Credibility, accuracy and readability of patient-oriented information about low back pain on Brazilian websites: a mixed-method review

Alonso, Thamires Prazeres; Santos, Raiany Pires dos; Correia, Igor Macedo Tavares; Nogueira, Leandro Alberto Calazans; Meziat Filho, Ney; Reis, Felipe José Jandre

doi:10.5935/2595-0118.20220069-en

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ORIGINAL ARTICLE • BrJP 6 (1) • Jan-Mar 2023 • https://doi.org/10.5935/2595-0118.20220069-en copy

Credibility, accuracy and readability of patient-oriented information about low back pain on Brazilian websites: a mixed-method review

Authorship SCIMAGO INSTITUTIONS RANKINGS

HIGHLIGHT

Information about low back pain in Brazilian websites failed to meet guideline-endorsed recommendations.

ABSTRACT

BACKGROUND AND OBJECTIVES:

Low-quality online health-related content may lead to inefective or harmful decision-making from patients related to their healthcare. The aim of this study was to evaluate the credibility, accuracy and readability of web-based content on Brazilian websites.

METHODS:

This is a mixed-method review with exploratory sequential design. Google was selected as the search engine for retrieving web-information about low back pain (LBP) in Brazilian websites. We assessed the URL on three domains: credibility, accuracy, and readability. Qualitative analysis of each URL was performed in three steps: (1) organization into thematic units; (2) data exploration; and (3) interpretation of the data and summarization.

RESULTS:

Credibility was assessed in 135 URLs, 72 (53%) URLs had no authorship, 119 (88%) did not mention the sources of their information, none presented a declaration of conflict of interest or the declared source of funding, 76 (56%) URLs present the date of creation. Accuracy was assessed in 121 URLs and none fully adhered to the guidelines. Readability was assessed in 128 and texts were classified as “very easy” or “easy” to read. Five main themes emerged in the qualitative analysis: (1) Explanations and causes for low back pain, (2) diagnosis, (3) recommendation about treatment, (4) recommendation for coping and self-management, and (5) lifestyle factors.

CONCLUSION:

Content analysis of web-based searches on the Brazilian Portuguese language demonstrated low credibility standards, mostly inaccurate information, and moderate-high readability levels about low back pain.

Keywords:
Access to information; Consumer health information; Information dissemination; Low back pain; Medical informatics

Theme	Sub-theme	Coding (n)	Examples
Explanations and causes for low back pain	Cause of low back pain attributed to biomedical factors	Posture (287) Muscular (120) Spine deformities (237) Injury/trauma (99) Work (56) Sciatica (129) Diseases (102)	An inadequate posture at work, especially office workers, on the couch at home, when using the cell phone or computer and when sleeping, contribute a lot to low back pain. (URL20) A herniated disc can cause irritation or compression to the sciatic nerve, resulting in pain. (URL31)
	Risk Factors	Age (48) Smoking (27) Overweight (72) Sedentary lifestyle (58)	The chronic form (of low back pain) usually happens among the elderly; the pain is not as intense, but it is almost permanent. (URL19) Smoking is believed to decrease the supply of oxygen to the disc, causing it to break down more quickly. (URL89) Sedentary lifestyle is one of the main causes of low back pain. (URL14)
Diagnosis	Assessment and complementary tests	Imaging tests (63)	More than 90% of the time, the diagnosis and cause are established with a good conversation with the patient and a thorough physical examination. When in doubt, the next step is plain radiography. (URL19) The main recommendation is to look for an orthopedist and have tests done to find out the real cause of the pain and the extent of the injury. (URL17)
Recommendation about treatment	Conservative treatment	Exercise/movement (293) Drugs (161) Manual Techniques (57) Rest (43) Back support belt (8)	The initial goal of treatment is pain relief. Several medications can be used, including analgesics, anti-inflammatory drugs, muscle relaxants, steroids and opioids, always after evaluating the risk-benefit of each one of them” (URL120) Use back support belt to correct posture and protect your lower back. (URL56) Spinal manipulation, performed by a chiropractor or certain other doctors (such as osteopathic physicians), can also provide relief when combined with an exercise program. (URL111)
	Surgical treatment	Surgery (60)	Surgery may be an option if symptoms have not responded to other treatments and continue to intensify. (URL92) In some cases, surgeries are performed to correct the anatomy and relieve low back pain. However, in addition to the risk during the procedure, the pathology can happen again, as the body remains unprepared for daily movement. (URL13)
Recommendation for coping and self-management	Information on work, posture, lifting and carrying objects	Posture (287) Weight (110) Work (56)	Try to maintain a good posture. The habit of using correct postures should be developed, especially when there is a need to remain seated or standing for a long time. But it is always important to take “breaks” to get out of the same position. (URL100) Avoid carrying too many weights and inappropriately (URL99)
Influence of lifestyle factors	Lifestyle guidance	Sleep (29) Nutrition (19)	Keeping a healthy and balanced diet, rich in anti-inflammatory foods is essential not only to maintain health, but to help minimize inflammation and discomfort caused by low back pain. (URL101) Social isolation can reduce the level of physical activity, as well as raise anxiety levels and worsen sleep quality. All these factors contribute to the onset or persistence of low back pain. (URL42)

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[1] Correspondence to: Felipe José Jandre dos Reis E-mail: felipe.reis@ifrj.edu.br