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Considering Spine Surgery

A Web-Based Calculator for Communicating Estimates of Personalized Treatment Outcomes

Moulton, Haley, BA; Tosteson, Tor D., ScD; Zhao, Wenyan, PhD; Pearson, Loretta, MPhil; Mycek, Kristina, MS, CAS; Scherer, Emily, PhD; Weinstein, James N., DO, MS∗,‡; Pearson, Adam, MD, MS∗,‡; Abdu, William, MD, MS∗,‡; Schwarz, Susan, MS§; Kelly, Michael, MD, MSc; McGuire, Kevin, MD∗,‡; Milam, Alden, MD||; Lurie, Jonathan D., MD, MS∗,‡

doi: 10.1097/BRS.0000000000002723

Study Design. Prospective evaluation of an informational web-based calculator for communicating estimates of personalized treatment outcomes.

Objective. To evaluate the usability, effectiveness in communicating benefits and risks, and impact on decision quality of a calculator tool for patients with intervertebral disc herniations, spinal stenosis, and degenerative spondylolisthesis who are deciding between surgical and nonsurgical treatments.

Summary of Background Data. The decision to have back surgery is preference-sensitive and warrants shared decision making. However, more patient-specific, individualized tools for presenting clinical evidence on treatment outcomes are needed.

Methods. Using Spine Patient Outcomes Research Trial data, prediction models were designed and integrated into a web-based calculator tool: Consumer Reports subscribers with back-related pain were invited to use the calculator via email, and patient participants were recruited to use the calculator in a prospective manner following an initial appointment at participating spine centers. Participants completed questionnaires before and after using the calculator. We randomly assigned previously validated questions that tested knowledge about the treatment options to be asked either before or after viewing the calculator.

Results. A total of 1256 consumer reports subscribers and 68 patient participants completed the calculator and questionnaires. Knowledge scores were higher in the postcalculator group compared to the precalculator group, indicating that calculator usage successfully informed users. Decisional conflict was lower when measured following calculator use, suggesting the calculator was beneficial in the decision-making process. Participants generally found the tool helpful and easy to use.

Conclusion. Although the calculator is not a comprehensive decision aid, it does focus on communicating individualized risks and benefits for treatment options. Moreover, it appears to be helpful in achieving the goals of more traditional shared decision-making tools. It not only improved knowledge scores but also improved other aspects of decision quality.

Level of Evidence: 2

Geisel School of Medicine, Hanover, NH

Consumer Report, Yonkers, NY

Dartmouth Hitchcock Medical Center, Lebanon

§Dartmouth College, Hanover, NH

Washington University, St Louis, MO

||OrthoCarolina, Charlotte, NC.

Address correspondence and reprint requests to Jonathan D. Lurie, MD, MS, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03766; E-mail:;

Received 17 January, 2018

Revised 21 March, 2018

Accepted 1 May, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the Office of Research on Women's Health, the National Institutes of Health, and the National Institute of Occupational Safety and Health, and the Centers for Disease Control and Prevention (U01-AR45444) funds were received in support of this work. The Multidisciplinary Clinical Research Center in Musculoskeletal Diseases at Dartmouth is funded by NIAMS (P60 AR062799).

Relevant financial activities outside the submitted work: board membership, consultancy, grants, royalties.

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