What do patients know about their low back pain? An analysis of the quality of information available on the Internet.

Previous surveys showed a poor quality of the web sites providing health information about low back pain. However, the rapid and continuous evolution of the Internet content may question the current validity of those investigations. The present study is aimed to quantitatively assess the quality of the Internet information about low back pain retrieved with the most commonly employed search engines. An Internet search with the keywords "low back pain" has been performed with Google, Yahoo!® and Bing™ in the English language. The top 30 hits obtained with each search engine were evaluated by five independent raters and averaged following criteria derived from previous works. All search results were categorized as declaring compliant to a quality standard for health information (e.g. HONCode) or not and based on the web site type (Institutional, Free informative, Commercial, News, Social Network, Unknown). The quality of the hits retrieved by the three search engines was extremely similar. The web sites had a clear purpose, were easy to navigate, and mostly lacked in validity and quality of the provided links. The conformity to a quality standard was correlated with a marked greater quality of the web sites in all respects. Institutional web sites had the best validity and ease of use. Free informative web sites had good quality but a markedly lower validity compared to Institutional websites. Commercial web sites provided more biased information. News web sites were well designed and easy to use, but lacked in validity. The average quality of the hits retrieved by the most commonly employed search engines could be defined as satisfactory and favorably comparable with previous investigations. Awareness of the user about checking the quality of the information remains of concern.