INTRODUCTION
With the growing availability of digital information, many patients have turned to the internet for medical advice. For years, video platforms such as YouTube have been widely used for medical education.1 In recent years, short-form video content has increased in popularity, particularly through social media apps like TikTok. On TikTok, individuals can create their own videos, featuring content that ranges from entertainment to education. With its 1.5 billion active monthly users and over four billion downloads,2 TikTok represents a significant platform for medical communication.
Carpal tunnel syndrome is the most common entrapment neuropathy and affects between 4% and 5% of the population, with a higher prevalence in 40- to 60-year-olds.3,4 Carpal tunnel syndrome management begins with conservative management for early disease with splinting and activity modification, but can be escalated to include corticosteroid injections and ultimately surgical intervention for severe cases.5 This variation in treatment highlights the importance of strong patient-physician relationships and a quality education on this disease to best treat this neuropathy.
TikTok can have a beneficial role in educating patients on their disease, diagnosis, and treatment options. It can provide a strong sense of community and support for patients debilitated by carpal tunnel syndrome. However, the clarity and accuracy of medical content on this app remain largely unexplored. This study aims to evaluate the quality and validity of TikTok content about carpal tunnel syndrome.
METHODS
A retrospective review of carpal tunnel syndrome content on TikTok was performed on a one-time search in September 2024. The keywords “carpal tunnel syndrome” and “#carpaltunnelsyndrome” were used to retrieve videos on a new TikTok account to avoid being personalized by the algorithm. Videos with the keywords retrieved with and without relevant hashtags in the titles. We analyzed all 131 videos to determine their inclusion in the study. Videos were excluded if they were not in English or unrelated to carpal tunnel syndrome. Overall, 121 videos were included in our analysis.
Creator type and the topic of each video were collected and reported [Table 1]. For content type, videos were counted multiple times if they fit various categories. Engagement data, including views, likes, comments, and shares of each video, were collected during September 2024 [Table 2].
TikTok videos were reviewed together by two hand surgery fellowship-trained orthopaedic surgeons. Each video was discussed and assigned agreed-upon scores. Two scoring systems were used to grade the content: DISCERN and Journal of the American Medical Association (JAMA) benchmark criteria. As this study did not involve human subjects, it was considered exempt from institutional review board approval.
DISCERN Questionnaire Scoring System
The DISCERN instrument comprises a 16-part questionnaire, as shown in Figure 1. Each question is scored from 1 (definite NO) to 5 (definite YES). Questions 1-8 evaluate the trustworthiness, reliability, and dependability of the source of the content. Questions 9-15 evaluate the overall quality of the information presented. The 16th question is an independent overall quality rating, also on a 1-5 scale. A total DICERN of 64-80 is considered excellent, 52-63 good, 41-51 fair, 30-40 poor, and 16-29 very poor.6
JAMA Benchmark Criteria
The JAMA benchmark criteria are a 4-point scale that represents the accuracy and reliability of online medical content [Figure 2], with an emphasis on the content creator type, source of information, the current relevance of the information, and disclosures of any conflicts of interest. A score of 1 is given for each category, which includes credible authors, attribution of resources, disclosures, and currency of content. Scores can range from 0 to 4, with a score of 0-1 indicating insufficient content, 2-3 indicating partially sufficient content, and 4 indicating sufficient content. Gradings can be seen in Table 3.7
Statistical Analysis
Median and standard deviations (SD) were calculated for engagement data, as the data was skewed; means were reported for gradings, as the data was normally distributed. Analysis of Variance (ANOVA) tests were conducted to compare engagement metrics and ratings between creator types, followed by post hoc pairwise t-tests to compare the ratings between creator groups.
RESULTS
Of the 121 videos, most of the content was created by laypeople (n = 41, 34%), with a few videos created by hand surgeons (n = 4, 3%) and other medical doctors/osteopathic doctors (n = 10, 8%). Categories for the content type are listed in Table 1. The most common type of content was on exercises and stretches for carpal tunnel syndrome (n=33, 27%), while the least common content type was on diagnosis (n=13, 11%).
Engagement data for all videos and videos by creator type are presented in Table 2. Overall, physical therapists had the greatest engagement, with an average of 2.2 million views per video. Hand surgeons and chiropractors had the least engagement compared to other types of creators. However, views (p = 0.23), likes (p = 0.54), comments (p = 0.59), and shares (p = 0.09) were not significantly different between the creator types.
Quality scores are presented in Table 3. Hand surgeons and other medical doctor/doctor of osteopathic (MD/DO) had the highest ratings for both DISCERN and JAMA scores. Nonetheless, the DISCERN averages for both hand surgeons and other MD/DO were classified as “poor,” although their JAMA scores noted their content to be very sufficient. Laypeople and physical therapists had the lowest ratings using the DISCERN criteria, while chiropractors and laypeople had the lowest JAMA scores. The DISCERN scores for these groups rated the content as “very poor,” while the JAMA scores suggest that the content is partially sufficient. Between creator types, DISCERN (p=0.001) gradings were significant, while JAMA gradings (p=0.14) were not significant. Post-hoc pairwise t-tests found that other MD/DOs created significantly higher rated DISCERN content than laypeople (p=0.0008), physical therapists (p=0.004), chiropractors (p=0.04), and other content creators (p=0.01). All other comparisons were not significant.
DISCUSSION
As internet connectivity continues to increase in society, the number of people turning to the internet for health care advice has risen steadily. It is estimated that 8 out of 10 internet users in the United States have searched for healthcare information online, with the majority using social media as a primary source of advice.8 Although the internet has advanced the way we communicate with one another, there is a significant risk of misinformation when anyone can post healthcare information, advice, or commentary.9 This study investigated the content related to carpal tunnel syndrome on TikTok, which has over a billion active users worldwide.
According to the literature, a substantial portion of healthcare content on social media is considered to be of poor quality, lacking reliable sources.8,10 In 2024, D’Ambrosi et al. used the DISCERN and JAMA criteria to analyze epicondylitis-related content on TikTok. They found that healthcare professionals produced the most reliable and accurate content, while non-healthcare professionals often provided inaccurate information.11 Another study that evaluated carpal tunnel syndrome-specific content on TikTok found a broad group of healthcare professionals (encompassing chiropractors, physicians, physical therapists, and nurses) had significantly lower DISCERN scores than laypeople.12 Nonetheless, ratings of the content’s educational content were overall poor for all evaluated subgroups. Similar studies of various other orthopedic conditions have found poor educational value of the majority of content on TikTok.11,13–16
Our results show that content related to carpal tunnel syndrome on TikTok is quite prevalent, with over 100 videos totaling more than 100 million views. However, most of this content is being produced by laypeople and physical therapists. Similar studies evaluating other orthopedic conditions have noted a similar lack of content created by physicians.11,13,16,17 In 2022, Chiang et al. surveyed 1,234 members of the Pediatric Orthopedic Society of North America and found that no member had an active TikTok account.18 Furthermore, as a social media platform, TikTok was noted to have a negative perception amongst orthopedic surgeons.18 Since this study, the rates of orthopedic surgeons on TikTok have likely increased, as 11% of our videos were created by MDs/DOs, with 3% of videos created by hand surgeons. Nonetheless, our results still highlight a paucity in physician-created content on this social media platform.
The lack of physician-created content may be further compounded by the relatively low engagement metrics seen in this cohort. Physical therapists had the greatest mean engagement metrics, although this difference was not significant. Conversely, hand surgeons had the lowest engagement metrics in all categories evaluated. Other studies evaluating engagement on TikTok and Instagram content pertaining to common orthopedic conditions found that physicians had significantly less engagement compared to non-physicians.16,19 The current trend in non-MDs/DOs creating social media content with more engagement and overall lower quality scores is concerning. Strategies for physicians to increase engagement include creating succinct videos, free of medical jargon, that incorporate humor through the use of puns, jokes, or skits to create entertaining and educational content. Videos emphasizing prevention and beneficial behavioral health habits are also concepts that have been found to increase patient engagement.20 By increasing engagement on quality content, physicians can help circumvent misconceptions and misinformation and amplify resources for patients to better understand their health conditions. Healthcare professionals should acknowledge the reach and impact that social media can have on patient care and provide appropriate counseling to patients on how to consume online medical content with caution.
Our results show that the majority of carpal tunnel syndrome content was rated as having poor or very poor educational value according to the DISCERN criteria and as partially sufficient according to the JAMA criteria metrics. Although there was an upward trend among hand surgeons and MD/DOs, who created the highest-scoring content, the overall average DISCERN scores for these creators were still found to be in the “poor” educational content category. This may be partially attributed to content creators using social media as an outlet to post satire, jokes, or skits. While entertaining, this content may have limited educational value for viewers. Prior studies suggest that neither healthcare professionals nor non-healthcare professionals consistently produce high-quality content on TikTok. A study that also examined carpal tunnel syndrome on TikTok only distinguished between creators who were healthcare professionals and those who were not. Nonetheless, both groups were found to produce low-quality content, with healthcare professionals receiving an average DISCERN score of 30.6 and non-healthcare professionals receiving an average score of 28.3. A possible explanation for this is that TikTok videos are too short in length to provide sufficient educational material that would result in a high score. A similar study on ankle sprains also categorized creators into healthcare professionals and non-healthcare professionals, finding that content created by healthcare professionals had higher DISCERN scores (29.5 vs. 26.9). However, both categories were classified as “very poor.”15 Our hand surgeon and other MD/DO groups displayed higher DISCERN scores compared to these studies, which may be because non-MD/DO healthcare professionals were excluded from these groups.
This study has several limitations. Our methods for searching TikTok videos likely included most, but not all, videos relevant to this study. Additionally, our study employed two raters from a single academic medical center, which may contribute to biases in the rating of results. Additionally, each video received only one score based on a discussion between the two hand surgeons; having more reviewers would add to the strength of this study. Also, a limited number of videos were analyzed, which may limit the generalizability of these findings. There was also limited content created by hand surgeons (n=4), which likely underpowers our statistical analysis of these ratings. Lastly, our analysis of TikTok videos did not include variables such as video length or the use of captions and graphics, which may have affected the videos’ scores. Nonetheless, our results align with many similar studies that have evaluated other orthopedic conditions, highlighting an overall lack of physician-created content and a generally poor rating for orthopedic TikTok content.11,13–15
CONCLUSION
Carpal tunnel syndrome-related TikTok content is of poor educational quality, with the majority of content created by laypeople rather than healthcare professionals. TikToks created by non-hand surgeon MD/DO physicians received a higher DISCERN rating than those created by laypeople, physical therapists, and chiropractors. However, they were still rated to be of poor quality. Healthcare professionals should acknowledge the potential impact of poor content quality on TikTok and explore ways to dispel misinformation by increasing their social media presence, while advising patients to consume online medical content with caution.
Declaration of conflict of interest
The authors do NOT have any potential conflicts of interest for this manuscript.
Declaration of funding
The authors received NO financial support for the preparation, research, authorship, and publication of this manuscript.
Declaration of ethical approval for study
This study was exempt from the IRB review.
Declaration of informed consent
There is NO information in the submitted manuscript that can be used to identify patients.