Authors: William B. Roberts, MS; Michael E. Bibens BS; Matt Vassar, PhD.
Institution:Oklahoma State University Center for Health Sciences, Dept. of Institutional Research
Institution Address: 1111 West 17th Street, Tulsa, OK, 74107
Corresponding Author: William Roberts; 1111 West 17th Street, Tulsa, OK, 74107; email@example.com
Conflicts of Interest: The authors have nothing to disclose.
Does Public Interest in Specific Injuries Increase When They Occur During Mixed Martial Arts Bouts? A Study of Google Search Patterns
Mixed martial arts (MMA) is a combat sport that combines fighting techniques from many disciplines, such as wrestling, boxing, karate, Muay Thai, and Brazilian Jiu Jitsu. Despite this sport’s popularity – influenced by the internet and social media – the effect of high-profile MMA injuries on the public’s subsequent online search patterns has yet to be explored. In this study, we examined injuries from popular UFC bouts and observe whether the volume of Google searches for specific injuries increased after the associated fights. Google Trend (GT) searches were conducted in order to evaluate the relationship between fighter search popularity and injury search popularity during the week the fight took place. The percent change in search interest for injuries increased in 9 of 10 cases (Mdn = 446%, IQR: 168.75%-1643.75%). The findings of this study are expected to inform sports medicine personnel regarding specific platforms for sharing their insights and recommendations for the treatment and prevention of MMA injuries and other trauma-related injuries. This study highlights how investigation of public search interest may ultimately have a positive impact on health care outcomes. Through the use of analyzing MMA injuries and the search patterns associated with them, the results of this study may aid sports medicine personnel in directing patients to online information that they have personally reviewed and approved.
Keywords: Google Trends, Mixed Martial Arts (MMA), Infodemiology, Public Interest, Altmetrics, Twitter
Mixed martial arts (MMA) is a combat sport based on the fighting techniques from many disciplines, such as wrestling, boxing, karate, Muay Thai, and Brazilian Jiu Jitsu. Bouts take place in an octagon-shaped cage and last either 3 or 5 rounds, depending on whether the bout is for a weight class championship. Fighters can defeat their opponent by knockout, referee stoppage, submission, or outscoring an opponent based upon the judges’ decision (21). In the early 1990s MMA made its way to the United States as the Ultimate Fighting Championship (UFC). Over time, the MMA has experienced a global surge in popularity and has attracted widespread media coverage (3,6).
While the internet and social media have played an important role in advancing MMA popularity, these media outlets have also become a means to publicize fight injuries. For example, MMA fighters have shared radiographic images of their injuries with fans on social media to make these injuries appear more genuine and to stimulate public interest (26). In addition, these outlets may also be used by experts, such as orthopedic surgeons, to teach the public about MMA and other traumatic sports related orthopedic injuries. Approximately 21% of orthopedic surgeons have a Facebook or Twitter account, and they could potentially use these platforms to lower the frequency of these injuries and increase the accuracy of information available regarding their treatment (7).
Previous studies using GT data have examined the effects of awareness campaigns on searches for particular disorders, such as deep vein thrombosis, skin cancer, and breast cancer (15,17,29,30-32) Other studies have focused on the influence celebrities have on public awareness of various disorders. Studies on search interest after Katie Couric’s colon cancer, Angelina Jolie’s breast cancer, and Robin Williams’s depression have found that public interest increased following a celebrity’s statement about a diagnosis or treatment (4,8,12).
Despite previous GT studies, the effect of high-profile MMA injuries on the public’s subsequent online search patterns has yet to be explored. This effect could be assessed by analyzing the frequency of Google keyword searches (5). Here we examine injuries from popular UFC bouts and observe whether the volume of Google searches for specific injuries increases after the associated fights. Results from this study may inform sports medicine physicians, orthopedic surgeons, athletic trainers, and others about public search interest in the UFC and related traumatic sports injuries at the time of occurrence (7,9). In turn, practitioners who diagnose, treat, and manage such injuries may consider creating a list of approved online resources with accurate information for their patients and social media followers.
Our sample of injuries was gathered from “Sherdog’s Top 10 Worst UFC Injuries” available at www.sherdog.com (31). In addition to recording injury information, we recorded the name of the fighter sustaining the injury, the date of injury occurrence, and the fighter’s popularity (measured by the number of Twitter followers).
Google Trends evaluation
Google Trends (GT) was used to evaluate search interest in these injuries before and after the bouts in question. GT is a free, publicly accessible online platform that captures temporal and geospatial internet search patterns for user-specified keywords (26). GT searches were conducted on June 4, 2018, by one of us (WR). GT can be searched using topics (i.e., a group of terms that share the same concept, in any language) or terms (i.e., search terms that show matches for all search terms in the query, in only the language searched). Searching by topic may be thought of as being more specific, while searching by term is more sensitive. For example, if one searches for the sport “Mixed Martial Arts” as a topic, users will see GT data for all searches related to MMA (e.g., UFC fighters, UFC bouts), but no search returns unrelated to MMA. In contrast, if one searches for “mixed martial arts” as a term, search returns related to mixed (e.g., mixed drinks), martial (e.g., dictionary definition of martial), and arts (e.g., local art museums). There is not a topic for everything, so in our study we used a combination of searches by topic and term.
Google Trends fighter-injury search
Each fighter was searched as a topic, and their injury was searched as a term. To illustrate this difference more clearly, when Leslie Smith was entered into GT, a drop-down menu provided a list of suggestions. The first suggestion was to search Leslie Smith as a term, and all other suggestions enabled searching Leslie Smith as a topic. We chose the topic Leslie Smith with the correct description (i.e., American mixed martial artist). The second part of each GT search included the injury that was sustained during the fight, searched as a term. For example, a complete search from this study included Leslie Smith (American mixed martial artist) and “cauliflower ear” as a term, and it yielded 2 sets of search data. Using this search combination allowed us to visualize spikes in the fighter and the injury occurring simultaneously. All our searches and their search filter settings are included in Table 1.
Table 1: Fighters and their characteristics.
|Injured Fighter||Google Trends Description||Injury Searched||Twitter followers||Percent change in Injury Search Interest||Number of Weeks to Return to Baseline||Time Range Searched|
|Anderson Silva||Brazilian mixed martial artist||Broken Leg||8.08M||2600||3 weeks||June 30, 2013-2014|
|Tim Sylvia||American mixed martial arts fighter||Dislocated Elbow||18.1K||2400||4 weeks||Jan 25th, 2004-2005|
|Jon Jones||American mixed martial artist||Broken Toe||2.03M||1800||3 weeks||Oct. 28th, 2012-2013|
|Rory MacDonald||Canadian mixed martial artist||Broken Nose||229K||1175||6 weeks||Jan. 11th, 2015-2016|
|Antonia Rodrigo Nogueira||Brazilian mixed martial artist||Broken Arm||1.33M||525||5 weeks||Jun. 12th, 2011-2012|
|Corey Hill||American mixed martial artist||Broken Leg||No Twitter Account||367||6 weeks||Jun. 15th, 2008-2009|
|Leslie Smith||American mixed martial artist||Cauliflower Ear||21.9K||225||2 weeks||May. 18th, 2014-2015|
|Rich Franklin||American mixed martial artist||Broken Nose||200K||150||2 weeks||Apr. 16th, 2006-2007|
|Mark Hominick||Canadian mixed martial artist||Hematoma||56.3K||112||3 weeks||Oct. 31st 2010-2011|
|Brandon Vera||Mixed martial artist||Broken Jaw||101K||0||No change in interest||Sept. 27th, 2009-2010|
Google Trends filter application
To narrow the scope of each search we applied 4 filters: location, time range, category, and search type. The location filter was set to “worldwide.” The time range filter for each fighter included data points 6 months before and 6 months after each fight. The category filter was “health,” thus allowing us to compare search volumes of each fighter and injury to all searches in the health category (5,28) The search type filter was set to “web search.”
Google Trends data scaling
GT data are not displayed as the total number of searches over time. Rather, GT accounts for search volume and population density in a certain region (13). Therefore, equal search volume will be charted differently for countries with different populations. This adjustment ensures that large populations, with higher raw numbers of search volumes, will not be perceived as always having the greatest interest in a search. Google Trends’ data are scaled from 0 to 100 where 0 indicates no search data are available and 100 indicates the greatest search interest for a topic or search term (19). When multiple items are searched simultaneously on GT, only the item with the highest search interest peaks at 100. For example, if we search Leslie Smith and “cauliflower ear,” only one of the plots of GT data will peak at 100. All other points in time for each plot will be scaled proportionally relative to the peak. When a spike in search interest for the fighter and injury occurred at the same time, we called this pattern of co-occurrence an “alignment.”
To enhance the reproducibility of our search we applied recommendations from the Checklist for Documentation of Google Trends by Nuti et al (24). Because of the small sample size, we used nonparametric statistics to analyze our data. Non parametric tests are distribution independent tests which are useful while using medians for analysis (25). Thus, median (IQRs) were used to summarize the data. Spearman’s rho was used to evaluate the association between the number of Twitter followers and the percent change in search behavior from baseline to peak. All statistical analyses were conducted using Stata 15.1.
Our sample size consisted of 10 injured fighters. The characteristics of these 10 fighters are shown in Table 1. The number of Twitter followers for each fighter ranged from 18.1K to 8.08 million. A co-occurring pattern was observed between searches for the fighter and for the injury (i.e., an alignment) in 9 of 10 cases (Figure 1). The percent change in search interest for injuries increased in 9 of 10 cases (median = 446%, IQR: 168.75%-1643.75%). Anderson Silva’s broken leg and Tim Silvia’s dislocated shoulder accounted for the greatest changes in search interest from baseline. Search interest for injuries returned to baseline in the ensuing weeks following each fight (median = 3weeks, IQR: 2.25-4.75 weeks). A moderate correlation was found between the number of Twitter followers and the percent change in search interest from baseline to peak (rs=.40)
Results from our study indicate that public interest in particular injuries increased following high-profile UFC fights. This finding may encourage timely dissemination of evidence-based information about particular injuries since search interest appears to increase shortly after injury occurrence. Here, we first discuss the roles of YouTube and social media in disseminating health information to large audiences in a timely manner. These two platforms are commonly used by the public to become familiar with recently occurring athletic injuries as well as sports medicine personnel when directing patients to online information that they have personally reviewed and approved. We then discuss potential avenues to maximize the accurate dissemination about sports-related injuries following bouts.
YouTube video accuracy
When the public seeks out health information on the internet, many options are available, and YouTube may be among the most popular of alternatives. An impressive body of literature is focused on the quality of health information presented to the public on YouTube. A systematic review on the use of YouTube to disseminate health information found that YouTube videos contain misleading information—mostly anecdotal—and the information often contradicts reference standards (23). Gonzalez-Estrada et al. (16) reported that the majority of YouTube videos on asthma management contained alternative approaches, such as live-fish ingestion and reflexology, as opposed to evidence-based treatments. In orthopedics, MacLeod et al. (22) found that information about femoroacetabular impingement on YouTube was of low overall quality, and a study on the X-stop device for lumbar spinal stenosis found that YouTube videos about the device contained a high degree of misinformation and failed to describe the controversy surrounding its use (2). Further, some studies have noted that reputable organizations (e.g., professional medical societies, disease-specific societies and organizations) are not producing videos on YouTube to combat the large volume of misinformation, and even when high-quality videos are available, they may not be prominently ranked by YouTube’s search algorithm (1,18). Collectively, these studies call for the dissemination of better evidence-based information to the public. This current deficit in accurate health information is best addressed by the physicians with expertise on the topic. Lander et al. (20) reported that one-third of orthopedic surgeons in their sample had posted at least 1 YouTube video, and this platform may be important for knowledge dissemination, given its fairly high use by orthopedic surgeons and the public.
Social media for dissemination
Social media presents another popular option for the dissemination of health care information. It has been estimated that only 21% of United States-based orthopedic surgeons have Facebook pages and 14% have Twitter accounts (7). However, given that 50% of orthopedic patients use social media, and of these, sports medicine patients use these platforms more than patients in all other orthopedic subspecialties (9), it seems prudent for the sports medicine community to use these platforms for disseminating accurate health information. Social media outlets are efficient mechanisms for releasing information in real time, and they could easily be used to provide accurate information about particular injuries that occur during sporting events, such as UFC fights. Djuricich (10) introduced the concept of evidence-based tweeting as one approach to quickly making research evidence available to large audiences.
Strengths and weaknesses
Our study has several strengths. We used the checklist by Nuti et al. (24) when developing the search strategies for this study to make our searches reproducible. We made careful use of the search functionality of GT and gave thorough consideration to each search term. Our study also had limitations. For one, the fights we selected were based on a ranking provided by Sherdog. While this site is widely used in the MMA community, there is a possibility of bias in these rankings. There are also limitations inherent in using GT data. For example, all data associated with GT are anonymous, which limits the ability of researchers to make assertions regarding the search patterns of different patient groups. Also, data are normalized, which limited our ability to examine the true magnitude of search volumes that could be obtained from raw search data. Furthermore, not all internet searches are conducted using the Google search engine.
Understanding the ways in which the public prefers to search for information on injuries may aid sports medicine personnel in directing patients to online information that they have personally reviewed and approved. Thus, sports medicine personnel may play a contributing role in increasing the accuracy of online health by decreasing the amount of inaccurate information that is accessible by the public (11,14).
The findings of this study are expected to inform orthopedic surgeons, sports medicine doctors, and athletic trainers on the specific electronically based platforms of which to disseminate their insights and recommendations for treatment and prevention of MMA injuries and other trauma-related injuries. This use of social media and online websites could lead to increased accuracy of online health information and ultimately improve treatment and prevention of these associated injuries. More broadly, this study highlights how investigation of public search interest may have a positive impact on health care outcomes.
1. Adhikari J, Sharma P, Arjyal L, Uprety D. 2016. YouTube as a Source of Information on Cervical Cancer. N. Am. J. Med. Sci. 8(4):183–86
2. Anderson JT, Sullivan TB, Ahn UM, Ahn NU. 2014. Analysis of Internet information on the controversial X-Stop device. Spine J. 14(10):2412–19
3. Bledsoe GH, Hsu EB, Grabowski JG, Brill JD, Li G. 2006. Incidence of injury in professional mixed martial arts competitions. J. Sports Sci. Med. 5(CSSI):136–42
4. Brigo F. 2015. Impact of news of celebrity illness on online search behavior: the “Robin Williams” phenomenon’. J. Public Health . 37(3):555–56
5. Brigo F, Trinka E. 2015. Google search behavior for status epilepticus. Epilepsy Behav. 49:146–49
6. Buse GJ. 2006. No holds barred sport fighting: a 10 year review of mixed martial arts competition. Br. J. Sports Med. 40(2):169–72
7. Call T, Hillock R. 2017. Professionalism, social media, and the Orthopaedic Surgeon: What do you have on the Internet? Technol. Health Care. 25(3):531–39
8. Cram P, Fendrick AM, Inadomi J, Cowen ME, Carpenter D, Vijan S. 2003. The impact of a celebrity promotional campaign on the use of colon cancer screening: the Katie Couric effect. Arch. Intern. Med. 163(13):1601–5
9. Curry E, Li X, Nguyen J, Matzkin E. 2014. Prevalence of internet and social media usage in orthopedic surgery. Orthop. Rev. . 6(3):5483
10. Djuricich AM. 2014. Social media, evidence-based tweeting, and JCEHP. J. Contin. Educ. Health Prof. 34(4):202–4
11. Dy CJ, Taylor SA, Patel RM, Kitay A, Roberts TR, Daluiski A. 2012. The effect of search term on the quality and accuracy of online information regarding distal radius fractures. J. Hand Surg. Am. 37(9):1881–87
12. Evans DG, Barwell J, Eccles DM, Collins A, Izatt L, et al. 2014. The Angelina Jolie effect: how high celebrity profile can have a major impact on provision of cancer related services. Breast Cancer Res. 16(5):442
13. Explore results by region – Trends Help. https://support.google.com/trends/answer/4355212?hl=en&ref_topic=4365530
14. Fabricant PD, Dy CJ, Patel RM, Blanco JS, Doyle SM. 2013. Internet search term affects the quality and accuracy of online information about developmental hip dysplasia. J. Pediatr. Orthop. 33(4):361–65
15. Glynn RW, Kelly JC, Coffey N, Sweeney KJ, Kerin MJ. 2011. The effect of breast cancer awareness month on internet search activity–a comparison with awareness campaigns for lung and prostate cancer. BMC Cancer. 11:442
16. Gonzalez-Estrada A, Cuervo-Pardo L, Ghosh B, Smith M, Pazheri F, et al. 2015. Popular on YouTube: a critical appraisal of the educational quality of information regarding asthma. Allergy Asthma Proc. 36(6):e121–26
17. Hay J, Coups EJ, Ford J, DiBonaventura M. 2009. Exposure to mass media health information, skin cancer beliefs, and sun protection behaviors in a United States probability sample. J. Am. Acad. Dermatol. 61(5):783–92
18. Ho M, Stothers L, Lazare D, Tsang B, Macnab A. 2015. Evaluation of educational content of YouTube videos relating to neurogenic bladder and intermittent catheterization. Can. Urol. Assoc. J. 9(9-10):320–54
19. How Trends data is adjusted – Trends Help. https://support.google.com/trends/answer/4365533?hl=en&ref_topic=6248052
20. Lander ST, Sanders JO, Cook PC, O’Malley NT. 2017. Social Media in Pediatric Orthopaedics. J. Pediatr. Orthop. 37(7):e436–39
21. Lystad RP, Gregory K, Wilson J. 2014. The Epidemiology of Injuries in Mixed Martial Arts: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2(1):2325967113518492
22. MacLeod MG, Hoppe DJ, Simunovic N, Bhandari M, Philippon MJ, Ayeni OR. 2015. YouTube as an information source for femoroacetabular impingement: a systematic review of video content. Arthroscopy. 31(1):136–42
23. Madathil KC, Rivera-Rodriguez AJ, Greenstein JS, Gramopadhye AK. 2015. Healthcare information on YouTube: A systematic review. Health Informatics J. 21(3):173–94
24. Nuti SV, Wayda B, Ranasinghe I, Wang S, Dreyer RP, et al. 2014. The use of google trends in health care research: a systematic review. PLoS One. 9(10):e109583
25. Mircioiu C, Atkinson J. 2017. A Comparison of Parametric and Non-Parametric Methods Applied to a Likert Scale. Pharmacy (Basel). 5(2):
26. Radin M, Sciascia S. 2017. Infodemiology of systemic lupus erythematous using Google Trends. Lupus. 26(8):886–89
27. Rahmani G, Joyce CW, McCarthy P. 2017. The sharing of radiological images by professional mixed martial arts fighters on social media. Acta Radiol Open. 6(6):2058460117716703
28. Refine Trends results by category – Trends Help. https://support.google.com/trends/answer/4359597?hl=en&ref_topic=4365530
29. Scheres LJJ, Lijfering WM, Middeldorp S, Cannegieter SC. 2016. Influence of World Thrombosis Day on digital information seeking on venous thrombosis: a Google Trends study. J. Thromb. Haemost. 14(12):2325–28
30. Sherdog.com. Sherdog’s Top 10: Worst UFC Injuries – Top 10. Sherdog. http://www.sherdog.com/news/articles/1/Sherdogs-Top-10-Worst-UFC-Injuries-105257
31. Troelstra SA, Bosdriesz JR, de Boer MR, Kunst AE. 2016. Effect of Tobacco Control Policies on Information Seeking for Smoking Cessation in the Netherlands: A Google Trends Study. PLoS One. 11(2):e0148489
32. Wood LN, Jamnagerwalla J, Markowitz MA, Thum DJ, McCarty P, et al. 2018. Public Awareness of Uterine Power Morcellation Through US Food and Drug Administration Communications: Analysis of Google Trends Search Term Patterns. JMIR Public Health Surveill. 4(2):e47
Figure 1. Google search volumes for the injured UFC fighter and the particular injury. Searches were conducted 6 months pre- and post injury. Dotted blue lines represent the fighter. Solid orange lines represent the injury.