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THE PROFESSIONAL SITE OF THE WEB OF THE BACK

The Web of the Back (equally accessible via: www.espalda.org or www.weboftheback.org) is the Foundation's Reference Center on the back and its disorders. It contains information for both the professional and the general public, including how the back is structured and how it functions. The Web provides all of the important information on prevention, diagnosis, treatment, prognosis, economic analyses and comparative effectiveness of different strategies for the clinical management of patients.

The disorders discussed on the Web are those known as mechanical musculoskeletal pathologies. They are disorders in which the pain varies according to posture, movement and exertion and is not due to systemic illnesses such as cancer or infections. They are the most common cause of back pain and include such diagnoses as arthrosis, disc herniation, disc protrusion, muscle contraction, scoliosis, spondylolisthesis, and spinal stenosis.

This section refers to the scientific area of the Web of the Back, addressed to health professionals. The Web's general area, addressed to the public, is described here.

Background.

The scientific information available on mechanical pathologies of the spine is extensive, disperse and of uneven methodological quality.

Thousands of articles referring to these mechanical pathologies are published every year. Additionally, they appear in many different magazines and journals: there are more than 30,000 medical publications in the world. Useful studies on handling patients with back disorders may appear in journals on internal medicine, neurosurgery, traumatology, rheumatology, sports medicine, rehabilitation or radiology, in addition to interdisciplinary magazines on the back or on pain management. Among such a profusion of sources, it is difficult for a practicing physician to find the studies he or she may need.

Furthermore, these articles are published in a great variety of languages. A practicing physician must be able to read them with ease in order to understand them.

At the same time, the studies published are of very uneven scientific or methodological quality. While medical magazines have a scientific review board that assures the methodological quality of the articles they publish, in fact, evaluations reveal that most of the articles published present methodological errors that are serious enough to undermine the validity of their findings. Therefore, practicing physicians must also be experts in research methodology in order to assess the reliability of each one of the articles they read.

Therefore, in order to stay up-to-date in the field of mechanical pathologies of the spine, one needs precisely the resources, knowledge and time that most doctors involved in patient care simply do not have.

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Objective.

The essential objective of the Professional Site at the Web of the Back is to help professionals involved in the management of mechanical pathologies of the spine to stay up to date in their field.

To this end, the Web is designed to allow any professional access to all the available information. The professional may select the topic or the study that specifically interests him or her, as well as read the structured summary of those studies whose methodological quality shows them to be reliable.

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Description.

The Web of the Back (www.espalda.org or www.weboftheback.org) is bilingual (Spanish/English) and can be consulted freely without limitation of any kind. It is divided into a scientific section, designed for health professionals, and a general information section, presented in non-technical language for the public.With its focus on evidence-based-medicine, the Professional Site of the Web of the Back is continually brought up to date and contains:

1. Bibliographic references for all of the scientific articles on back ailments published in medical journals throughout the world. This information includes all of the articles published since January 1, 1990 in reviews included in any of the existing electronic medical databases.

2. Analysis of the scientific studies and their classification, into accepted or rejected, according to the reliability of their methodological quality. The methodological reasons preventing an article from being accepted and that call its reliability into question will be sent to anyone who requests them, but are not shown publicly on the Web in order not to offend its authors or the magazine in which it was published.

3. Structured summary, in Spanish and English, of those articles which, because of their reliability, have been found acceptable.

4. Evidence-based clinical guideline recommended by the available scientific studies, which define the most effective and beneficial protocol for diagnosis and treatment based on the available scientific knowledge at the time.

5. Explanation of work method, detailed description of the criteria used to search for and assess the articles, including the criteria used to evaluate each kind of study, and the mechanisms for quality control used at each stage of the process.

6. Glossary of methodological terms, explaining their meaning to physicians.

7. Identification of the individuals participating in and responsible for each stage of the process of creation of the Web's contents.

In addition to bringing its material up-to-date constantly, the Professional Site at the Web of the Back also continually adds material which could interest the international professional community dedicated to back ailments or which it may request from the Web's Editorial Staff through the tools provided on the page, as for example:

• Scales to measure reliably, the degree of pain, disability or limitation in the quality of life, which, once scientifically validated, are available in English and/or in Spanish

• A listing of all of the congresses and meetings dedicated to back problems, indicating relevant information for their inclusion (clinical aspect, research oriented or mixed, areas of special interest within the topic of back disorders-treatment, diagnosis, prevention, etc.-language, date, place and information on the scientific committee and organizers).

A team of experts in medical research and methodology is responsible for finding the potentially relevant studies and for evaluating their scientific quality as well as summarizing those which have provided sufficiently reliable results. This team is wholly independent from the Kovacs Foundation and several mechanisms have been organized to ensure that its work cannot be interfered with in any instance.

Furthermore, in each phase of the process of preparing the Web contents, various mechanisms of quality control have been established. Thus, for example, different mechanisms are used to ensure that the search for scientific studies is exhaustive and various systems are applied to ensure the accuracy of the evaluation of the scientific studies as well as maintaining the criteria for this evaluation up-to-date or for the comparison of several evaluations made by different experts of a single study. A detailed report of these quality control mechanisms for each phase of the process can be found on the Web page (either www.espalda.org or www.weboftheback.org)..

The process of preparing the Web's scientific area and the methods used to this end are designed and supervised by a multinational Editorial Committee that brings together the most prestigious experts in the field of medical research, methodology and clinical investigation in the area of back problems, such as David Kleinbaum, Francisco Pozo, Steve Bernstein and Víctor Abraira. The complete list of the Editorial Committee members can be found on the Web.

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Along with the Kovacs Foundation, the following have participated in this project.

• An international, multidisciplinary team of more than 80 experts in medical documentation, research methodology, medical translation, and clinical specializations related to back disorders, directed by the Editorial Committee of the Web's Professional Site.

• In order to assure the asepsis and independence of this work, the Web's Professional Site is funded exclusively by the Kovacs Foundation.

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Status.

The professional site came into being on June 28, 1998. Description of the work method and the glossary have been accessible since January 25, 2001 and the evaluated scientific articles from September 25, 2001.

The Web's work methods, shown on the Web and specifically including the criteria used to evaluate the methodological quality of the studies evaluated, have also been subjected to assessment by the international scientific community through their publication in different research fora.

Due to the reliability of their work methods, the summaries of the scientific articles favorably assessed by the Web of the Back are included in the Cochrane Library Plus, of the Cochrane Collaboration.

The computerized medical databases reviewed between January 2001 and June 2004 contain more than 9 million scientific articles. In-depth and up-to-date information on the number of articles related to back problems that have been identified, evaluated and summarized can be found in the Web's Professional Site (either www.espalda.org or www.weboftheback.org). In this period, the Web of the Back has received more than 5 million visitors from all around the world