Are Popular YouTube Videos Demonstrating Pelvic Floor Physical Therapy Exercises Also Reliable?

Objectives: Pelvic floor physical therapy (PFPT) is a first-line intervention for many pelvic floor conditions. Multiple barriers were identified limiting patients’ access to this treatment option. The alternatives for patients with limited access to the gold standard in-person PFPT include YouTube-based video-directed pelvic floor exercises. The quality of instructional and educational content of this wildly utilized alternative is unknown. This study aimed to assess the correlation between the popularity of the PFPT instructional videos and the contents' reliability.

Methods: YouTube was searched using the terms “Kegels”, “Pelvic floor exercises”, “Pelvic floor physical therapy”, “Pelvic floor workout”, and “Pelvic floor exercises for women.” The first 100 videos for each search term were screened. English language videos providing actionable instruction in PFPT were included Videos that were duplicated, irrelevant, without verbal instruction, related to male anatomy, marked as “Ads”, or about surgical approaches were excluded. Relevant metrics were collected for each video. Two independent reviewers assessed the videos for reliability using the Medical Quality Video Evaluation (MQ-VET) tool. The modified DISCERN tool, the Journal of American Medical Association (JAMA) benchmark criteria, and the Global Quality Score (GQS) were used to assess domains of medical educational quality not included in MQ-VET. Popularity was assessed using the Video Power Index (VPI), calculated using the formula: Like count x view count/100. The association between MQ-VET and VPI was determined by using Spearman’s rank correlation. An intraclass correlation coefficient (ICC) was calculated using an absolute agreement, 2-way mixed-effects model to test for inter-rater reliability of the MQ-VET scores.

Results: 500 videos were screened. 234 videos were duplicates, and 99 videos did not meet the inclusion criteria. 167 videos were reviewed (Table 1). The median VPI and MQ-VET score was 201114.76 (IQR 7194020.29) and 48.00 (IQR 12.75) (Figure 2), respectively. Two videos had the highest MQ-VET score of 62.5: https://youtu.be/b3LaDSWBJW0 and https://youtu.be/08ocxE0FDLI. Spearman’s R-value was 0.292 (p < 0.001), demonstrating a weak positive correlation between MQ-VET scores and VPI. The inter-rater reliability of the MQ-VET was good, with an ICC of 0.86 (95% CI 0.71-0.92).

Conclusions: We identified a statistically significant weak positive correlation between the reliability and popularity of YouTube videos about PFPT. This demonstrates that it is more likely that patients will encounter reliable, accurate videos when choosing results with a greater number of views or likes. However, the top search results are not guaranteed to be the most reliable videos, because the demonstrated correlation is weak. Providers still need to critically evaluate the content of specific videos before making recommendations to patients.