Credibility, Accuracy, and Comprehensiveness of Internet-Based Information About Low Back Pain: A Systematic Review

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Abstract

Background

Low back pain (LBP) affects millions of people worldwide, and misconceptions about effective treatment options for this condition are very common. Websites sponsored by organizations recognized as trustworthy by the public, such as government agencies, hospitals, universities, professional associations, health care organizations and consumer organizations are an important source of health information for many people. However, the content of these websites regarding treatment recommendations for LBP has not been fully evaluated.

Objective

This study aimed to determine the credibility, accuracy, and comprehensiveness of treatment recommendations for LBP in noncommercial, freely accessible websites.

Methods

We conducted a systematic review of websites from government agencies, hospitals, universities, professional associations, health care organizations and consumer organizations. We conducted searches on Google. Treatment recommendations were coded based on the 2016 National Institute for Health and Care Excellence (NICE) guidelines and the 2017 American College of Physicians guideline on LBP. Primary outcomes were credibility of the website (4-item Journal of the American Medical Association benchmark), accuracy (proportion of website treatment recommendations that were appropriate), and comprehensiveness of website treatment recommendations (proportion of guideline treatment recommendations that were appropriately covered by a website).

Results

We included 79 websites from 6 English-speaking countries. In terms of credibility, 31% (25/79) of the websites clearly disclosed that they had been updated after the publication of the NICE guidelines. Only 43.28% (487/1125) website treatment recommendations were judged as accurate. Comprehensiveness of treatment recommendations correctly covered by websites was very low across all types of LBP. For acute LBP, an average of 28% (4/14) guideline recommendations were correctly covered by websites. Websites for radicular LBP were the least comprehensive, correctly covering an average of 16% (2.3/14) recommendations.

Conclusions

Noncommercial freely accessible websites demonstrated low credibility standards, provided mostly inaccurate information, and lacked comprehensiveness across all types of LBP.

Related collections

Most cited references 23

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William M. Silberg (1997)

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Prognosis for patients with chronic low back pain: inception cohort study

Luciola da C Menezes Costa, Christopher Maher, James McAuley … (2009)

Objectives To describe the course of chronic low back pain in an inception cohort and to identify prognostic markers at the onset of chronicity. Design Inception cohort study with one year follow-up. Setting Primary care clinics in Sydney, Australia. Participants The study sample was a subcohort of an inception cohort of 973 consecutive patients presenting to primary care with acute low back pain (<2 weeks’ duration). 406 participants whose pain persisted for three months formed the inception cohort of patients with chronic low back pain. Main outcome measures Outcomes and putative predictors measured at initial presentation, onset of chronicity (study entry), and follow-up at nine and 12 months. Recovery was determined from measures of pain intensity, disability, and work status. The association between potential prognostic factors and time to recovery was modelled with Cox regression. Results Completeness of follow-up was 97% of total person time for all outcomes. The cumulative probability of being pain-free was 35% at nine months and 42% at 12 months and for complete recovery was 35% at nine months and 41% at 12 months. Of the 259 participants who had not recovered from pain related disability at entry to the chronic study, 47% had recovered by 12 months. Previous sick leave due to low back pain, high disability levels or high pain intensity at onset of chronicity, low levels of education, greater perceived risk of persistent pain, and being born outside Australia were associated with delayed recovery. Conclusion More than one third of patients with recent onset, non-radicular chronic low back pain recover within 12 months. The prognosis is less favourable for those who have taken previous sick leave for low back pain, have high disability levels or high pain intensity at onset of chronic low back pain, have lower education, perceive themselves as having a high risk of persistent pain, and were born outside Australia.

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The treatment of acute low back pain--bed rest, exercises, or ordinary activity?

A Malmivaara, S E Lappi, R Paloheimo … (1995)

Bed rest and back-extension exercises are often prescribed for patients with acute low back pain, but the effectiveness of these two competing treatments remains controversial. We conducted a controlled trial among employees of the city of Helsinki, Finland, who presented to an occupational health care center with acute, nonspecific low back pain. The patients were randomly assigned to one of three treatments: bed rest for two days (67 patients), back-mobilizing exercises (52 patients), or the continuation of ordinary activities as tolerated (the control group; 67 patients). Outcomes and costs were assessed after 3 and 12 weeks. After 3 and 12 weeks, the patients in the control group had better recovery than those prescribed either bed rest or exercises. There were statistically significant differences favoring the control group in the duration of pain, pain intensity, lumbar flexion, ability to work as measured subjectively, the Oswestry back-disability index, and number of days absent from work. Recovery was slowest among the patients assigned to bed rest. The overall costs of care did not differ significantly among the three groups. Among patients with acute low back pain, continuing ordinary activities within the limits permitted by the pain leads to more rapid recovery than either bed rest or back-mobilizing exercises.

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Author and article information

Contributors

Giovanni Ferreira:

Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneyLevel 10 North, King George V BuildingSydney, 2050Australia61 0286279961giovanni.ferreira@sydney.edu.au

ORCID: http://orcid.org/0000-0002-8534-195X

Journal

Journal ID (nlm-ta): J Med Internet Res

Journal ID (iso-abbrev): J. Med. Internet Res

Journal ID (publisher-id): JMIR

Title: Journal of Medical Internet Research

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Print): 1439-4456

ISSN (Electronic): 1438-8871

Publication date Collection: May 2019

Publication date (Electronic): 07 May 2019

Volume: 21

Issue: 5

Electronic Location Identifier: e13357

Affiliations

[1 ] Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health The University of Sydney Sydney Australia

Author notes

Corresponding Author: Giovanni Ferreira giovanni.ferreira@ 123456sydney.edu.au

Author information

Giovanni Ferreira http://orcid.org/0000-0002-8534-195X

Adrian C Traeger http://orcid.org/0000-0002-1646-1907

Gustavo Machado http://orcid.org/0000-0002-8544-0448

Mary O'Keeffe http://orcid.org/0000-0001-7104-9248

Christopher G Maher http://orcid.org/0000-0002-1628-7857

Article

Publisher ID: v21i5e13357

DOI: 10.2196/13357

PMC ID: 6529212

PubMed ID: 31066689

SO-VID: 9a98cd42-ae85-4f99-9271-55246f073ffc

Copyright © ©Giovanni Ferreira, Adrian C Traeger, Gustavo Machado, Mary O'Keeffe, Christopher G Maher. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 07.05.2019.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/.as well as this copyright and license information must be included.

History

Date received : 10 January 2019

Date revision requested : 27 February 2019

Date revision received : 1 March 2019

Date accepted : 3 March 2019

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