Sharp criticism of information on treatment of back pain from The Back Letter

Revelations in an Australian study of the information on non-commercial websites about treatment of back pain has made tempers boil among researchers of MSK disease because the websites do not live up to expectations. The renowned newsletter The Back Letter recently levelled criticism at the institutions behind the websites for their contents.

Researchers from the University of Sydney have conducted a systematic review of the credibility, accuracy and comprehensiveness of Internet based information about the treatment of low back pain found on the freely available websites of trusted non-commercial English-speaking institutions.

The study revealed a low level of credibility, mostly provided inaccurate information and did not include all types of low back pain according to Giovanni Ferreira, lead investigator of the study. The revelations have led to vehement criticism of the reliability and information level revealed in the study in the August edition of the respected newsletter The Back Letter.

- Internet sites at some of the most trusted institutions in the United States and other societies are not providing patients and the general public accurate, evidence-based information about low back pain and its treatment. These organizations are missing an opportunity to help resolve a major public health crisis, The Back Letter writes.

The newsletter quotes Alice Kongsted, Senior Researcher at NIKKB and Professor at the University of Southern Denmark for calling the results of the study disheartening. In a tweet dated May 8th concerning the study she writes:

- Well done – but sad results. Non-commercial, freely accessible websites demonstrated low credibility standards, provided mostly inaccurate information across all types of back pain.

The author of the paper is also not particularly impressed.

- I was very surprised and disappointed. Previous reviews that addressed similar research questions had examined a lot of websites with commercial interests. We thought that only including websites from sources deemed trustworthy by the public would give us a different scenario. Unfortunately, that’s not what happened.

Mette Jensen Stochkendahl, Senior Researcher at NIKKB and associate professor at the University of Southern Denmark, is also critical about the websites in question. In a review of the research paper in the Danish chiropractors’ periodical KIROPRAKTOREN from June 2019, she writes:

- The researchers systematically studied publicly accessible non-commercial websites from six English-speaking countries. They defined credibility based on four pre-defined points. Accuracy was defined as the number of recommendations which were in accordance with the two guidelines and comprehensiveness from the share of recommendations from the guidelines which were shared on a website.

- The Australians found 79 websites, of which 31 % declared they had been updated after the publication of the two guidelines. Only 43 % of the recommendations regarding treatment of back pain was assessed as correct. At the same time, the treatments mentioned only covered a very small share of the total treatments, regardless of type of back pain. As an example, only 28 % on average of the treatments for acute low back pain was described correctly but the description of treatment of radicular low back pain was particularly bad; only 16 % of the treatments were described correctly.

- The Australian research group concluded that non-commercial websites, which are seen as trustworthy sources, fail both in communicating clinical recommendations and first choice of treatments but also in rejecting inefficient treatments. They simply contain too many incorrect or misguiding recommendations. Ultimately, this incorrect information could lead to more patients seeking out unnecessary or inefficient treatment.

It was not clear from the review whether the inaccurate information about back pain therapies reflected poor research efforts by website developers, a casual attitude towards these Internet resources, misguided societal beliefs, or loyalty of sponsoring institutions to treatment approaches that lack evidence support.

The institutions studied include the Mayo Clinic, the Cleveland Clinic, the Johns Hopkins Hos­pitals, Massachusetts General Hospital, and New England Baptist Hospital, to name a few.

The Back Letter does not hesitate in calling the results of the study scandalous and bitterly disappointing.

- Patients and the general public should demand that prestigious, trusted institutions provide accurate and compre­hensive inf01mation on low back pain and its treatment-at websites, in institutional guidelines, and in decision aids and shared decision-making materials employed in clinical settings, The Back Letter concludes.

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