scholarly journals Application of a diagnosis-based clinical decision guide in patients with low back pain

2011 ◽  
Vol 19 (1) ◽  
Author(s):  
Donald R Murphy ◽  
Eric L Hurwitz
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Decision ◽  
Low Back

scholarly journals Clinician acceptance of complex clinical decision support systems for treatment allocation of patients with chronic low back pain

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stephanie Jansen-Kosterink ◽  
Lex van Velsen ◽  
Miriam Cabrita
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Perceived Usefulness ◽  
Intention To Use ◽  
Low Back ◽  
Research Model ◽  
Online Questionnaire ◽  
Treatment Allocation

Abstract Background The uptake of complex clinical decision support systems (CDSS) in daily practice remains low, despite the proven potential to reduce medical errors and to improve the quality of care. To improve successful implementation of a complex CDSS this study aims to identify the factors that hinder, or alleviate the acceptance of, clinicians toward the use of a complex CDSS for treatment allocation of patients with chronic low back pain. Methods We tested a research model in which the intention to use a CDSS by clinicians is influenced by the perceived usefulness; this usefulness, in turn is influenced by the perceived service benefits and perceived service risks. An online survey was created to test our research model and the data was analysed using Partial Least Squares Structural Equation Modelling. The study population consisted of clinicians. The online questionnaire started with demographic questions and continued with a video animation of the complex CDSS followed by the set of measurement items. The online questionnaire ended with two open questions enquiring the reasons to use and not use, a complex CDSS. Results Ninety-eight participants (46% general practitioners, 25% primary care physical therapists, and 29% clinicians at a rehabilitation centre) fully completed the questionnaire. Fifty-two percent of the respondents were male. The average age was 48 years (SD ± 12.2). The causal model suggests that perceived usefulness is the main factor contributing to the intention to use a complex CDSS. Perceived service benefits and risks are both significant antecedents of perceived usefulness and perceived service risks are affected by the perceived threat to autonomy and trusting beliefs, particularly benevolence and competence. Conclusions To improve the acceptance of complex CDSSs it is important to address the risks, but the main focus during the implementation phase should be on the expected improvements in patient outcomes and the overall gain for clinicians. Our results will help the development of complex CDSSs that fit more into the daily clinical practice of clinicians.

scholarly journals Prediction of Treatment Outcomes for Patients with Chronic Low Back Pain: the Development of a Clinical Decision Guideline for Spine Surgeons

2016 ◽  
Vol 6 (1_suppl) ◽  
pp. s-0036-1582716-s-0036-1582716
Author(s):  
Miranda Van Hooff ◽  
Hanneke Van Dongen ◽  
Maarten Spruit ◽  
Raymond Ostelo ◽  
Marinus De Kleuver
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Treatment Outcomes ◽  
Chronic Low Back Pain ◽  
Clinical Decision ◽  
Low Back

scholarly journals P086: Effectiveness of interventions to decrease imaging among emergency department low back pain presentations: a systematic review

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S107
Author(s):  
C. Lui ◽  
S. Desai ◽  
L. Krebs ◽  
S.W. Kirkland ◽  
D. Keto-Lambert ◽  
...  
Keyword(s):  
Emergency Department ◽  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Spine ◽  
Grey Literature ◽  
Clinical Decision ◽  
Unintended Consequences ◽  
Relative Reduction ◽  
Significant Heterogeneity ◽  
Low Back

Introduction: Low back pain (LBP) is an extremely frequent emergency department (ED) presentation. Although LBP imaging often results in no change to the ED management, does not identify abnormalities, and has documented risks (e.g., radiation exposure), advanced imaging (i.e., computed tomography [CT], magnetic resonance imaging [MRI]) for patients with LBP has become increasingly frequent in the ED. The objective of this review was to identify and examine the effectiveness and safety of interventions aimed at reducing imaging in the ED for LBP patients. Methods: Six bibliographic databases and grey literature were searched. Comparative studies assessing interventions aimed at reducing ED imaging for adult patients with LBP were eligible for inclusion. Two reviewers independently screened study eligibility, completed data extraction, and assessed the quality of included studies. Due to a limited number of studies and significant heterogeneity, a descriptive analysis was performed. Results: The search yielded 510 unique citations of which three before-after studies were included. Quality assessment identified potential biases relating to comparability between the pre- and post-intervention groups, reliable assessment of outcomes, and an overall lack of information on the intervention (i.e., time point, description, intervention data collection). The interventions to reduce lumbar spine imaging varied considerably. Study interventions included: 1) clinical decision support (i.e., a specialized X-ray requisition form), which reported a 47.4% relative reduction of lumbar spine radiography referrals; 2) clinical decision guidelines, which reduced referrals by 43.8%; and 3) multidisciplinary protocols, which reported a reduction in the MRI referral rate by 26.1%. Despite reductions in simple imaging, CT use increased in two of the three studies. Conclusion: LBP has been identified as a key area of imaging overuse (e.g., Choosing Wisely recommendation). Yet, evidence of interventions’ effectiveness in reducing imaging for ED patients with LBP is sparse. While there is some evidence to suggest that interventions can reduce the use of simple imaging in LBP in the ED, unintended consequences have been reported and additional studies employing higher quality methods are strongly recommended.

scholarly journals The Nijmegen Decision Tool for Chronic Low Back Pain. Development of a Clinical Decision Tool for Secondary or Tertiary Spine Care Specialists

PLoS ONE ◽  
2014 ◽  
Vol 9 (8) ◽  
pp. e104226 ◽  
Author(s):  
Miranda L. van Hooff ◽  
Jan van Loon ◽  
Jacques van Limbeek ◽  
Marinus de Kleuver
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Clinical Decision ◽  
Low Back ◽  
Decision Tool ◽  
Spine Care

scholarly journals An Electronic Clinical Decision Support System for the Management of Low Back Pain in Community Pharmacy: Development and Mixed Methods Feasibility Study (Preprint)

2019 ◽  
Author(s):  
Aron Simon Downie ◽  
Mark Hancock ◽  
Christina Abdel Shaheed ◽  
Andrew J McLachlan ◽  
Ahmet Baki Kocaballi ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Decision Support System ◽  
Community Pharmacists ◽  
Clinical Decision ◽  
Prototype System ◽  
Low Back ◽  
User Testing ◽  
First Line ◽  
System Usability

BACKGROUND People with low back pain (LBP) in the community often do not receive evidence-based advice and management. Community pharmacists can play an important role in supporting people with LBP as pharmacists are easily accessible to provide first-line care. However, previous research suggests that pharmacists may not consistently deliver advice that is concordant with guideline recommendations and may demonstrate difficulty determining which patients require prompt medical review. A clinical decision support system (CDSS) may enhance first-line care of LBP, but none exists to support the community pharmacist–client consultation. OBJECTIVE This study aimed to develop a CDSS to guide first-line care of LBP in the community pharmacy setting and to evaluate the pharmacist-reported usability and acceptance of the prototype system. METHODS A cross-platform Web app for the Apple iPad was developed in conjunction with academic and clinical experts using an iterative user-centered design process during interface design, clinical reasoning, program development, and evaluation. The CDSS was evaluated via one-to-one user-testing with 5 community pharmacists (5 case vignettes each). Data were collected via video recording, screen capture, survey instrument (system usability scale), and direct observation. RESULTS Pharmacists’ agreement with CDSS-generated self-care recommendations was 90% (18/20), with medicines recommendations was 100% (25/25), and with referral advice was 88% (22/25; total 70 recommendations). Pharmacists expressed uncertainty when screening for serious pathology in 40% (10/25) of cases. Pharmacists requested more direction from the CDSS in relation to automated prompts for user input and page navigation. Overall system usability was rated as excellent (mean score 92/100, SD 6.5; 90th percentile compared with similar systems), with acceptance rated as good to excellent. CONCLUSIONS A novel CDSS (high-fidelity prototype) to enhance pharmacist care of LBP was developed, underpinned by clinical practice guidelines and informed by a multidisciplinary team of experts. User-testing revealed a high level of usability and acceptance of the prototype system, with suggestions to improve interface prompts and information delivery. The small study sample limits the generalizability of the findings but offers important insights to inform the next stage of system development.

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