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)

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Comprehensive Center (P60)
Project #
1P60AR062799-01
Application #
8293841
Study Section
Special Emphasis Panel (ZAR1-KM (M1))
Project Start
Project End
Budget Start
2012-09-01
Budget End
2013-08-31
Support Year
1
Fiscal Year
2012
Total Cost
$230,883
Indirect Cost
$87,626
Name
Dartmouth College
Department
Type
DUNS #
041027822
City
Hanover
State
NH
Country
United States
Zip Code
03755
Marfeo, Elizabeth E; Ni, Pengsheng; McDonough, Christine et al. (2018) Improving Assessment of Work Related Mental Health Function Using the Work Disability Functional Assessment Battery (WD-FAB). J Occup Rehabil 28:190-199
Moulton, Haley; Tosteson, Tor D; Zhao, Wenyan et al. (2018) Considering Spine Surgery: A Web-Based Calculator for Communicating Estimates of Personalized Treatment Outcomes. Spine (Phila Pa 1976) 43:1731-1738
Abdu, William A; Sacks, Olivia A; Tosteson, Anna N A et al. (2018) Long-Term Results of Surgery Compared With Nonoperative Treatment for Lumbar Degenerative Spondylolisthesis in the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976) 43:1619-1630
Klare, Christian M; Fortney, Thomas A; Kahng, Peter W et al. (2018) Prognostic Factors for Success After Irrigation and Debridement With Modular Component Exchange for Infected Total Knee Arthroplasty. J Arthroplasty 33:2240-2245
Tapp, Stephanie J; Martin, Brook I; Tosteson, Tor D et al. (2018) Understanding the value of minimally invasive procedures for the treatment of lumbar spinal stenosis: the case of interspinous spacer devices. Spine J 18:584-592
Skolasky, Richard L; Scherer, Emily A; Wegener, Stephen T et al. (2018) Does reduction in sciatica symptoms precede improvement in disability and physical health among those treated surgically for intervertebral disc herniation? Analysis of temporal patterns in data from the Spine Patient Outcomes Research Trial. Spine J 18:1318-1324
Munson, J C; Bynum, J P W; Bell, J-E et al. (2018) Impact of prescription drugs on second fragility fractures among US Medicare patients. Osteoporos Int 29:2771-2779
Martin, Brook I; Lurie, Jon D; Farrokhi, Farrokh R et al. (2018) Early Effects of Medicare's Bundled Payment for Care Improvement Program for Lumbar Fusion. Spine (Phila Pa 1976) 43:705-711
Passias, Peter G; Poorman, Gregory; Lurie, Jon et al. (2018) Patient Profiling Can Identify Spondylolisthesis Patients at Risk for Conversion from Nonoperative to Operative Treatment. JB JS Open Access 3:e0051
Prohaska, Matthew G; Keeney, Benjamin J; Beg, Haaris A et al. (2017) Preoperative body mass index and physical function are associated with length of stay and facility discharge after total knee arthroplasty. Knee 24:634-640

Showing the most recent 10 out of 88 publications