YouTube, TikTok, and Bilibili as sources of medical information on lumbar spinal stenosis

Lumbar spinal stenosis (LSS) is a common degenerative condition that impairs mobility and quality of life, particularly in older adults. Video-sharing platforms are increasingly used for health information, yet the quality and reliability of LSS-related videos and cross-platform differences remain unclear. This study compares the content, uploader characteristics, and information quality of LSS-related videos on YouTube, TikTok, and Bilibili and examines associations between video quality and audience engagement. A cross-sectional search of YouTube, TikTok, and Bilibili was conducted on February 1, 2026, using relevant Chinese and English keywords. Of the retrieved videos, 253 met the eligibility criteria. Reliability, overall quality, understandability, actionability, and audiovisual quality were assessed using the modified DISCERN instrument, Global Quality Score, Patient Education Materials Assessment Tool understandability and Patient Education Materials Assessment Tool actionability score scores, and Video Information and Quality Index (VIQI). The sample comprised 89 YouTube, 80 Bilibili, and 84 TikTok videos, with median durations of 389, 171, and 103 seconds, respectively. TikTok videos were the shortest and showed relatively high engagement across available metrics. YouTube videos more frequently covered etiology and prevention and were predominantly uploaded by hospitals/departments and verified physicians; Bilibili and TikTok videos focused mainly on treatment, and TikTok had the highest proportion of verified physician uploaders. YouTube videos had higher modified DISCERN instrument and Global Quality Scores. Total VIQI scores were higher on YouTube and TikTok than on Bilibili, whereas Patient Education Materials Assessment Tool actionability scores did not differ significantly across platforms. Associations between video quality and audience engagement varied by platform, with VIQI showing the most consistent positive correlations. The quality and dissemination characteristics of LSS-related videos differed across platforms. YouTube videos were more reliable, TikTok videos showed greater dissemination appeal, and Bilibili showed no clear advantage in most quality metrics. High audience engagement did not necessarily indicate medical reliability. Platform recommendation systems should consider uploader qualifications, content reliability, and presentation quality to promote high-quality LSS information.