultation in an orthopaedic clinic.4 Given the
increased incidence of ankle sprain in younger populations
and the desire for information dissemination quickly within
this population, assessing the efficacy of social media platforms such as TikTok in broadcasting medical advice takes
on unprecedented importance. Therefore, this study aims to
assess the quality and educational suitability of the information presented in videos on ankle sprain rehabilitation
Foot & Ankle Orthopaedics
Figure 1. Flowchart of the search process for videos related to
ankle sprain exercises.
exercises on TikTok. We hypothesize that the information
contained on TikTok related to ankle sprain would be of
poor quality.
Materials and Methods
Search Strategy and Data Collection
The social media platform TikTok (https://www.tiktok.
com/en/) was queried to find videos related to ankle sprain
exercises on August 13, 2022. The search was conducted by
using the hashtag “#anklesprainexercises” without any
search filters. The search term “#anklesprainexercises” was
cross checked with various other search terms including
“#anklesprainrehab,” “anklesprainadvice,” “#anklespraininfo,” and significant overlap with regard to pulled videos
was found with these other search terms. Thus, we decided
to focus solely on the search term “#anklesprainexercises.”
Our search yielded a large number of total videos
(n = 390). To add an element of randomization to the selection, we elected to implement a form of block randomization and chose to analyze every third video for inclusion in
the study (n = 130).20 We then performed an initial screening
of the videos and eliminated those that were (1) exercises
that target different muscle groups (n = 11), (2) not directly
related to ankle sprain exercises (n = 5), (3) duplicates
(n = 1), (4) private page (n = 1), and (5) not in English (n = 1).
After full screening, 100 videos remained (Figure 1).
For each of the videos included in the analysis, we
recorded the creator of the video’s data (username, video
identification number, and if they were a health care provider), the number of views, likes, shares, comments, and
favorites. Video creators were deemed as a “health care
provider” if they listed a degree (MD, DC, DPT, etc) in
the video description (which is easily visible to the
viewer) or obviously were affiliated with an active health
care provision practice. In the 3 cases where uncertainty
existed, the uploader’s homepage was searched and
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Anastasio et al
1. Are the aims clear?
2. Does it achieve its aims?
3. Is it relevant?
4. Is it clear what sources of information were used to compile the publication (other than the author or producer)?
5. Is it clear when the information used or reported in the publication was produced?
6. Is it balanced and unbiased?
7. Does it provide details of additional sources of support and information?
8. Does it refer to areas of uncertainty?
9. Does it describe how each treatment works?
10. Does it describe the benefits of each treatment?
11. Does it describe the risks of each treatment?
12. Does it describe what would happen if no treatment is used?
13. Does it describe how the treatment choices affect overall quality of life?
14. Is it clear that there may be more than one possible treatment choice?
15. Does it provide support for shared decision-making?
Based on the answers to all the following questions, rate the overall quality of the publication as a source of information about treatment
choices.
1 = serious or extensive shortcomings
2
3 = potentially important but not serious shortcomings
4
5 = minimal shortcomings
Figure 2. DISCERN instrument.
reviewed for more information regarding their background as a health care provider. The uploader’s homepage contained more details regarding their background,
education, and affiliated degrees, and allowed for determination of status as a health care provider. This study did
not require any human participants or animals; thus, ethics committee approval was not required.
Scoring System
Two separate scoring systems were used to evaluate the
quality and educational value of the videos: the DISCERN,
a previously validated tool used for evaluating reliability
and quality of a treatment approach, and the Ankle Sprain
Exercise Education Score (ASEES) to assess the education
suitability of the information in each video. The ASEES
score was modified from a similar scale created for evaluating scoliosis exercise video quality from previously published work by Jang et al.17
DISCERN for quality assessment. The DISCERN is a questionnaire that provides researchers with a reliable and accurate way of assessing the quality of information on treatment
choices for a health problem. The tool is well validated,7 has
been used since the late 1990s, and is composed of 15 questions in addition to a final section in which an assessment of
the overall quality of the information is made (Figure 2).
The first set of 8 questions assess the reliability of the
publication (DISCERN 1) and the next set of 7 questions
reviews the quality of the author’s source base (DISCERN
2), and the final question then rates the publication as a
whole in terms of its quality as a source of information
(DISCERN 3). Although initially designed as a tool for
written information, DISCERN has been successfully
applied as a scoring test for grading the quality of videos in
prior research.1,7 DISCERN scores are categorized as follows: excellent is denoted by scores of 63 to 75 points,
good is denoted by scores of 51 to 62 points, fair is denoted
by scores of 39 to 50 points, poor is denoted by scores of
27 to 38 points, and very poor is denoted by scores of 16 to
26 points.
ASEES for educational suitability assessment. To grade the
educational value of the videos, we developed ASEES as a
modification from previously published work by Jang
et al.17 Although neither this test nor the tests from which
4
Foot & Ankle Orthopaedics
the ASEES was derived have been formally validated, in
conjunction with the DISCERN, metrics of this kind have
been used to assess whether or not viewers can properly
understand and follow exercises after watching a TikTok
video.17
The ASEES has 5 grading marks: “Exercise cycle
(Does the video describe the exercise cycle?),” “Target
(Does the video describe the target area of the exercise?),”
“Effect (Does the video describe the expected effect of
the exercise?),” “Safety (Does the video describe the precautions and safety components of the exercise?),” and
“Rationale (Does the video explain the rationale of the
exercise?).” Each grading mark is scored between 0 and
5, with increasing scores demonstrating higher quality.
The sum of all 5 grading marks is the final ASEES score
(0-25, with scores of 0 representing the lowest possible
quality and scores of 25 representing the highest possible
quality).
Table 1. Characteristics of Included Videos.
Assessment. The videos were collected by 2 reviewers and
independently evaluated by our orthopaedic research team.
Once the data regarding video distribution metrics was collected for each video, the content of the videos was graded
using the DISCERN and ASEES tools. Each video was
graded separately by 2 medical students who had received
training on ankle sprain proprioceptive exercise. Any points
of discrepancy between the 2 reviewers were resolved by a
third author, an orthopaedic surgeon.
After scoring the videos anonymously, the videos were
placed into groups based on the uploader’s background
into 3 categories: general users, health care providers, and
health organizations. The health care provider category
included users that described themselves as health care
professionals such as chiropractors, physicians, physical
therapists, and nurses. The health organization group
includes clinics, hospitals, and treatment centers. In this
study, there were no videos from users that were in the
health organization group.
Basic Characteristics
Statistical analysis. Scoring and characteristic data are presented as the mean (SD), median (interquartile range
[IQR]), and percentage. A 2-sample t test was used to compare the 2 types of uploaders by using the mean, SD, and
sample size of each continuous and categorical variable.
Statistical significance was set at P <.05, for comparisons
other than interrater reliability. For interobserver reliability,
the class 3 model intraclass correlation coefficient (ICC)
was calculated for both the DISCERN and ASEES grading
scales with a 95% CI using a 2-factor analysis of variation
without replication model. The benchmarking of ICC values was adapted from previous studies as follows: <0.50,
poor; 0.50 to 0.75, moderate; 0.76 to 0.90, good; and >0.9:
excellent reliability.9,22 All analyses were performed using
Microsoft Excel (Redmond, WA).
Characteristics
Number of views, median (IQR)
Likes, median (IQR)
Comments, median (IQR)
Favorites, median (IQR)
Shares, median (IQR)
Scoring, mean (SD)
DISCERN 1
DISCERN 2
DISCERN 3
Total DISCERN
ASEES
Total (n=100)
5377.5 (1074.0-20275.0)
267.5 (41.5-1678.0)
4.0 (0.0-23.0)
42.0 (4.8-264.5)
13.0 (1.8-67.8)
14.71 (2.18)
11.08 (2.65)
2.20 (0.66)
28.00 (4.70)
8.87 (3.80)
Abbreviations: ASEES, Ankle Sprain Exercise Education Score; IQR,
interquartile range.
Results
In total, 130 videos were pulled after searching
“#anklesprainexercises.” Of the 130 videos, 30 videos were
excluded after applying exclusion criteria and randomization protocol, and 100 videos were included in the final
analysis. Table 1 presents the basic characteristics of the
videos analyzed.
Type of Uploaders
General users uploaded more videos (68%) when compared to health care professionals (32%). However, the
dissemination statistics (ie, number of views, likes, comments, favorites, and shares) between the general users
and health care professionals were all statistically insignificant (Table 2). The tabulated scores for DISCERN 1,
DISCERN 3, Total DISCERN, and ASEES between general users and health care professionals were all statistically significant (P = .015, P = .026, P = .012, and P = .030,
respectfully) (Table 2), indicating much lower quality ratings in videos uploaded by general users than those
uploaded by health care professionals.
The DISCERN grading results are recorded in Table 3.
DISCERN scores are categorized as follows: “excellent” is
denoted by scores of 63 to 75 points, “good” by scores of 51
to 62 points, “fair” by scores of 39 to 50 points, “poor” by
scores of 27 to 38 points, and “very poor” by scores of 16 to
26 points. These labels provide an overall summary and
quality of the video. Generally, “poor” videos are those that
fail to clearly specify the aims of the video, provide a balanced and unbiased overview of the topic, document source
information, and describe risks associated with the presented exercise. General users had a higher percentage of
their videos graded as “very poor” (61.8%) in comparison
5
Anastasio et al
Table 2. Characteristics of the Videos Across the Type of Uploaders.
Characteristics
Number of views, median (IQR)
Likes, median (IQR)
Comments, median (IQR)
Favorites, median (IQR)
Shares, median (IQR)
Scoring, mean (SD)
DISCERN 1
DISCERN 2
DISCERN 3
Total DISCERN
ASEES
General Users (n=68)
Health Care Professionals (n=32)
P Value
6777.5 (1358.3-19600.0)
368.0 (46.0-1738.8)
4.0 (0.0-23.0)
48.0 (5.0-409.0)
15.5 (2.8-82.0)
3250.0 (911.0-21450.0)
99.0 (35.5-603.8)
3.5 (0.0-25.8)
21.0 (3.8-174.0)
10.5 (1.0-51.8)
.256
.450
.860
.825
.684
14.35 (2.21)
10.85 (2.65)
2.10 (0.66)
26.93 (4.51)
8.30 (3.77)
15.48 (1.94)
11.56 (2.61)
2.41 (0.60)
29.45 (4.72)
10.06 (3.62)
.015
.212
.026
.012
.030
Abbreviations: ASEES, Ankle Sprain Exercise Education Score; IQR, interquartile range.
Table 3. Percentage of DISCERN Grades Across the 2 Types
of Uploaders.
Grading
Very poor
Poor
Fair
Good
Excellent
General
Users, %
Health Care
Professionals, %
Total, %
61.8
35.3
2.9
0.0
0.0
34.4
65.6
0.0
0.0
0.0
53.0
45.0
2.0
0.0
0.0
to the number of videos uploaded by health care professionals deemed “very poor” (34.4%). Health care professionals
had a higher percentage of their videos graded as “poor”
(65.6%) in comparison to the videos uploaded by general
users (35.3%). In addition, general users had a higher percentage of their videos graded as “very poor” (2.9%) in
comparison to the number of videos uploaded by health
care professionals deemed “very poor” (0.0%). Neither
general user nor health care professionals had videos graded
as “good” or “excellent.”
Interobserver Reliability
The estimates for interobserver reliability for the DISCERN
and ASEES were 0.87 (95% CI, 0.81-0.91) and 0.59 (95%
CI, 0.44-0.70), respectively. According to prior studies,
these results correlate to “good” and “moderate” reliability
for each of those scoring systems, respectively.9,22
Discussion
Inclusion of medical information on social media platforms
has provided patients more ways to obtain medical advice
without having to physically interact with a clinician or
therapist.34,38 By expanding the availability of freely accessible information, patients can avoid in-person visits and
save money, time, and potential exposure to various
communicable diseases, especially in light of the recent
pandemic.5,19,26,42 Moreover, patients in medically underserved areas may require only internet service to gain access
to a vast amount of medical information. For these reasons,
health care professionals have started to utilize social media
as a means to reach a wider audience.31 Despite these advantages, many of these media platforms do not regulate their
content based on quality and reliability of information.
Thus, the potential for dissemination of biased, incomplete,
or even potentially damaging information exsists.3,15
Although the availability of the internet has increased
access to informational resources, no overall improvement
in health literacy has followed.29 Especially among youth
(a large proportion of TikTok’s userbase) in the United
States, widespread poor health literacy has been documented to and found to be associated with adverse health
outcomes.24,32 Despite poor health literacy, younger individuals paradoxically demonstrated higher competency
than older populations in using social media to find information related to search topics of interest, such a healthrelated material.28 Thus, the growth of TikTok’s younger
audience has allowed for the dissemination of a massive
quantity of medical information on topics ranging from
COVID-19 to scoliosis.17,21,27,35 Although other specialties
have evaluated the quality of the widely viewed information on TikTok pertaining to their respective field, orthopaedics has lagged behind in assessing orthopaedic-related
content.21,27,35 With just more than 6 million total views of
the videos in our analysis (which represent only a portion
of the videos related to ankle sprain on the TikTok), this
platform has the potential to have a wide impact on patient
perception of injury and treatment options.
Our intent was to analyze the videos that a TikTok user
would be most likely to encounter if searching the platform
for exercises related to rehabilitation of ankle sprain.
However, our data analysis revealed that videos of ankle
sprain exercises found on TikTok were found to be low in
6
quality. Concerningly, there were no videos that were categorized as “good” or “excellent” with an average DISCERN
score of 28.00. Fifty-three percent of the videos were graded
as “very poor,” and 45.0% of the videos were graded as
“poor.” More specifically, the DISCERN 1, DISCERN 2,
and DISCERN 3 were all calculated to be less than 50% of
the maximum score for the DISCERN tool. Although there
was a statistically significant difference between the
DISCERN scores for general users and health care professionals, these results are not likely clinically relevant, as
this difference is less than 1 point and the range for considering a “poor” or “very poor” score is >10 points. In addition, the ASEES scores were low with the total average
score around 35% of the maximal value for the ASEES.
These results further indicate that the videos did not accurately describe components of the exercise, safety considerations, rationale, and/or targeted effects.
There are a few potential explanations for these concerning results, which do not reflect on the quality or background of the uploader. For example, the short video
playtime does not allow for appropriate citation of sources
or in-depth discussion of risks and safety features, all
important factors included in the DISCERN metric.
Similarly, although TikTok may provide visual demonstrations of various exercises, users do not have access to
direct professional feedback as would be available during a
formal physical therapy visit. Evidence suggests that
repeated engagement in exercise with incorrect technique
may worsen instability, increase muscular imbalance, or
exacerbate prior injuries, especially if eccentric loading is
improperly performed.10,18 Overall, our findings corroborate previous studies evaluating the quality of TikTok videos for dissemination of medical information.8,21,25
A recent study by Jang et al17 looked at the quality and
reliability of TikTok for exercises on scoliosis. This study
used the DISCERN and SEES scores to assess the videos.
Similar to our findings, this study did not rate any of the
videos as excellent or good according to the DISCERN,
and their mean SEES score was 2.02 out of 5. The authors
concluded that the overall educational suitability of videos
about scoliosis exercise in TikTok were low and advised
against using TikTok as a source for scoliosis exercise
information.
This study also found that the quality of ankle sprain
rehabilitation exercises differed between general users and
health care professionals. Despite general users trending
toward more social attraction across all categories from
likes to shares, they had significantly lower scores for both
the DISCERN and ASEES tools when compared to those
uploaded by health care professionals. Although health care
professionals did produce higher quality videos, the overall
quality of the majority of the instructional videos was still
graded as being “poor” or “very poor.” Thus, these videos
may be inadequate to act as a stand-in for formal physical
therapy or clinical visits. TikTok is an objectively inferior
Foot & Ankle Orthopaedics
avenue for information dissemination compared to appropriate medical consultation from a board-certified physician. However, orthopaedic surgeons should be aware of
the widespread use of this platform as a delivery mechanism for ankle sprain–related content and may consider
advocating for improved scientific regulation and content
creation on TikTok. Moreover, some orthopaedic surgeons
who are inclined toward engagement with social media may
view the expanding use of TikTok as an opportunity for distribution of more accurate medical information. This study
highlights the extraordinary view counts that TikTok videos
can amass. Among other use cases, TikTok may be an excellent platform to prescreen patients for clinical appointments
(videos such as: “Do I need to see my doctor for my ankle
sprain?”) or provide detailed exercise demonstrations with
links to research-based therapeutic guidelines.
Future research should aim to evaluate if patients with
ankle sprain use TikTok as an adjunct to advice from an
orthopaedic provider, or as the primary means of treatmentrelated information. Additionally, as short-form information sharing platforms such as TikTok expand in use, future
research should aim to determine if ankle sprain recurrence
and rates of progression to chronic instability are impacted
by reliance on web-based platforms in lieu of formal rehabilitative intervention for proprioceptive-type exercises.
Limitations
There are several limitations in our assessment of the educational quality of the videos related to ankle sprain exercises posted to TikTok. The potential for selection bias
exists with the search term used. In an attempt to simulate a
search term that a majority of users interested in this topic
may utilize, we picked a general search term, “ankle sprain
exercises.” However, users who are familiar with their
injury pattern may favor more specific search terms.
Similarly, because we elected to incorporate a randomization protocol to select every third video for inclusion, we
may have excluded some of the more popular and potentially higher-quality videos near the top of the algorithm.
Furthermore, the process of grading videos contains inherent subjectivity and observer bias. We attempted to mitigate
this bias by including the use of a well-validated tool, the
DISCERN, in addition to the use of the ASEES. Each video
was independently reviewed by 2 separate reviewers, and a
third reviewer was used where there was any significant
discrepancy between grading scores. The ASEES and other
scoring systems of its kind have not been formally validated
and the DISCERN is a tool developed to assess the quality
of written information. Thus, the use of these and similar
instruments for analyzing the video quality of TikTok may
be inadequate. Therefore, this study highlights the need for
future research investigating the optimal scoring metrics for
short-form informational videos as social media use grows
worldwide.
Anastasio et al
Another major concern is that there is no way to definitively confirm whether an account is a true health care professional or not. Finally, it is possible that the short-form
video format of TikTok could lead to production of poorly
cited content. Although TikTok videos are generally under a
minute long, videos up to 10 minutes long can be uploaded
onto the platform. Thus, videos with low scores could possibly be attributed to short video playtime.
Conclusion
In summary, the increasing utilization of social media platforms such as TikTok among younger demographics has led
to wide dissemination of short-form videos on a variety of
health-related topics, including ankle sprain. These videos
are of questionable quality and completeness. Notably, there
was significant improvement in video quality across multiple
scoring systems from health care professionals in comparison to general users. However, the overall educational value
for both groups remained poor. Although readily accessible
health care information via online resources can provide
access for underserved populations, providers should remain
aware of the broad dissemination of this material while also
raising awareness of the deficiencies of the platform as a
medium for distribution of orthopaedic-related information.
The orthopaedic surgery community, in failing to acknowledge inaccurate and poorly cited information on social media
and produce easily accessible yet high-quality content, is falling behind other medical subspecialties in adapting to the
modern world of information dissemination.
Ethical Approval
No ethics approval was needed for this study. No patients were
included in this work. Online, publicly available videos were
analyzed.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
ORCID iDs
Kian Bagheri, BA,
https://orcid.org/0000-0003-0303-5949
Mikhail A. Bethell, MS,
https://orcid.org/0000-0002-2270-9067
References
1. Aydin MF, Aydin MA. Quality and reliability of information
available on YouTube and Google pertaining gastroesophageal reflux disease. Int J Med Inform. 2020;137:104107. doi:
10.1016/j.ijmedinf.2020.104107
7
2. Basch CH, Meleo-Erwin Z, Fera J, Jaime C, Basch CE. A
global pandemic in the time of viral memes: COVID-19 vaccine misinformation and disinformation on TikTok. Hum
Vaccin Immunother. 2021;17(8):2373-2377. doi:10.1080/21
645515.2021.1894896
3. Battineni G, Baldoni S, Chintalapudi N, et al. Factors affecting the quality and reliability of online health information.
Digit Health. 2020;6:2055207620948996. doi:10.1177/2055
207620948996
4. Bozzola E, Spina G, Agostiniani R, et al. The use of social media
in children and adolescents: scoping review on the potential
risks. Int J Environ Res Public Health. 2022;19(16):9960.
doi:10.3390/ijerph19169960
5. Cabrera-Maqueda JM, Minhas JS. New horizons for stroke
medicine: understanding the value of social media. Stroke.
2018;49(2):e25-e27.
6. Carter PN, Hall EE, Ketcham CJ, Ahmed OH. Not just for
dancing? A content analysis of concussion and head injury
videos on TikTok. Front Sports Act Living. 2021;3:692613.
doi:10.3389/fspor.2021.692613
7. Charnock D, Shepperd S, Needham G, Gann R. DISCERN: an
instrument for judging the quality of written consumer health
information on treatment choices. J Epidemiol Community
Health. 1999;53(2):105-111. doi:10.1136/jech.53.2.105
8. Chen K, Zhou L, Zhao R, Tang Y. Assessing the quality of
hearing aids-related videos on TikTok. Front Public Health.
2022;10:901976.
9. Cicchetti DV. Guidelines, criteria, and rules of thumb for
evaluating normed and standardized assessment instruments
in psychology. Psychol Assess. 1994;6:284-290. doi:10.1037/
1040-3590.6.4.284
10. De Ridder R, Willems T, Vanrenterghem J, Roosen P.
Influence of balance surface on ankle stabilizing muscle
activity in subjects with chronic ankle instability. J Rehabil
Med. 2015;47(7):632-638. doi:10.2340/16501977-1970
11. de Vasconcelos GS, Cini A, Sbruzzi G, Lima CS. Effects
of proprioceptive training on the incidence of ankle sprain in
athletes: systematic review and meta-analysis. Clin Rehabil.
2018;32(12):1581-1590. doi:10.1177/0269215518788683
12. Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and
prevention of acute and recurrent ankle sprain: an overview
of systematic reviews with meta-analysis. Br J Sports Med.
2017;51(2):113-125. doi:10.1136/bjsports-2016-096178
13. Eghtesadi M, Florea A. Facebook, Instagram, Reddit and
TikTok: a proposal for health authorities to integrate popular
social media platforms in contingency planning amid a global
pandemic outbreak. Can J Public Health. 2020;111(3):389391. doi:10.17269/s41997-020-00343-0
14. Hall JB, Woods ML, Luechtefeld JT. Pediatric physical therapy telehealth and COVID-19: factors, facilitators, and barriers
influencing effectiveness—a survey study. Pediatr Phys Ther.
2021;33(3):112-118. doi:10.1097/pep.0000000000000800
15. Hesse BW, Nelson DE, Kreps GL, et al. Trust and sources of
health information: the impact of the Internet and its implications for health care providers: findings from the first
health information national trends survey. Arch Intern Med.
2005;165(22):2618-2624. doi:10.1001/archinte.165.22.2618
16. Iqbal M. TikTok revenue and usage statistics. Accessed
August 22, 2022. https://www.businessofapps.com/data/tiktok-statistics/
8
17. Jang CW, Kim M, Kang S-W, Cho HE. Reliability, quality,
and educational suitability of TikTok videos as a source of
information about scoliosis exercises: a cross-sectional study.
Healthcare. 2022;10(9):1622.
18. Kaminski TW, Hartsell HD. Factors contributing to chronic
ankle instability: a strength perspective. J Athl Train. 2002;
37(4):394-405.
19. Khoshrounejad F, Hamednia M, Mehrjerd A, et al. Telehealthbased services during the COVID-19 pandemic: a systematic review of features and challenges. Front Public Health.
2021;9:711762. doi:10.3389/fpubh.2021.711762
20. Kim J, Shin W. How to do random allocation (randomization). Clin Orthop Surg. 2014;6(1):103-109. doi:10.4055/cios.
2014.6.1.103
21. Kong W, Song S, Zhao YC, Zhu Q, Sha L. TikTok as a
health information source: assessment of the quality of
information in diabetes-related videos. J Med Internet Res.
2021;23(9):e30409. doi:10.2196/30409
22. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr
Med. 2016;15(2):155-163. doi:10.1016/j.jcm.2016.02.012
23. Lin CI, Houtenbos S, Lu YH, Mayer F, Wippert PM. The
epidemiology of chronic ankle instability with perceived
ankle instability—a systematic review. J Foot Ankle Res.
2021;14(1):41. doi:10.1186/s13047-021-00480-w
24. Mårtensson L, Hensing G. Health literacy—a heterogeneous phenomenon: a literature review. Scand J Caring Sci.
2012;26(1):151-160.
25. Meade MJ, Meade EA, Dreyer CW. Orthodontic clear aligners and TikTok videos: a content, reliability and quality analysis. Int Orthod. 2022;20(3):100663.
26. Monaghesh E, Hajizadeh A. The role of telehealth during
COVID-19 outbreak: a systematic review based on current
evidence. BMC Public Health. 2020;20(1):1193. doi:10.1186/
s12889-020-09301-4
27. Ostrovsky AM, Chen JR. TikTok and its role in COVID-19
information propagation. J Adolesc Health. 2020;67(5):730.
doi:10.1016/j.jadohealth.2020.07.039
28. Poellhuber B, Anderson T, Racette N, Upton L. Distance students’ readiness for and interest in collaboration and social
media. Interact Technol Smart Educ. 2013;10(1):63-78.
29. Qi S, Hua F, Xu S, Zhou Z, Liu F. Trends of global health
literacy research (1995–2020): analysis of mapping knowledge domains based on citation data mining. PLoS One.
2021;16(8):e0254988. doi:10.1371/journal.pone.0254988
30. Rivera MJ, Winkelmann ZK, Powden CJ, Games KE.
Proprioceptive training for the prevention of ankle sprains: an
Foot & Ankle Orthopaedics
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
evidence-based review. J Athl Train. 2017;52(11):1065-1067.
doi:10.4085/1062-6050-52.11.16
Rolls K, Hansen M, Jackson D, Elliott D. How health care
professionals use social media to create virtual communities:
an integrative review. J Med Internet Res. 2016;18(6):e5312.
Sansom-Daly UM, Lin M, Robertson EG, et al. Health literacy in adolescents and young adults: an updated review.
J Adolesc Young Adult Oncol. 2016;5(2):106-118.
Siva N, Koirala M, Raiker R, Waris S, Pakhchanian H,
Puckett Y. Evaluation of trends in breast cancer–related content on TikTok. J Clin Oncol. 2022;40(16_suppl):11046. doi:
10.1200/JCO.2022.40.16_suppl.11046
Smailhodzic E, Hooijsma W, Boonstra A, Langley DJ. Social
media use in healthcare: a systematic review of effects on
patients and on their relationship with healthcare professionals. BMC Health Serv Res. 2016;16(1):442. doi:10.1186/
s12913-016-1691-0
Song S, Xue X, Zhao YC, Li J, Zhu Q, Zhao M. Short-video
apps as a health information source for chronic obstructive pulmonary disease: information quality assessment of
TikTok videos. J Med Internet Res. 2021;23(12):e28318.
doi:10.2196/28318
Szeto MD, Mamo A, Afrin A, Militello M, Barber C. Social
media in dermatology and an overview of popular social
media platforms. Curr Dermatol Rep. 2021;10(4):97-104.
doi:10.1007/s13671-021-00343-4
Tam J, Porter EK, Lee UJ. Examination of information and
misinformation about urinary tract infections on TikTok and
YouTube. Urology. 2022;168:35-40. doi:10.1016/j.urology.
2022.06.030
Ventola CL. Social media and health care professionals: benefits, risks, and best practices. P T. 2014;39(7):491-520.
Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidencebased clinical guideline. Br J Sports Med. 2018;52(15):956.
doi:10.1136/bjsports-2017-098106
Wu J, Trahair E, Happ M, Swartz J. TikTok, #IUD, and
user experience with intrauterine devices reported on social
media. Obstet Gynecol. 2023;141(1):215-217. doi:10.1097/
aog.0000000000005027
Xu AJ, Taylor J, Gao T, Mihalcea R, Perez-Rosas V, Loeb
S. TikTok and prostate cancer: misinformation and quality of information using validated questionnaires. BJU Int.
2021;128(4):435-437. doi:10.1111/bju.15403
Zhang Y, He D, Sang Y. Facebook as a platform for health
information and communication: a case study of a diabetes
group. J Med Syst. 2013;37(3):1-12.