Table 2.

Inventory of computer-based tools and questionnaires located

Name of CDSS	Purpose	Description	Stage of Development	Hardware and Software	Data Input Requirements	Output(s)	TargetRecipient of Output	Limitations
Keele STarT Back Screening Tool (SBST) [34]	The SBST allocates low back pain patients into three risk groups and is intended to assist clinicians in their decisions about choice of treatment in primary care settings	Questionnaire consisting of nine items covering aspects of fear avoidance beliefs, depression, disability and presence of leg pain and neck/shoulder pain. Patients are allocated into one of three subgroups (low, medium or high risk of chronicity) based on the obtained score. Treatments are targeted based on score	The developers have conducted one RCT to compare treatment informed by the SBST to usual care. Patients managed using the SBST had better functional outcomes at 1-year, but this effect was mainly seen in the medium and high risk groups. Acceptable concurrent validity has been demonstrated with the OMPQ [162–164] The presence of high depression, fear avoidance beliefs, or catastrophizing scores increase significantly from the SBST low risk group, over the medium group to the high-risk group [165] Fair agreement between SBST tool (K = 0.22) and clinicians classification of patients into risk groups [33] StarT Back Tool has been translated and cross culturally validated into Danish [166], Spanish [167],French [168], German [155], Swedish [163], Chinese [156], and Finnish [169] The test–retest reliability of the SBST total score was excellent (intraclass correlation coefficient = 0.78; [169] 0.93 [156]; and 0.90 [164]) and good for the psychosocial subscale (0.68) [169] The StarT Back Tool demonstrated acceptable to outstanding discrimination to determine individuals with different levels of disability as indicated by widely accepted questionnaires such as the Roland Morris Disability Questionnaire, Tampa Scale of Kinesiophobia among others (AUC ranged from 0.79 to 0.91 [155], and 0.75–0.89 [156]	Not needed	9 questions are answered with a Likert-scale regarding pain and activities of daily living. The tool has been translated into several languages	Treatments recommendations based on risk categories: low, medium or high risk. The authors suggest that the low risk group only needs a ‘light’ intervention with e.g., analgesics and advice, the medium group requires treatments involving elements such as exercises or manual therapy, and that a combination of physical and cognitive-behavioral approaches should be considered for the high risk groups	Primary care providers	The tool has not been validated via clinical trial outside the United Kingdom There is also a need for a large RCT designed to test whether treatment effects differ across the SBST subgroups
Repetitive Strain Injury (RSI) Quick Scan, Now named ‘Compufit Quick Scan’ [40, 52]	To assess the presence or absence of potential risk factors for the establishment of risk profiles related to neck, shoulder and arm symptoms in computer workers and potentially determine targeted treatment	Computer-based survey aimed at identifying workers’ at risk of arm, shoulder and neck symptoms. Based on score results, recommendations are made to the worker to reduce risk of symptoms. In total, the questionnaire consists of 81 items, divided over two categories and 11 subcategories. A description of the actual questions can be found at: www.compufitquickscan.com/ne/quickscan/	The tool has been tested in a cluster randomized control trial and associated cost-effectiveness evaluation. Use of the tool did not reduce work disability and the tool was not found to be cost-effective The tool does have acceptable internal consistency, reliability and concurrent validity. Cronbach’s alpha was mostly between 0.40 and 0.85. Six scales scored 0.70 or higher. Concurrent validity of the RSI with original questionnaires was acceptable [170] The concurrent validity of the questionnaire symptom items with the observations of 2 physicians was defined as poor to moderate with kappa values between 0.16 and 0.53 [171] Predictive Validity of the RSI QuickScan questionnaire was tested. High scores of the RSI QuickScan on 9 out of 13 scales, including previous symptoms, were significantly related to arm, shoulder and neck symptoms at follow-up [172]	Internet-based RSI QuickScan survey/questionnaire (https://www.compufitquickscan.com/ne/quickscan)	Items are answered following a web platform	Interventions can be targeted at each of the factors in the RSI QuickScan, with a total of 16 interventions aimed at reducing the associated risk [36, 52]. A score of 30 % or less of the maximum on a scale was classified as a low risk, colour-coded “green”. A score of 31 % to 60 % of the maximum on a scale was classified as a medium risk, colour-coded “amber”. A score of 61 % or more of the maximum on a scale was classified as a high risk, colour-coded “red”.	Primary care providers and ergonomists	The RSI QuickScan appears to have a modest effect and was not cost-effective. However, this might have been due to problems with implementation of expensive ergonomic interventions, which were sold at regular commercial prices during the trial. This was despite commitment from all participating organizations prior to starting the study that they were prepared to invest in the necessary preventive measures
Pain Recovery Inventory of Concerns and Expectations (PRICE) [36]	Brief screening questionnaire to triage return-to-work strategies among patients with low back pain	Questionnaire consisting of 46 items measuring, depressive symptoms (12 items), pain catastrophizing (2 items), lack of organizational support (7 items), activity limitation (15 items), fear of movement (4 items), perceiving grave life impacts (3 items) poor expectations for recovery (2 items), and pain intensity (1 item) [36]	A confirmatory cluster analysis replicated previous findings of three risk subgroups: distressed, avoidant, and lacking employer support Validity of the PRICE screening was supported by its prospective association with the 3-month disability outcome measures (return to work, functional limitation, and clinical case rating) [36]	Not needed	Subjects are asked to respond to each of the 46 items on different Likert-type scales scale (i.e. “strongly disagree” to “strongly agree.”; “not at all” to “all the time”)	PRICE can be used to identify early intervention needs among working adults with low back pain based on the group classifications It provides an indication of whether attention should be focused on workplace coordination, physical activation, or psychological coping, and this may improve the ability to provide more patient-centered strategies for early disability prevention	Primary care providers	This questionnaire is at an early stage of development. Future trials should be conducted to validate the classification and targeted management approach
Orebro Musculoskeletal Pain Questionnaire (OMPQ) [39]	Screening tool aimed at identifying high-risk patients with MSK pain in need of early intervention	Questionnaire consisting of 24-items that allocates patients into three different risk categories related to work absenteeism and guides potential interventions for those with low (reassurance and advice), moderate (physical therapy) or high risk (psychologically-informed care)	The OMPQ was initially developed as a screening tool and has been evaluated in several settings and translated into several languages for this purpose. However, it has recently been evaluated as a potential CDS tool for selecting interventions for patients with MSK pain. One study is underway in Germany that evaluates the OMPQ as a CDS tool [44]	Not needed	24 items with various response options for different sections of the tool	After OMPQ administration and scoring, the questionnaire categorized patients into one of three risk level categories: low, medium and high risk. Various cut-points have been recommended for the categorization, with the developers stating the cut-off scores are related to the population studied	Primary care providers	Has only been evaluated as a CDS tool in one student thesis, with negative results. The OMPQ was not explicitly developed as a CDS tool, although early risk stratification implies different approaches for different categories
Pain Management Advisor (PMA) [35]	To enhance primary care providers’ management of chronic pain	Computer-based tool that relies on rule-based algorithms derived from expert knowledge of pain specialists  User asked a series of questions to refine the diagnosis and determine appropriate therapy  Interactive capability (e.g., for explanations, therapeutic rationales, therapy guidelines)	Working version developed: some field testing conducted	Computer program  PMA written in MicroSoft Visual Basic, v. 5.0, run as an expert application in XpertRule  Algorithms stored in MicroSoft Access database  MicroSoft Help Utility used for explanations and queries	Patient demographics  Diagnosis  Pain characteristics  Laboratory tests and imaging studies  Current medications  Prior therapies  Concurrent disease conditions  Allergies  Psychological status	A prioritized list of recommendations: (1) medical management (pharmacologic and nonpharmacological management, physical, psychosocial modalities); (2) invasive procedures; (3) referrals	Primary care providers.	This software was only tested qualitatively in one study. No further testing has been published
Decision Support Software (DSS) [38]	To determine whether the use of software as a decision support system can help with evaluation and control of physical job stresses and prevent re-injury of workers who have experienced or are concerned about work-related musculoskeletal disorders The ergonomists used the database as a decision support tool in the control of work-related MSK disorders (WMSDs)	Computer-based tool consisting of decision support software is a spreadsheet-based database program written in Microsoft Excel. It has a graphical user interface (GUI) in the WindowsTM environment, and contains video clips of representative cycles of the selected job and in some cases, multiple videos showing multiple views It was designed specifically for the site, but is adaptable to other manufacturing plants with relatively stable work patterns. The software program is a database that stores detailed job information such as standardized work data, videos, and upper-extremity physical stress ratings for over 400 jobs in the plant. Additionally, the database users were able to record comments about the jobs and related control issues	Testing usability and effectiveness to prevent worker injuries No further testing The database seems to be useful to facilitate the quality of job evaluation. This improvement in quality can lead to better intervention and control of MSK problems [38]	Pentium-based PCs Ideally a portable computer Windows 95 Excel Program Visual interface For video import, mpg images are needed	Upper extremity exposure ratings (evaluated by the research team) for repetition, posture, contact stress, and force Standard data: work elements and times for selected job, obtained from the company standard data system -Text box that allows users to store and retrieve comments about selected job -Menu to search for a job by department, section, line position, and by date Videos of the work environment	Information from database was used to make recommendations for injury prevention and management strategies by the ergonomists	Ergonomists	This software was only tested qualitatively in one study. No further testing has been published [38]
Soft Tissue Continuum of Care Model [37]	The model was designed as a high-level, decision-making tool or “roadmap” to promote a consistent, evidence-based approach to manage soft tissue injuries	The model with computer-based tool that involves 3 main components: (1) Staged application of rehabilitation services; (2) Case management protocols and case planning checkpoints; and (3) Contracted services with providers	A population-based, quasi-experimental, before-and-after design with concurrent control groups was used to evaluate the model’s impact and effectiveness	Computer-based prompts were given to workers’ compensation case managers via a custom-built program	Data on type of injury and time since injury is used from within the workers’ compensation administrative database to generate prompts for case managers	Based on type of injury and time of recovery, claimants are referred to different assessment and treatment programs	Workers’ compensation case managers	Further validation of this model is recommended through the implementation of experimental design such as RCT
Work Assessment Triage Tool (WATT) [32]	The classification algorithm and accompanying computer-based CDS tool help categorize injured workers toward optimal rehabilitation interventions based on unique worker characteristics	Computer-based tool comprised of 18 variables related to: injury duration, occupation, job attachment and working status at time of RTW assessment, availability of modified work, National Occupational Classification Code, ICD9 diagnostic group, calendar days injury to assessment, the ‘Occupation’ item from the PDI Pain VAS out of 10, and 9 items from the SF36 (items 2, 4, 5, 7, 12, 14, 18, 21, 25)	The algorithm used by the WATT was developed using machine learning techniques and demonstrated high accuracy for correct classifications during internal validation [32, 41] Concurrent validity of WATT with clinician’s recommendations was tested. Percent agreement between clinician and WATT recommendations was low to moderate. The WATT did not improve upon clinician recommendations, but was more likely to recommend evidence-based interventions [42]	HTML-based computer program that can run on any computer system with access to the Internet	Data entered into WATT involves 18 items related to injury duration, occupation, job attachment and working status at time of RTW assessment, availability of modified work, National Occupational Classification Code, ICD9 diagnostic group, calendar days injury to assessment, the ‘Occupation’ item from the PDI, Pain VAS out of 10, and9 items from the SF36 (items 2, 4, 5, 7, 12, 14, 18, 21, 25)	The rehabilitation options available to clinicians were: physical therapy, interdisciplinary functional restoration, workplace-based rehabilitation, ‘hybrid’ functional restoration/workplace-based rehabilitation; complex interdisciplinary bio-psychosocial rehabilitation and no further rehabilitation	Primary care providers and case managers	This tool is at the early stages of validation. Findings do not provide evidence of concurrent validity of the WATT against clinician recommendations. WATT appeared more likely than clinicians to recommend treatments supported by current evidence such as workplace-based interventions. Further validation is needed