Instructions

Instructions

  1. Watch the video instructions below
  2. Read the written description below (Optional)
  3. View the Case Study tabs and interact with the visualization
  4. Click on the I'm Finished! tab and follow the instructions




Visualization

The visualization displays Patient-Reported Outcomes over time for individuals in a low back pain rehabilitation program.

  • y-axis (vertical axis): The y-axis variable is the PROMIS Physical Function score, which is a common patient-reported outcome for low back pain programs.

  • x-axis (horizontal axis): Time is the x-axis variable, where Time represents the total time elapsed between the first PROMIS Physical Function score and the current PROMIS Physical Function score for an individual (i.e. PROMIS score over time). For example, if a patient had PROMIS scores measured on 1/1/2020, 2/1/2020, and 3/1/2020 then the patient would have 3 PROMIS scores at 0 days (1/1/2020), ~30 days (2/1/2020) and ~60 days (3/1/2020).

  • Red line: The red line is the patient of interest. The is the patient you are interested in making comparisons with.

  • Gray lines: The gray lines are all other patients who are not the patient of interest. Each of these lines represent different patient experiences.

  • Dashed line: The dashed line is a trend line. A trend line is the average PROMIS score for all patients in physical therapy with low back pain who meet the filter criteria. A completely horizontal trend line means that the average PROMIS score did not change over time. Positive and negative trend lines represent increases and decreases in the average PROMIS score over time, respectively (for PROMIS scores, higher scores are better).

Filters

There are several filters on the right-hand side of the interface that can be manipulated to change the data that are shown, and the description for each filter variable is provided below:

  • Patient MRN: a patient’s (synthetic) medical record number. Values can be entered into this text box, and the corresponding patient will become highlighted in red.

  • Gender: a patient’s gender, indicated by their medical record (Male, Female, or All)

  • Acuity: the acuity of the individual’s low back pain (Acute, Subacute, Chronic, or All)

  • Level of Function- Day 1: a patient’s baseline PROMIS score (Low, Medium, or High)

  • Include Surgery Patients?: whether or not you would like patients who have had back surgery to be included (Only Surgery patients, Only Non-surgery patients, or All)

  • Age: age of the individual at baseline

  • Days in Physical Therapy: The number of days the patient has been in Physical Therapy, with the first PROMIS score representing the first day.

  • MCID Upper Reference: MCID is short for minimal clinically important difference. MCID lines are lines that represent the minimum amount of change required in a health outcome in order for a patient to identify that change as important/meaningful. The MCID Upper Reference is shown at 3 points above a patient’s baseline PROMIS Physical Function score.

  • MCID Lower Reference: MCID is short for minimal clinically important difference. MCID lines are lines that represent the minimum amount of change required in a health outcome in order for a patient to identify that change as important/meaningful. The MCID Lower Reference is shown at 3 points below a patient’s baseline PROMIS Physical Function score.

  • Highlight Patient: this toggle allows you to highlight the patient in red so that all other data points are almost invisible, or show all of the other patients while dimming the patient in red

Your Task

Imagine you are a clinician working with a patient in a low back pain rehabilitation program. After a few weeks/months of being in the program, the patient is interested in seeing how the their health outcome (PROMIS Physical Function score, in this case) has changed over the course of the program, and how their score compares to similar patients. Your task is to manipulate the visualization so that you and the patient can see how their health outcome has changed throughout the program, and how this change compares to similar patients.

Click on the Case Study tabs shown at the top, and try using the case study information to filter the visualization and see how the patient’s PROMIS Physical Function score changes over time relative to patients with similar demographic and clinical information. You can reset the visualization back to its initial values by reloading the web page.

If you have questions please feel free to contact the PI of this study, Jason Dude (email: ).

Case Study 1

Meet Janet

  • Janet (MRN: 7747382) is a 64 y/o female with LBP over the past 6-7 months (chronic)

  • It started out with general soreness but pain seems to be getting more frequent

  • Patient cannot identify any activity that caused the onset of pain

  • Pain is primarily in lower lumbar region with aching that goes into the buttocks and upper thigh with walking

  • When she presents to PT her PROMIS Physical Function score is 42.87

  • Her Level of Function at Day 1 is classified as Medium

  • She has been in the rehab program for 67 days now, and she has not had a back surgery

Try using Janet’s information to filter the visualization below and see how her PROMIS Physical Function score changes over time relative to patients with similar demographic and clinical information. (Note: You can reset the visualization by reloading this webpage)

Think about having this information in front of you as you talk with Janet. How would you interpret the information? Does this help you make any decisions? What else do you need to know?

Case Study 2

Meet Arthur

  • Arthur (MRN: 21467265) is a 36 y/o male with LBP after working in the yard for several hours 4 weeks ago (acute)

  • Felt a “pull” in his back as he was trying to unearth a root ball

  • Pain is right at belt line and seems to be staying the same since his injury

  • Aggravating: sitting >2 hours, lifting, bending

  • Alleviating: avoiding static positioning for long times or avoiding bending, lifting

  • Current pain score: average 4/10, worst 6/10, best 0/10

  • Current PROMIS Physical Function score: 41.19

  • His Level of Function at Day 1 is classified as Medium

  • He has been in the rehab program for 30 days now, and he has not had a back surgery

Try using Arthur’s information to filter the visualization below and see how her PROMIS Physical Function score changes over time relative to patients with similar demographic and clinical information. (Note: You can reset the visualization by reloading this webpage)

Case Study 3

Meet Cindi

  • Cindi (MRN: 21387192) is a 31 y/o female with LBP on and off over the past several years

  • Her current episode was aggravated during training for the National Guard and has persisted 3 months (chronic)

  • She reports increased pain when carrying a rucksack, jarring movement, or heavy lifting

  • Aggravating: carrying a rucksack, jarring or quick movement, heavy lifting

  • Alleviating: unsure, general soreness present most of the time

  • She has not changed activity level but notes relief with ibuprofen

  • Her physical function score has been variable and after 3 months has a PROMIS score of 50.35

  • Her Level of Function at Day 1 is classified as High

  • She has been in the rehab program for 91 days now, and she has not had a back surgery

Try using Cindi’s information to filter the visualization below and see how her PROMIS Physical Function score changes over time relative to patients with similar demographic and clinical information. (Note: You can reset the visualization by reloading this webpage)

Does the ability to compare Cindi to other patients with a similar presentation help you in treatment planning? How would you interpret Cindi’s experience with other patients like her?

Case Study 4

Meet Nate

  • Nate (MRN: 6967486) is a 36 y/o male with LBP with aching into his right leg for the past 2 weeks (acute)

  • Pain began the day after a skiing trip. He reports full day of skiing and 6-hours of driving

  • When he awoke the next morning, his low back was stiff and he had trouble standing upright

  • Over the course of the day, his right leg began aching and he was unable to sit >5 minutes

  • This is your second visit with Nate and his PROMIS Physical Function score is 35.47

  • Current pain score: average 5/10, worst 8/10, best 0/10

  • His Level of Function at Day 1 is classified as Low

  • He has been in the rehab program for 15 days now, and he has not had a back surgery

Try using Nate’s information to filter the visualization below and see how her PROMIS Physical Function score changes over time relative to patients with similar demographic and clinical information. (Note: You can reset the visualization by reloading this webpage)

I’m Finished!

I’m Finished!

Once you have completed the four case studies you may complete the survey. Optionally, you can now take as much time as you’d like to continue exploring and interacting with the visualization. When you are ready to complete the survey:

1. Keep this tab open so you can reference the visualization

2. Navigate back to the survey tab and check the box indicating you have finished viewing the visualization

3. Complete the survey, which should take approximately 10-15 minutes

If you have questions please feel free to contact the PI of this study, Jason Dude (email: ).


Title