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Technique Articles Are More Effective at Increasing Social Media Attention in Comparison With Original Research Articles: An Altmetrics-Based Analysis

Open AccessPublished:March 25, 2022DOI:https://doi.org/10.1016/j.asmr.2022.02.002

      Purpose

      To compare social media attention and citation rates between technique articles and matched original research articles (ORAs) regarding surgical procedures.

      Methods

      All technique articles published from August 2019 through July 2020 in the free, electronic versions of Arthroscopy Techniques and JBJS Essential Surgical Techniques were matched by topic to articles in the “Original Research” sections of Arthroscopy, Sports Medicine, and Rehabilitation and JBJS Open Access in a 4:1 ratio within this time frame. The primary outcome was the Altmetric Attention Score (AAS). Secondary outcomes included citations, bibliometrics, and social media metrics. Independent t tests were used to compare primary and secondary outcomes between technique articles and ORAs. A multivariate linear regression analysis was performed to determine the association between article type and social media attention while controlling for confounding bibliometric characteristics.

      Results

      A total of 285 matched research articles (n = 57, 20.0%) and technique articles (n = 228, 80.0%) were included. The mean AAS among all technique articles was 3.63 ± 10.08 (range, 0-96) whereas the mean AAS among all ORAs was 1.30 ± 3.98 (range, 0-25), representing a statistically significant difference (P = .016). The mean citation rate among all technique articles was not significantly different from that among ORAs (P = .73). Multivariate linear regression analysis showed a statistically significant positive association between AAS and article type, with an additional mean increase in the AAS of 2.91 (95% confidence interval, 0.04-5.77; P = .047) for every technique article compared with an ORA. Furthermore, a significant positive relation was noted between the article origin and the AAS, with an increase in the AAS of 3.00 (95% confidence interval, 0.82-5.17; P = .007) for every article published in North America compared with an article originating from another continent.

      Conclusions

      Technique articles resulted in significantly greater AASs and social media attention in comparison with open-access ORAs on similar topics. Publications that described technical procedures in a technique journal and studies from North America were positively associated with greater AASs and greater numbers of citations received by articles.

      Clinical Relevance

      An improved understanding of how much attention is given to technique articles versus matched ORAs by social media may influence the methods authors and journals use for distributing content. The present study suggests that one option to increase the amount of social media attention received for a particular study may be to utilize an accompanying surgical technique video or illustrations as these are easily shareable on social media and offer rapid dissemination of knowledge, similar to that of an infographic. However, physicians who view multimedia within technique articles should be encouraged to review the accompanying articles and the supporting original research as a primary source before making changes in their clinical practice.
      The use of the internet has increased substantially since the start of the century, with social media becoming a critical platform for the dissemination of research among health care providers and institutions.
      • Kunze K.N.
      • Vadhera A.
      • Purbey R.
      • Singh H.
      • Kazarian G.S.
      • Chahla J.
      Infographics are more effective at increasing social media attention in comparison with original research articles: An Altmetrics-based analysis.
      ,
      Internet World Stats
      World internet users statistics and 2021 world population stats.
      Multiple studies have since investigated the impact of social media in the dissemination of critical research as measured by the Altmetric Attention Score (AAS), a tool that enumerates the impact of shared research on various media platforms via an aggregate score accrued by a particular article.
      • Kunze K.N.
      • Vadhera A.
      • Purbey R.
      • Singh H.
      • Kazarian G.S.
      • Chahla J.
      Infographics are more effective at increasing social media attention in comparison with original research articles: An Altmetrics-based analysis.
      ,
      • Powell A.G.M.T.
      • Bevan V.
      • Brown C.
      • Lewis W.G.
      Altmetric versus bibliometric perspective regarding publication impact and force.
      • Marincek C.
      • Franchignoni F.
      Some thoughts on bibliometrics, usage metrics and Altmetrics concerning the International Journal of Rehabilitation Research.
      • Kim H.J.
      • Yoon D.Y.
      • Kim E.S.
      • et al.
      The most mentioned neurointervention articles in online media: A bibliometric analysis of the top 101 articles with the highest Altmetric Attention Scores.
      • Wang J.
      • Alotaibi N.M.
      • Ibrahim G.M.
      • Kulkarni A.V.
      • Lozano A.M.
      The spectrum of Altmetrics in neurosurgery: The top 100 “trending” articles in neurosurgical journals.
      Specifically within orthopaedic surgery, the positive association between the citation rate and the AAS has been established, inciting researchers to find innovative methods to share their findings, including graphical or video media that allow for rapid knowledge dissemination and acquisition. Two popular examples of these media include infographics and peer-reviewed surgical technique videos.
      • Kunze K.N.
      • Polce E.M.
      • Vadhera A.
      • et al.
      What is the predictive ability and academic impact of the Altmetrics score and social media attention?.
      However, despite the potential for easily digestible, visual representations of knowledge to be disseminated across online media platforms,
      • Geeslin A.G.
      Editorial Commentary: Infographics engage a broader audience than traditional scientific articles in the medical literature: The latest social media influencer?.
      the extent of their shareability and ultimate impact are not well understood.
      Previous studies have shown the enhanced effectiveness of alternative methods of communicating research outcomes. When comparing infographics with original research articles (ORAs), Kunze et al.
      • Kunze K.N.
      • Vadhera A.
      • Purbey R.
      • Singh H.
      • Kazarian G.S.
      • Chahla J.
      Infographics are more effective at increasing social media attention in comparison with original research articles: An Altmetrics-based analysis.
      found a statistically significant difference in the AAS and overall social media attention favoring infographics. Therefore, visual representations of new orthopaedic research and knowledge appear to be well received and easily shareable by those who frequent online media. However, many orthopaedic journals have recently introduced companion technique journals to demonstrate established surgical concepts, as well as to present recently developed techniques. Although the sharing of technique videos on similar online mediums is common, their influence on readership and online sharing remains poorly understood.
      An improved understanding of the online activity of technique articles and original research may influence the methods used by journals for distributing this content. The purpose of this study was to compare social media attention and citation rates between technique articles and matched ORAs regarding surgical procedures. We hypothesized that technique articles would have a significantly higher AAS on average in comparison to matched ORAs on the same subject.

      Methods

      Article Selection Criteria

      This study was exempt from institutional review board approval. All articles from August 2019 through July 2020 from the electronic versions of Arthroscopy, Sports Medicine, and Rehabilitation (ASMAR), Arthroscopy Techniques, JBJS Open Access, and JBJS Essential Surgical Techniques were obtained. This time frame was chosen to allow maximal time for articles to be disseminated within the research community and accrual of social media attention and citation rates (the total number of citations that each article accrued since its publication) while maintaining their recency in accordance with prior Altmetric studies.
      • Kim H.J.
      • Yoon D.Y.
      • Kim E.S.
      • et al.
      The most mentioned neurointervention articles in online media: A bibliometric analysis of the top 101 articles with the highest Altmetric Attention Scores.
      In addition, no articles were published in ASMAR before August 2019,
      • Lubowitz J.H.
      • Brand J.C.
      • Rossi M.J.
      Arthroscopy, Sports Medicine, and Rehabilitation (ASMAR): A new, open access, electronic journal.
      leaving the selected time frame as the best available time frame for analysis of citation rates and AASs as they pertains to our study. These journals were chosen for this analysis based on the following factors: (1) they had the highest companion-journal impact factor in the field of orthopaedic surgery during the queried time frame
      • Ponkilainen V.T.
      • Uimonen M.
      • Raittio L.
      • Kuitunen I.
      • Eskelinen A.
      • Reito A.
      Multivariable models in orthopaedic research: A methodological review of covariate selection and causal relationships.
      ; (2) all articles within the journal were available to the public on an open-access basis; and (3) the AAS was reported for all articles. Furthermore, the open-access companions from the respective technique journals were chosen for this analysis to minimize the effects that formatting variation, visibility, and publication frequency, as well as differences in the degree and type of self-promotion among multiple journals reviewed by different editorial groups, that may have an impact on the primary outcome.
      The citation rate and the AAS for each article were collected simultaneously in July 2021. Control articles in the “Original Research” sections of ASMAR and JBJS Open Access were selected and matched in a 1:4 ratio on the basis that they directly pertained to a surgical technique or its specific outcomes, as identified by the technique articles in Arthroscopy Techniques and JBJS Essential Surgical Techniques, representing an unbiased sample of articles for comparison. This ratio was chosen because it elicits the lowest bias in matching studies and maximizes statistical power as previously confirmed by applied statistical theory and it has been similarly deployed in prior Altmetric studies.
      • Kunze K.N.
      • Vadhera A.
      • Purbey R.
      • Singh H.
      • Kazarian G.S.
      • Chahla J.
      Infographics are more effective at increasing social media attention in comparison with original research articles: An Altmetrics-based analysis.
      ,
      • Linden A.
      • Samuels S.J.
      Using balance statistics to determine the optimal number of controls in matching studies.
      We extracted all articles classified as basic science or computer model studies, prospective randomized controlled trials, prospective cohort studies, prospective case series, retrospective cohort or case-control studies, retrospective case series, case studies or case reports, cross-sectional studies, systematic reviews and/or meta-analyses, and current concept reviews. Articles classified as editorials, letters to the editor, editorial commentaries, and acknowledgments of reviewers were excluded from the analysis.

      Primary and Secondary Outcomes

      The primary outcomes of interest were the AAS, calculated through weighted social media attention scores that a control or technique article receives,
      • Trueger N.S.
      • Thoma B.
      • Hsu C.H.
      • Sullivan D.
      • Peters L.
      • Lin M.
      The Altmetric score: A new measure for article-level dissemination and impact.
      and the cumulative article citation rate. The AAS includes activity from multiple media platforms, including but not limited to Facebook, Twitter, Reddit, blogs, news articles, and Mendeley.
      Digital Science
      Attention source coverage dates.
      The overall score—calculated and updated in real time to provide an accurate estimate of the impact of an individual article’s dissemination
      • Trueger N.S.
      • Thoma B.
      • Hsu C.H.
      • Sullivan D.
      • Peters L.
      • Lin M.
      The Altmetric score: A new measure for article-level dissemination and impact.
      —is determined by the attention received from each of the considered aforementioned social media outlets and their relative weights (Table 1). There is no upper limit to the score because each article can continue to accumulate attention over time, with the lowest score being 0 (signifying no social media mentions or attention as calculated by the metric).
      Table 1Altmetric Attention Score Calculation
      • Kunze K.N.
      • Vadhera A.
      • Purbey R.
      • Singh H.
      • Kazarian G.S.
      • Chahla J.
      Infographics are more effective at increasing social media attention in comparison with original research articles: An Altmetrics-based analysis.
      ,
      • Ibrahim A.M.
      • Lillemoe K.D.
      • Klingensmith M.E.
      • Dimick J.B.
      Visual abstracts to disseminate research on social media: A prospective, case-control crossover study.
      Social Media OutletWeight
      News8.0
      Blog5.0
      Policy document3.0
      Patent3.0
      Wikipedia3.0
      Twitter1.0
      Peer review (Publons or PubPeer)1.0
      Google+
      Not trackable since 2019 but historical data were kept.
      1.0
      F10001.0
      Weibo
      Not trackable since 2015 but historical data were kept.
      1.0
      Syllabus (Open Syllabus)1.0
      LinkedIn0.5
      Reddit0.25
      Facebook0.25
      YouTube0.25
      Pinterest0.25
      Q&A (Stack Overflow)0.25
      Mendeley Readers0 (tracked but not considered in calculation)
      NOTE. The total score is calculated as a function of the listed social media weights.
      Q&A, question and answer.
      Not trackable since 2019 but historical data were kept.
      Not trackable since 2015 but historical data were kept.

      Data Collection

      Collected variables, including the AASs and citation rates, were obtained using the Altmetric Bookmarklet,
      Digital Science
      How is the Altmetric Attention Score calculated?.
      which reports the aggregate AAS along with relevant statistics regarding mentions from all major social media platforms. The number of citations for each study was extracted through the Dimensions citation database, a platform affiliated with Altmetric that provides the total number of times a work is cited and has been deemed appropriate for citation rate analysis.
      • Parrish J.M.
      • Jenkins N.W.
      • Brundage T.S.
      • Hrynewycz N.M.
      • Singh K.
      The top 100 spine surgery articles on social media: An Altmetric study.
      Secondary variables, either article or Altmetric related, were chosen a priori and collected in accordance with previously published Altmetric investigations.
      • Kunze K.N.
      • Vadhera A.
      • Purbey R.
      • Singh H.
      • Kazarian G.S.
      • Chahla J.
      Infographics are more effective at increasing social media attention in comparison with original research articles: An Altmetrics-based analysis.
      ,
      • Kunze K.N.
      • Polce E.M.
      • Vadhera A.
      • et al.
      What is the predictive ability and academic impact of the Altmetrics score and social media attention?.
      Article characteristics included journal, issue, article title, date of publication, highest degree of first author, number of authors, number of academic institutions, geographic region of origin of the publication, disclosure of any conflict of interest (presence or absence of general self-reported conflict of interest), subject of study, study design, number of referenced studies, and level of evidence as defined by Arthroscopy.
      • Poehling G.G.
      • Jenkins C.B.
      Levels of evidence and your therapeutic study: What’s the difference with cohorts, controls, and cases?.
      Altmetric variables considered and further analyzed included the number of Twitter mentions, number of Facebook mentions, number mentions by news outlets, and number of reads on Mendeley.

      Statistical Analysis

      All statistical analyses were performed with Stata software (version 16.1; StataCorp). Normality was verified with the Shapiro-Wilk test. Bibliometric and Altmetric characteristics were summarized by descriptive statistics using means with standard deviations for continuous variables and frequencies with percentages for categorical variables, compared between groups using 2-way t tests. A multivariate linear regression analysis was conducted to determine (1) the association between article type (technique articles and control research articles) and AAS and (2) the influence of bibliometric characteristics on this relation. The level of statistical significance was defined as P < .05.

      Results

      Article Characteristics

      A total of 285 matched articles published between August 2019 and July 2020 were included. Of these, 57 were control research articles (20.0%) and 228 were technique articles (80.0%). Complete bibliometric and Altmetric characteristics are described in Table 2. Significant differences were noted in the number of references, authors, and institutions, with control research articles having more of each represented on average (P < .01).
      Table 2Bibliometric and Altmetric Characteristics of Included Technique Articles and Original Research Articles
      Original Research Articles (n = 57)Technique Articles (n = 230)P Value
      Author degrees.63
       Other degree
      Other author degrees included BS (bachelor of science); MS (master of science); PhD (doctor of philosophy); MD, PhD; MD, MBA (master of business administration); MD, MS; MD, MPH (master of public health); and PT (physical therapist).
      27 (47.4)98 (42.6)
       MD or DO30 (52.6)132 (57.4)
      Study origin.97
       Continent other than North America28 (49.1)111 (48.3)
       North America29 (50.9)119 (51.7)
      General COI.32
       No29 (50.9)95 (41.3)
       Yes28 (49.1)135 (58.7)
      Subject of study.13
       Knee22 (38.6)94 (40.9)
       Shoulder16 (28.1)72 (31.3)
       Hip10 (17.5)17 (7.4)
       Other
      Other subjects of study included elbow, wrist, imaging, and foot and ankle.
      9 (15.8)47 (20.4)
      No. of references28.3 ± 11.015.3 ± 7.9<.001
      Statistically significant (P < .05).
      No. of authors5.1 ± 2.44.1 ± 1.8.006
      Statistically significant (P < .05).
      No. of institutions2.6 ± 1.41.9 ± 1.1.003
      Statistically significant (P < .05).
      Twitter mention.84
       No39 (68.4)143 (62.2)
       Yes18 (31.6)87 (37.8)
      No. of Tweets1.9 ± 5.93.3 ± 9.5.19
      Facebook mention.66
       No51 (89.5)194 (84.3).13
       Yes6 (10.5)36 (15.7)
      No. of Facebook mentions0.1 ± 0.30.2 ± 0.5
      Mendeley Readers.32
       No38 (66.7)136 (59.1)
       Yes19 (33.3)94 (40.9)
      No. of Mendeley Readers3.1 ± 5.23.1 ± 4.8.96
      NOTE. Data are presented as number (percentage) or mean ± standard deviation.
      COI, conflict of interest; DO, doctor of osteopathy; MD, doctor of medicine.
      Other author degrees included BS (bachelor of science); MS (master of science); PhD (doctor of philosophy); MD, PhD; MD, MBA (master of business administration); MD, MS; MD, MPH (master of public health); and PT (physical therapist).
      Other subjects of study included elbow, wrist, imaging, and foot and ankle.
      Statistically significant (P < .05).

      Social Media Attention

      The mean AAS among all technique articles was 3.63 ± 10.08 (range, 0-96) whereas the mean AAS among all control research articles was 1.30 ± 3.98 (range, 0-25), representing a statistically significant difference (P = .016) (Table 3). A multivariate linear regression model controlling for bibliometric characteristics previously found to influence the AAS in prior studies was constructed to determine the influence of article type on AAS (Table 4). This model showed a statistically significant and positive association between AAS and article type, with an additional increase in the AAS of 2.91 (95% confidence interval [CI], 0.04-5.77; P = .047) on average for every technique article relative to an ORA. Furthermore, a significant positive relation was noted between the continent of origin and the AAS, with an additional increase in the AAS of 3.00 (95% CI, 0.82-5.17; P = .007) on average for every article published in North America compared with an article published in another continent.
      Table 3Mean Altmetric Attention Score and Citation Rate Among Technique Articles and Original Research Articles
      Altmetric Attention ScoreCitation Rate
      Original research articles1.3 ± 4.00.4 ± 0.8
      Technique articles3.6 ± 10.10.4 ± 0.8
      P value.016
      Statistically significant (P < .05).
      .73
      NOTE. Data are presented as mean ± standard deviation.
      Statistically significant (P < .05).
      Table 4Multivariate Linear Regression Model for Key Publication Characteristics, Citations, and Altmetric Attention Scores
      VariableRegression Coefficient95% CIP Value
      Technique (reference: original article)2.910.04 to 5.77.047
      Statistically significant (P < .05).
      COI (reference: no COI)–0.35–2.53 to 1.83.75
      North America (reference: other continents)3.000.82 to 5.17.007
      Statistically significant (P < .05).
      Area of study–0.04–0.50 to 0.43.88
      No. of authors0.11–0.43 to 0.66.68
      Degree of first author (reference: non-MD and non-DO)1.19–0.91 to 3.28.27
      Month published (reference: April)
       January–1.76–6.26 to 2.73.44
       February–0.24–5.19 to 4.71.92
       March8.21–4.22 to 5.36.81
       May4.34–0.45 to 9.13.08
       June1.44–2.70 to 5.59.49
       July0.66–4.17 to 5.48.79
       August0.53–12.15 to 13.22.93
       September4.28–6.28 to 14.94.42
       October3.74–13.83 to 21.31.68
       November–1.87–6.05 to 2.30.38
       December0.90–3.34 to 5.13.68
      No. of citations4.212.91 to 5.51<.001
      Statistically significant (P < .05).
      NOTE. Other author degrees included BS (bachelor of surgery); MS (master of surgery); PhD (doctor of philosophy); MD, PhD; MD, MBA (master of business administration); MD, MS; MD, MPH (master of public health); and PT (physical therapist).
      CI, confidence interval; COI, conflict of interest.
      Statistically significant (P < .05).

      Citation Rates

      The mean citation rate among all technique articles was 0.35 ± 0.83 (range, 0-4), whereas the mean citation rate among all control research articles was 0.41 ± 0.81 (range, 0-4). This difference was not statistically significant (P = .73). Multivariate linear regression analysis showed that the citation rate was significantly associated with the AAS (β = 4.21; 95% CI, 2.91-5.51; P < .001) (Table 4).

      Discussion

      The main findings of this study are as follows: (1) Technique articles had greater AASs on average compared with ORAs pertaining to surgical techniques or outcomes of the same topic. (2) After adjusting for key confounding bibliometric characteristics, technique articles were significantly predictive of and positively associated with a higher AAS. (3) Citation rates did not differ between original articles and technique articles at a minimum of 1 year after online publication.
      The mean AAS was 3.6 for technique articles and 1.3 for control research articles, representing a statistically significant difference in social media attention in favor of technique articles. The use of orthopaedic technique journals as a platform to highlight established procedures and recently developed surgical innovations has become commonplace within the field, with Techniques in Orthopaedics as one of the first journals publishing such content as early as 1986.
      • Lawrence D.
      From the editor.
      However, with the evolution of the internet as the largest contemporary source of health care information and advancements in technology,
      • Moorhead S.A.
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      • Hoving C.
      A new dimension of health care: Systematic review of the uses, benefits, and limitations of social media for health communication.
      ,
      • Choules A.P.
      The use of elearning in medical education: A review of the current situation.
      many orthopaedic journals began supplementing traditional articles by including videos to enhance viewer understanding of topics or procedures.
      • Cheng E.Y.
      • Swiontkowski M.F.
      JBJS Essential Surgical Techniques: Celebrating 10 years of innovation.
      Technique videos have been shown to be an effective tool to share medical knowledge, as well as surgical demonstrations, and the results of our study suggest that they are highly shared across social media.
      • Choules A.P.
      The use of elearning in medical education: A review of the current situation.
      Similarly, surgical videos are powerful tools to facilitate acquiring new surgical skills and accelerate learning new techniques.
      • Ibrahim A.M.
      • Varban O.A.
      • Dimick J.B.
      Novel uses of video to accelerate the surgical learning curve.
      In a randomized controlled trial, Pan et al.
      • Pan M.
      • Harcharik S.
      • Moskalenko M.
      • Luber A.
      • Bernardo S.
      • Levitt J.
      Instructional video for teaching venepuncture.
      found that video instruction significantly improved student confidence and performance of venipuncture as compared with students taught without video demonstrations. Therefore, not only do technique articles that contain videos increase social media attention and shareability, but they may also enhance content teaching and knowledge retention.
      It is interesting to note that both established and newer journals are migrating from publishing predominately text-based articles to an all-video, online format featuring enhanced abstracts.
      • Cheng E.Y.
      • Swiontkowski M.F.
      JBJS Essential Surgical Techniques: Celebrating 10 years of innovation.
      It is plausible that the visual format of technique videos may garner even greater social media attention than currently contextualized through the results of this study by allowing for the presentation of information in a concise, visually appealing manner while upholding patient privacy and the efficacy of the treatment.
      • Ibrahim A.M.
      • Varban O.A.
      • Dimick J.B.
      Novel uses of video to accelerate the surgical learning curve.
      Moreover, as social media platforms, such as Instagram, transition their company missions to video sharing rather than photograph sharing,
      • Singh S.
      Instagram on its way to becoming a video and entertainment platform—‘It’s no more a photo-sharing app,’ says company chief. Business Insider.
      technique videos are poised to become more amenable to sharing and viewing on social media platforms in comparison to links to traditional articles and pictures. For instance, the International Hernia Collaboration, a closed Facebook group dedicated to sharing deidentified surgical videos to discuss how surgeons handle challenging patient presentations, has grown 6-fold since 2016, with over 11,000 members.
      • Ibrahim A.M.
      • Varban O.A.
      • Dimick J.B.
      Novel uses of video to accelerate the surgical learning curve.
      ,
      Facebook. International Hernia Collaboration.
      The ability for surgeons and trainees to learn from these videos may help reduce potential patient morbidity that is associated with learning any new surgical procedure.
      • Ibrahim A.M.
      • Varban O.A.
      • Dimick J.B.
      Novel uses of video to accelerate the surgical learning curve.
      Ultimately, the use of narrated videos to demonstrate the management of difficult cases may allow journals to increase their readership and maintain a far-reaching presence regardless of decreases in the numbers of print articles they publish.
      In this study, technique articles were found to be a significant positive predictor of increased social media attention. Specifically, the mean increase in the AAS from technique articles was 2.91 relative to ORAs. Although articles were matched by subject, this finding reinforces that significant differences exist in social media attention between technique articles and ORAs and that social media attention may translate into increased citations and impact. As such, technique videos have the potential to have an increasingly strong impact throughout online forums. Previous studies have found the AAS to be a significant predictor of a greater number of citations within the orthopaedic literature
      • Kunze K.N.
      • Polce E.M.
      • Vadhera A.
      • et al.
      What is the predictive ability and academic impact of the Altmetrics score and social media attention?.
      and in many other fields of medicine.
      • Chang J.
      • Desai N.
      • Gosain A.
      Correlation between Altmetric score and citations in pediatric surgery core journals.
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      Twitter mentions and academic citations in the urologic literature.
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      • et al.
      Does Tweeting improve citations? One-year results from the TSSMN prospective randomized trial.
      Kunze et al.
      • Kunze K.N.
      • Vadhera A.
      • Purbey R.
      • Singh H.
      • Kazarian G.S.
      • Chahla J.
      Infographics are more effective at increasing social media attention in comparison with original research articles: An Altmetrics-based analysis.
      have postulated that researchers commonly cite studies they first encounter when writing their own manuscripts to enhance hypothesis generation and idea generation. Similarly, sharing technique videos may ultimately allow for social media to serve as a platform by which journals can not only optimize the extent of their reach in the scientific community but also garner increased citation rates and academic impact of their research.
      • Kunze K.N.
      • Vadhera A.
      • Purbey R.
      • Singh H.
      • Kazarian G.S.
      • Chahla J.
      Infographics are more effective at increasing social media attention in comparison with original research articles: An Altmetrics-based analysis.
      Furthermore, North America was an independent factor associated with an article achieving increased social media attention, with a mean increase in the AAS of 3.0 compared with articles from other origins. This finding is not surprising, given that most of the publications in the included journals were from North America and previous studies have similarly shown that articles from North America are associated with higher citation rates
      • Fassoulaki A.
      • Vassi A.
      • Kardasis A.
      • Chantziara V.
      Altmetrics should not be used for ranking of anaesthesia journals.
      and AASs.
      • Kunze K.N.
      • Polce E.M.
      • Vadhera A.
      • et al.
      What is the predictive ability and academic impact of the Altmetrics score and social media attention?.
      ,
      • Fassoulaki A.
      • Vassi A.
      • Kardasis A.
      • Chantziara V.
      Altmetrics should not be used for ranking of anaesthesia journals.
      The association among the citation rate, the AAS, and publications from North America has previously been described in the orthopaedic literature
      • Kunze K.N.
      • Polce E.M.
      • Vadhera A.
      • et al.
      What is the predictive ability and academic impact of the Altmetrics score and social media attention?.
      and is likely a reflection of high rates of publication in the United States.
      • Powell A.G.M.T.
      • Bevan V.
      • Brown C.
      • Lewis W.G.
      Altmetric versus bibliometric perspective regarding publication impact and force.
      As such, considering that our study identified a positive association between AAS and citation rate, these findings are plausible and logical within the context of our study.
      Although technique videos have been shown to enhance conceptual understanding and retention of content compared with written words alone
      • Pan M.
      • Harcharik S.
      • Moskalenko M.
      • Luber A.
      • Bernardo S.
      • Levitt J.
      Instructional video for teaching venepuncture.
      ,
      • Ibrahim M.
      • Antonenko P.D.
      • Greenwood C.M.
      • Wheeler D.
      Effects of segmenting, signalling, and weeding on learning from educational video.
      while garnering increased social media attention as suggested by our study, researchers should be cautioned on the limitations of using and interpreting content through these formats. For videos longer than 6 minutes, viewership engagement and learning begin to decrease at a rapid rate, with attention decreasing by over 50% after approximately 10 minutes.
      • Brame C.J.
      Effective educational videos: Principles and guidelines for maximizing student learning from video content.
      However, the relative time limit of presenting information through multimedia may require oversimplification of challenging procedures. Consequently, visual presentations may not support the same level of detailed explanation as other methods of surgical demonstration such as laboratory courses and instructional course lectures. Another key concern is that technique articles often lack long-term follow-up, patient outcome data, and control groups for comparison. This represents a low level of evidence that requires support from higher-level original research. Clinicians who view multimedia within technique articles should understand that although they are engaging media to enhance their skills, they should also be encouraged to review the accompanying articles and the supporting original research as a primary source before making changes in their practice.

      Limitations

      This investigation is not without limitations. First, this study examined a subset number of articles from 4 orthopaedic journals under 2 editorial groups. Therefore, the findings of this study may represent the unique practices of these journals’ readership and may not broadly apply to the greater orthopaedic literature. Second, the time restriction, given the initiation of ASMAR in August 2019, precludes the understanding of longer-term social media attention and citation rates. However, by including articles within a full year past their initial publication, our study allotted and captured an adequate length of time to accrue AASs and citations as implemented in prior Altmetric investigations
      • Kunze K.N.
      • Vadhera A.
      • Purbey R.
      • Singh H.
      • Kazarian G.S.
      • Chahla J.
      Infographics are more effective at increasing social media attention in comparison with original research articles: An Altmetrics-based analysis.
      ,
      • Kunze K.N.
      • Polce E.M.
      • Vadhera A.
      • et al.
      What is the predictive ability and academic impact of the Altmetrics score and social media attention?.
      ,
      • Polce E.M.
      • Kunze K.N.
      • Farivar D.
      • et al.
      Orthopaedic randomized controlled trials published in general medical journals are associated with higher Altmetric Attention Scores and social media attention than nonorthopaedic randomized controlled trials.
      while maintaining article recency.
      • Kim H.J.
      • Yoon D.Y.
      • Kim E.S.
      • et al.
      The most mentioned neurointervention articles in online media: A bibliometric analysis of the top 101 articles with the highest Altmetric Attention Scores.
      Third, the selective inclusion of ORAs matched by topic to technique articles based on our study purpose may inherently bias the amount of social media attention each article receives. Finally, our analysis examined only a subset of bibliometric characteristics. However, these characteristics have been used in prior literature
      • Kunze K.N.
      • Vadhera A.
      • Purbey R.
      • Singh H.
      • Kazarian G.S.
      • Chahla J.
      Infographics are more effective at increasing social media attention in comparison with original research articles: An Altmetrics-based analysis.
      ,
      • Polce E.M.
      • Kunze K.N.
      • Farivar D.
      • et al.
      Orthopaedic randomized controlled trials published in general medical journals are associated with higher Altmetric Attention Scores and social media attention than nonorthopaedic randomized controlled trials.
      and have been deemed feasible for appropriate analytical use.
      • Kunze K.N.
      • Polce E.M.
      • Vadhera A.
      • et al.
      What is the predictive ability and academic impact of the Altmetrics score and social media attention?.
      Therefore, the decision was made to select and include these characteristics in our study.

      Conclusions

      Technique articles resulted in significantly greater AASs and social media attention in comparison with open-access ORAs on similar topics. Publications that described technical procedures in a technique journal and studies from North America were positively associated with greater AASs and greater numbers of citations received by articles.

      Supplementary Material

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