JMIR Publications

ABSTRACT

Background:

Low back pain (LBP) is a highly prevalent problem causing substantial personal and societal burden. Though there are specific types of LBP, each with evidence-based treatment recommendations, most patients receive a nonspecific diagnosis which does not facilitate evidence-based and individualized care.

Objective:

We designed, developed, and initially tested the usability of a LBP diagnosis and treatment decision support tool based on available evidence for use by clinicians who treat LBP, with an initial focus on chiropractic care.

Methods:

Our three-step user-centered design approach consisted of identifying clinical requirements through analysis of evidence reviews; iteratively identifying task-based user requirements and developing a working web-based prototype; and evaluating usability through scenario-based interviews and the System Usability Scale (SUS).

Results:

Clinical requirements included 44 patient interview and exam items that provided evidence of 12 possible working diagnoses, each with relevant treatment recommendations and corresponding patient educational materials. User requirements focused on tasks related to inputting data, and reviewing and selecting working diagnoses, treatments, and patient education. Users believed it would be important to have the tool accessible from within an electronic health record. SUS score for the prototype was 84.75 (range: 67.5-95), considered the top 10th percentile. Users believed the tool was easy to use though would require some training to use effectively. With such training and practice, users believed it would improve care and shed light on the “black hole” of LBP diagnosis and treatment.

Conclusions:

Our systematic process of defining clinical requirements and eliciting user requirements to inform a clinician-facing decision support tool produced a prototype application that was viewed positively and with enthusiasm by clinical users. With further planned development, this tool has the potential to guide clinical evaluation, inform more specific diagnosis, and encourage patient education and individualized treatment planning for patients with LBP through the application of evidence at the point of care.