This study aimed to test the feasibility and validation of a CDSS based on Nwugarian Spinal Manual Therapy (NSMT) for low-back pain (LBP) diagnosis.
This mixed-methods study involved patients with LBP and clinicians (physiotherapists and orthopaedic surgeons). A three-interphase (patient (self-service login), clinician (interviews and tests login), and admin interphase)) CDSS developed on 10 provocative tests and 22 consensus questions algorithm was developed and tested. The feasibility testing of the CDSS was done via survey and in-depth interviews. Validation of the CDSS was in comparison with clinician diagnosis; and two diagnostic checklists (McKenzie Institute’s Lumbar Spine Assessment Algorithm (MILSAA), and Evidence-Based Practical Diagnostic Checklist (EBPDC) approaches for LBP. Sensitivity and specificity were used to test the accuracy of the CDSS for diagnostic testing. Descriptive statistics were used to summarise the findings.
The mean usability rating, perceived impact scores and total quality rating scores were 28.8±0.59 (out of 50), 25.0±3.65 (out of 30), and 18.3±0.57 (out of 22.5), respectively. There was a significant association between CDSS and MILSAA's assessment (χ2 = 5.593; p = 0.018). The sensitivity and specificity of the CDSS to diagnose LBP compared with orthopaedists, physiotherapists, MILSAA and EBPDC assessments were 60.0%, 64.7%, 85.7%, and 93.3%, respectively; and 16.7%, 50.0%, 65.2%, and 100%, respectively. The CDSS was considered feasible based on acceptability, satisfaction and implementability.
The CDSS demonstrated moderate to high sensitivity and specificity in identifying serious spinal pathologies, as validated by clinical experts and standard checklists.
A CDSS based on the NSMT is a feasible and user-friendly tool to assist in the clinical diagnosis of LBP, aiming to enhance patient outcomes and improve their quality of care.
Clinical decision support systems
Low back pain
