P52. Clinical guidelines for the evaluation, assessment, and treatment of lumbar disc herniations: how accurate is the internet?

BACKGROUND CONTEXT Lumbar disc herniation (LDH) affects 1-3% of the population and is a common indication for spine surgery. Due to this relatively high prevalence and the potential impact of LDH on daily functioning, patients with LDH are likely to search the Internet for related information. However, previous studies have shown that health information found online is likely inaccurate and incomplete. PURPOSE In the current study, we assessed the accuracy of online information about LDH, using the North American Spine Society (NASS) Clinical Practice Guidelines as a comparison. STUDY DESIGN/SETTING An informal review of online search results for LDH was conducted. OUTCOME MEASURES Frequency of individual recommendations across websites. METHODS Online searches were performed utilizing three common search engines (Google, Bing, Yahoo) and keywords associated with LDH. The top 20 websites from each search were selected, and the content regarding diagnosis and treatment of LDH was compared to the NASS Clinical Practice Guidelines. RESULTS On average, websites mentioned only 59% of recommendations supported by Level I evidence. Websites included three recommendations not discussed in the NASS guidelines out of an average of 12 total recommendations. Muscle and sensory testing and physical therapy were the most frequent recommendations, appearing on over 80% of websites. Websites were equally likely to contain recommendations backed by high-quality evidence as recommendations not included in the NASS guidelines. CONCLUSIONS This study demonstrates that websites regarding LDH contain a mix of information, with only a fraction of recommendations aligning with clinical guidelines. Patients who use these websites are presented with unsubstantiated information, conceivably impacting their expectations and decision making in physician offices. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Lumbar disc herniation (LDH) affects 1-3% of the population and is a common indication for spine surgery. Due to this relatively high prevalence and the potential impact of LDH on daily functioning, patients with LDH are likely to search the Internet for related information. However, previous studies have shown that health information found online is likely inaccurate and incomplete. In the current study, we assessed the accuracy of online information about LDH, using the North American Spine Society (NASS) Clinical Practice Guidelines as a comparison. An informal review of online search results for LDH was conducted. Frequency of individual recommendations across websites. Online searches were performed utilizing three common search engines (Google, Bing, Yahoo) and keywords associated with LDH. The top 20 websites from each search were selected, and the content regarding diagnosis and treatment of LDH was compared to the NASS Clinical Practice Guidelines. On average, websites mentioned only 59% of recommendations supported by Level I evidence. Websites included three recommendations not discussed in the NASS guidelines out of an average of 12 total recommendations. Muscle and sensory testing and physical therapy were the most frequent recommendations, appearing on over 80% of websites. Websites were equally likely to contain recommendations backed by high-quality evidence as recommendations not included in the NASS guidelines. This study demonstrates that websites regarding LDH contain a mix of information, with only a fraction of recommendations aligning with clinical guidelines. Patients who use these websites are presented with unsubstantiated information, conceivably impacting their expectations and decision making in physician offices.