Research Review by Dr. Shawn Thistle©


Sept. 2004

Study Title:

Back pain online: A cross-sectional survey of the quality of web-based information on low back pain


Butler L, Foster NE

Publication Information:

Spine 2003; 28(4): 395-401


The goal of this study was to evaluate the quality of information available regarding low back pain and treatment that the "average" patient may access on the Internet. Recent surveys have indicated that patients are increasingly keen to search the Internet for information regarding medical and health topics. Without a doubt, the Internet has changed the way information is disseminated.

However, unlike many other medical information sources, the Internet is not subject to peer review. Therefore, anyone (including me!), regardless of qualification or intent, can make information available online.

Previous authors have investigated the quality of information online for a number of topics, and the general consensus is that although good information can be found on the Internet, few websites provide accurate information. This exemplifies the need for critical review and the development of quality indicators for health information published online.

Since low back pain is such a common complaint, the availability of quality information on this topic could help reduce unnecessary hospital visits, reduce pain beliefs and help prevent chronicity. This study used a scoring system based on eight criteria to evaluate 60 websites located through searches of major search engines.

These criteria included scores for overall quality of the site, as well as the quality of low back pain information. Information was judged based on adherence to current research evidence and published practice guidelines.

The average score of the sites used in this study was 7.4 4.85 (out of a possible 38). 97% of the sites actually scored below 50% of the available points, indicating poor overall quality. The most striking result was that 76% of the sites failed to provide a source for their information.

Further, only 30% identified the author of the material and only 20% disclosed the qualifications of the author. With regards to treatment options, most sites (90%) failed to even mention spinal manipulation as an option. Inaccurate information was most commonly found regarding the use of exercise and bed rest.

Conclusions & Practical Application:

This study indicates that people accessing the Internet for information about low back pain do not receive advice based on the best available evidence. Health care practitioners who commonly treat low back pain should consider compiling an index of reliable, evidence-based sources of online information that could be distributed to their patients.