Information about Low Back Pain on Brazilian official Websites do not follow the current guidelines.   July 12th, 2022

Information about Low Back Pain on Brazilian official Websites do not follow the current guidelines.

The internet presents much health information that is available to anyone with easy access. It has become the primary source for patients and families to find information about their clinical condition including symptoms, preventive methods and treatment options [1].

As more people search the internet for medical information, the reliability and validity of online materials become important issues. People (including the lay public and health care professionals) believe thatwebsites sponsored by official organizations, such as government agencies (e.g., Ministry of Health), professional councils and associations, are recognized as a trustworthy source of information. However, the content of these websites is poorly investigated.

Recently, we published a mixed-method study aimed to evaluate the credibility, accuracy and readability of low back pain web-based content on Brazilian official websites (websites sponsored by government agencies and professional associations) [2]. Credibility was assessed using the 4-item (currency of information, declaration of authorship, presentation of a list of references, and disclosure of any conflict of interest, funding, or sponsorship) Journal of the American Medical Association (JAMA) benchmark [3]. Accuracy was defined as the number and proportion of website recommendations that were judged clear and accurate according to the 2015 Evidence-Informed Primary Care Management of Low Back Pain [4], the 2016 National Institute for Health and Care Excellence (NICE) guidelines ( and the 2017 American College of Physicians guidelines for the management of low back pain with or without sciatica [5]. Readability was assessed using the Flesch-Kincaid index adapted to Portuguese [6].

We analysed 84 unique URLs. Of the 84 URLs included, 17 were excluded from the credibility-related analysis, 26 excluded from the accuracy analysis and 12 from the readability analysis. In credibility analysis (n=67), we found that 58 (86.6%) URLs had no authorship, 63 (94%) did not mention the sources of their information, and none presented a declaration of conflict of interest or the declared source of funding. Findings from accuracy analysis (n=58) showed that topics with the highest rates of accurately/clearly described information were the recommendation to remain active (n=17; 29%) and recommendations for exercises (n=19; 32.7%). These topics also presented the highest rates of information that is partially accurate/lacking clarity. Topics not included in the majority of URLs were psychological treatments (n=54; 93.1%), coping and self-management (n=50; 86.2%), multimodal treatments (n=50; 86.2%) and manual therapies (n=49; 84.5%). The readability analysis (n=72) showed that in 20 (27.8%) URLs the readability of the text was considered “very easy” to understand, representing a level of education “up to the 4th grade” of elementary school and in 47 (65.2%) of the URLs the degree of difficulty of reading was classified as “easy”, equivalent to a level of “up to the 8th grade” of elementary school.

Inaccurate information can contribute to overuse including overutilization of the healthcare system, unnecessary tests and ineffective treatments [7]. In addition, much of this inaccurate information can contribute to unhelpful beliefs, maladaptive behaviors and high levels of disability. Our study highlights an urgent need of reliable information about low back pain in Brazil. Brazilian official websites represent healthcare professionals, and they should provide accessible and evidence-based information about low back pain for many different types of users.

Prof. Felipe Reis

Felipe Reis is a Professor at the Instituto Federal do Rio de Janeiro, Brazil, visiting research at McGill University and visiting professor at the Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium. My research interests are: the integration of pain, emotion and cognition, and pain education. I am the current chair of the IASP Special Interest Group Pain, Mind and Movement.


[1] Kim R, Kim H, Jeon B. The good, the bad, and the ugly of medical information on the internet. Mov Disord 2018;33:754–7.

[2] Santos RP, Alonso TP, Correia IMT, Nogueira LC, Meziat-Filho N, Reis FJJ. Patients should not rely on low back pain information from Brazilian official websites: A mixed-methods review. Brazilian J Phys Ther 2022;26:100389.

[3] Silberg WM. Assessing, Controlling, and Assuring the Quality of Medical Information on the Internet. Jama 1997;277:1244.

[4] Group TOPLBPW. Evidence-Informed Primary Care Management of Low Back Pain. Edmonton, Canada Towar Optim Pract 2015.

[5] Qaseem A, Wilt TJ, McLean RM, Forciea MA. Clinical Guidelines Committee of the American College of P. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2017;166:514–30.

[6] Martins TBF, Ghiraldelo CM, Nunes MG V., Júnior ONO. Readability Formulas Applied to Textbooks in Brazilian Portuguese. Notas Do ICMSC-USP ICMC 1996:1–12.

[7] Maher CG, O’Keeffe M, Buchbinder R, Harris IA. Musculoskeletal healthcare: Have we over-egged the pudding? Int J Rheum Dis 2019.

Further reading: