Evaluating the readability, quality and reliability of online patient education materials on chronic low back pain

Background There are concerns over the reliability and comprehensibility of health-related information on the internet. We analyzed the readability, reliability and quality of online patient education materials obtained from websites associated with chronic low back pain (cLBP). Methods On 26 April 2022, the term ‘cLBP’ was used to perform a search on Google, and 95 eligible websites were identified. The Flesch Reading Ease Score (FRES) and Gunning Fog (GFOG) index were used to evaluate the readability. The Journal of the American Medical Association (JAMA) score was used to assess the reliability and the Health on the Net Foundation code of conduct (HONcode) was used to assess quality. Results The mean (SD) FRES was 55.74 (13.57) (very difficult) and the mean (SD) GFOG was 12.76 (2.8) (very difficult) of the websites reviwed. According to the JAMA scores, 28.4% of the websites had a high reliability rating and 33.7% adhered to the HONcode. Websites of different typologies were found to significantly differ in their reliability and the quality scores (p<0.05). Conclusion The reading ability required for cLBP-related information on the internet was found to be considerably higher than that recommended by the National Health Institute and had low reliability and poor quality. We believe that online information should have readability appropriate for most readers and must have reliable content that is appropriate to educate the public, particularly for websites that provide patient education material.