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Quality and Readability of Online Patient Information on Regenerative Therapies for Chronic Musculoskeletal Pain: An Infodemiology Study
ABSTRACT
Background:
Regenerative therapies are increasingly promoted for chronic pain related to degenerative musculoskeletal conditions, despite heterogeneous clinical evidence. Patients frequently rely on information from clinic websites offering these therapies, yet the reliability and readability of this information remain unclear.
Objective:
This study aims to assess the quality and readability of publicly accessible patient-directed websites promoting regenerative therapies for chronic musculoskeletal pain.
Methods:
We conducted an infodemiology study of publicly accessible English-language websites identified on August 3, 2025, using predefined regenerative therapy and musculoskeletal condition search terms in DuckDuckGo. The first 50 URLs per search term were screened. Eligible websites providing patient-directed information underwent full-text review by two independent reviewers. Website quality was assessed using the QUEST (0-28) and the Sandvik (0-14) tools, with higher scores indicating better quality. Readability was evaluated using the Gunning Fog Index (GFI), and the Flesch Reading Ease score (FRES) scores. Descriptive statistics were reported.
Results:
Of 172 included websites, 83.1% were private or commercially affiliated, predominantly from North America (U.S. 76.1%, Canada 19.8%). Overall quality was low, with mean (SD) QUEST and mean (SD) Sandvik scores of 5.42 (5.68) and 6.59 (2.25), respectively and fewer than 10% websites had high QUEST scores. Inter-rater reliability was good for both tools with intraclass correlation coefficient (ICC) of 0.83. Readability violated recommended patient-education levels of 8th grade, with mean GFI score corresponding to college level, and mean FRES indicating difficult readability. Inter-rater agreement was good for GFI (ICC = 0.76), and excellent for FRES (ICC = 0.90)
Conclusions:
Publicly available online information promoting regenerative therapies for chronic musculoskeletal pain is generally low in reliability and credibility and written above recommended patient-education reading levels. Improved transparency, evidence-aligned patient-education resources, and clearer regulatory guidance are needed to support informed decision-making.
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.