Patients who understand their individualized likelihood of benefits and risk of harms with surgery are more likely to make treatment choices that are consistent with their goals and values, but patients often lack information pertinent to these decisions when considering back surgery. This project, based on a unique collaboration between clinical researchers at Dartmouth and a non-profit consumer research organization (Consumers Union), will develop web-based tools to facilitate the transfer of scientific results from complex clinical trials directly to physicians and patients, applying individualized results to improve routine clinical practice. We will develop a web-based calculator for each of three common back pain diagnoses studied in the NlAMS-funded Spine Patient Outcomes Research Trial . Prediction models will be validated internally and with data from the Maine Lumbar Spine Study (MISS, 8. Atlas, PI) and a large Dutch lumbar herniated disc randomized trial. The first phase of the study will develop and validate outcomes models for predicting benefits and risks of lumbar spine surgery based on newly available 8-year outcomes for the 2,427 back and leg pain patients in SPORT. The second phase of the proposed research will use a structured product development process for the calculator interface. An expert panel of physicians and methodologists will be consulted concerning information architecture and design. Cognitive interviews and iterative web development using patients and expert physician panels will be used to inform revisions in design and data presentation. The third phase of the project will evaluate the calculator in a survey of providers and their patients considering surgery at participating SPORT centers and a convenience sample of Consumers Union subscribers to evaluate its usability, understandability, and impact on decision-making in patients considering back surgery. Following the successful completion of the validation and evaluation phases, the calculator will be freely disseminated as a vveb application.

Public Health Relevance

We propose to develop web-based calculators that allow patients with low back disorders to apply the best clinical evidence to their individual circumstances and make more informed treatment choices about back surgery. A strong collaboration of researchers will develop, validate and evaluate novel methods for disseminating individualized risk and benefit information. Evaluation will feature the complementary strengths of a multi-center clinical trial around and a non-profit consumer research organization (Consumers Union)

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Comprehensive Center (P60)
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Special Emphasis Panel (ZAR1-KM (M1))
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Dartmouth College
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