Parents are known to use the internet to gather information about their children’s health-related symptoms (Kubb & Foran, 2020). Although parents have said they consider the credibility of a website’s author in their online searches, this may not be true in practice (Benedicta et al., 2020). Therefore, any information available online about childhood health conditions, such as non-specific back pain, has the potential to be read by parents. This is concerning, because Ferreira et al. (2019) and Santos et al. (2022) have shown that online information about adult low back pain is largely inaccurate and lacking credible sources. A recent scoping review (Hauber, Robinson, Kirby et al., 2023) showed that interventions offered to adolescents with persistent back pain in randomized trials have focused almost exclusively on biomechanical and postural factors and largely ignored psychosocial contributors to pain. Therefore, we undertook a cross-sectional content analysis of consumer websites to determine whether public-facing content echoes this biomechanical bias. 

 

This was a descriptive cross-sectional analysis. The study protocol was registered on Open Science Framework on 28 March 2023 (https://doi.org/10.17605/OSF.IO/8X7KU). Web pages served up via Google search using a virtual private network (VPN) in each of 5 English-speaking countries (Australia, Canada, England, Ireland, and the United States) were screened for eligibility according to our systematic search strategy (see published protocol: Hauber, Robinson, Fechner et al., 2023). Content related to treatment of adolescent back pain was analysed via directed manifest content analysis (Hsieh & Shannon, 2005; Kleinheksel et al., 2020). An a priori codebook with 34 treatment-related codes was developed by the authors; 9 additional codes were inductively created during content analysis. 

 

Results 

Of 245 unique web pages, 48 were deemed eligible for analysis. Of the 43 total treatment codes, 37 were present in at least one web page. The 5 most frequently identified codes were: See the doctor/get a diagnosis (85%), Ergonomics/posture/biomechanics (52%), Reassurance (48%), Physiotherapy (48%), and OTC pharmaceuticals/supplements (46%). Codes related to psychosocial treatments were mentioned much less frequently than codes related to physical/structural treatment: Change the focus (13%), Parental/caregiver behavior (8%), and Stress management (8%) were the most frequent psychosocial codes. Despite recent promising research programs, cognitive behavioral therapy (CBT; 2%), intensive or interdisciplinary pain treatment (2%), and psychotherapy (non-CBT; 6%) were rarely mentioned.

 

Parents of adolescents with non-specific back pain are being encouraged to continue engaging with clinicians in an attempt to find a diagnosis for their teen’s persistent back pain. In addition, non-specific persistent back pain is not differentiated from acute back pain in online sources, potentially causing confusion for parents. Due to the emphasis on physical/structural treatments, parents may be surprised if clinicians focus on improving teens' general health, mental health, and psychosocial factors as part of treatment. As in our scoping review of RCTs (Hauber, Robinson, Kirby et al., 2023), the concept of persistent pain as a biopsychosocial phenomenon is not reflected in most websites containing treatment recommendations for adolescent back pain. 

 

Because online health information can form a meaningful part of many patients’ and caregivers’ understanding of their or their children’s health-related symptoms, treatment, and prognosis, it seems crucial for clinicians to be aware of the information that is easily findable online and written for a general consumer audience. 

 

Ethical Permissions 

Ethical approval was not required for this analysis of publicly available online information.