Table 3.

Summary table of original studies evaluating computer-based tools or questionnaires for selecting interventions for patients with musculoskeletal disorders

Authors (ID)	Year	Study design	Population	Body part	Context	Tool mentioned	Properties tested	Methods	Outcome	Results
Hill et al. [34]	2011	RCT	851 adults aged ≥18 years with low back pain with or without radiculopathy	Low Back	Ten general practice clinics in England	Questionnaire: Keele STarT Back Screening Tool that stratifies patients into low, medium or high risk, requiring different interventions	Validity of a stratified/classification approach to primary care Sensitivity/specificity for identifying treatments	Eligible patients were randomly assigned to intervention (use of SBST to inform management) or control group (usual care). Disability, cost and quality of life were evaluated	Results indicate a classification approach using the tool significantly improves patient outcomes and is associated with substantial economic benefits	Positive
Hill et al. [33]	2010	Methodological study	12 consecutively consulting patients with primary care back pain	Low Back	8 General Practices in the United Kingdom	Questionnaire: Keele STarT Back Screening Tool that stratifies patients into low, medium or high risk, requiring different interventions	Agreement between clinicians and STarT Back tool	12 patients underwent a video-recorded clinical assessment. The SBST was completed on the same day. Clinical experts reviewed the videos and categorized subjects to low, medium or high-risk	Clinicians make inconsistent risk estimations for primary care patients with back pain when using intuition alone, with little agreement with the STarT Back tool	Unclear
Spekle et al. [40]	2010	Cluster RCT	741 computer workers from 7 Dutch organisations in various work branches (e.g., health care, local government, nature conservation, engineering, education and regulatory affairs), located throughout the Netherlands The population consisted of office staff, local government officials, engineers, consultants, teachers, health care personnel, nature conservation professionals, researchers and managers	Arm, shoulder and neck pain	Employees of a large occupational health service in the Netherlands	Questionnaire: RSI QuickScan intervention program	Effectiveness of the intervention program for reducing symptoms and sick leave	The participants were assigned to either an intervention or usual care group by means of cluster randomization. At baseline and after 12 months of follow-up, participants completed the RSI QuickScan questionnaire to determine exposure to the risk factors and prevalence of arm, shoulder and neck symptoms. A tailor-made intervention program was proposed to participants with high-risk profiles at baseline. Examples of implemented interventions are an individual workstation check, a visit to the occupational health physician and an education program on the prevention of arm, shoulder and neck symptoms	There were no significant differences in changes in the prevalence of arm, shoulder and neck symptoms or sick leave between the intervention and usual care group	Negative
Spekle et al. [52]	2010	Economic evaluation alongside a cluster RCT	638 computer users with and without shoulder, arm and neck symptoms	Arm, shoulder and neck	Workers from seven Dutch companies	Questionnaire: RSI QuickScan intervention program	Cost–benefit of the RSI QuickScan program	Workers were randomized to either the intervention or usual care group. The intervention consisted of a tailor-made program based on the RSI-QuickScan program. Usual care group did not receive elaborate advice. The participants completed the questionnaire at baseline and 12-month follow-up. Effectiveness and cost were compared	The RSI QuickScan intervention program did not prove to be cost-effective. However, with a relatively small investment, the program increased the number of workers who received information on healthy computer use and improved their work posture and movement	Negative
Shaw et al. [36]	2013	Cohort study	496 workers with acute (fewer than 14 days) work-related low back pain	Low Back	A private network of occupational health clinics in the USA with eight participating clinics located in various states	Questionnaire: The Pain Recovery Inventory of Concerns and Expectations (PRICE) measure. Designed to subgroup patients within the first 2 weeks of an episode of back pain to determine needed treatment depending on whether disability is related to pain beliefs, emotional distress, or workplace concerns	Sensitivity analysis conducted to reduce the number of items while maintaining scale reliability, then classification accuracy was tested using a confirmatory cluster analysis	Patients were recruited from the consecutive caseload of patients reporting low back pain, and volunteer patients completed a brief demographic questionnaire and a 10-page psychosocial test battery. Participants were then followed-up at 3-months to determine pain, function, and work status	The reduced PRICE measure is a 46-item screening measure that can be used to identify early intervention needs of working adults with low back pain	Unclear Not testing effectiveness, only development
Aravena-Paez [39]	2014	Retrospective cohort study	2046 workers compensation claimants with back disorders	Low Back	Rehabilitation facilities in Alberta, Canada with contracts to treat workers’ compensation claimants	Questionnaire: OMPQ. Screening tool aimed at identifying high-risk patients with MSK pain in need of early intervention	Tested level of agreement between clinician recommendations and OMPQ categories. Also examined whether a match between OMPQ categories and actual programs were associated with better RTW outcomes	Secondary analysis of a dataset used for developing a CDS tool. Examined whether a match between OMPQ categories, clinician recommendations and actual rehab program undertaken was related to a better return to work outcome	The OMPQ had limited agreement with clinician recommendations suggesting other measures or factors are considered when making treatment recommendations. Finally, concordance of OMPQ categorization and actual rehabilitation undertaken did not appear to favorably impact outcomes	Negative
Knab et al. [35]	2001	Quasi-experimental study	100 patients with chronic pain referred for treatment at a chronic pain clinic	All	VA San Diego Healthcare System Pain Clinic in the United States	Computerized: Pain management advisor (PMA)	Validity and acceptability of recommendations made based on a computerized tool	A pain specialist used a decision support system to determine appropriate pain therapy and sent letters to the referring physicians outlining these recommendations. Separately, five board-certified PCPs used a CBDS system to “treat” the 50 cases. Patients were followed up 1-year later	The use of a Computer-Based Decision-Support system may improve the ability of primary care physicians to manage chronic pain and may facilitate screening of consults to optimize specialist utilization	Positive
Womack and Armstrong [38]	2005	Quasi-experimental study	Workers in an automobile assembly plant conducting over 400 jobs in the plant	Upper extremity	Worksite-based study. The plant built small trucks in a 2.1 million square foot facility. There were over 500 on- and offline assembly jobs and a workforce of ~2580 union employees	Computerized: Decision support system (DSS) for helping ergonomists better match workers with the work environment	Utility of the tool over a 20-month period	Evaluation of qualitative comments regarding utility of the tool as well as 1-on-1 semi-structured interviews with users	Of 197 comments entered by users, 25 % pertained to primary prevention, 75 % pertained to secondary prevention, and 94 comments (47.7 %) described ergonomic interventions. Use of the software tool improved the quality and efficiency of the ergonomic job analysis process	Positive
Stephens and Gross [37]	2007	Quasi-experimental study	171,736 workers’ compensation claimants with any type of MSK injury aged 18–65 years	All	Rehabilitation facilities in Alberta, Canada with contracts to treat workers’ compensation claimants	Soft Tissue Injury Continuum of Care Model with computerized prompts for case managers	Effectiveness of the tool compared to usual care	A population-based, quasi-experimental, before-and-after design with concurrent control groups was used to evaluate the model’s impact. Data were extracted from the main WCB-Alberta administrative database from 2 years before model implementation to 5 years after	Implementation of a soft tissue injury continuum of care involving staged application of various types of rehabilitation services appears to have resulted in more rapid and sustained recovery	Positive
Gross et al. [32]	2013	Cohort study	8611 injured Canadian workers’ compensation claimants with any type of MSK injury between 18 and 65 years old	All	Rehabilitation facilities in Alberta, Canada with contracts to treat workers’ compensation claimants	Computerized: Work Assessment Triage Tool	Classification accuracy of the tool	Data were extracted from a workers’ compensation database and machine-learning techniques were used to generate and test a tool	A CDS tool was developed for selecting rehabilitation interventions for injured workers. Preliminary validation was also conducted	Not testing effectiveness, only tool development
Zhang et al. [41]	2013	Methodological study (rule-based classifiers)	8611 injured Canadian workers’ compensation claimants with any type of MSK injury between 18 and 65 years old	All	Rehabilitation facilities in Alberta, Canada with contracts to treat workers’ compensation claimants	Computerized: Work Assessment Triage Tool	Accuracy of various rule-based classifiers	Data were extracted from a workers’ compensation database and various machine-learning techniques and rule-based classifiers were tested	This paper presents a description of the algorithm development from a computer science/machine learning perspective	Not testing effectiveness, only tool development
Qin et al. [42]	2015	Cross sectional	434 injured Canadian workers’ compensation claimants with any type of MSK injury between 18 and 65 years old	All	Workers’ compensation rehabilitation facility in Alberta, Canada	Computerized: Work Assessment Triage Tool (WATT). Designed to categorize injured workers to various programs including functional restoration, workplace-based intervention, or chronic pain programs	Concurrent validity of the tool’s recommendations	Level of agreement was examined between the WATT and clinical recommendations by therapists participating in a clinical trial	Percent agreement between clinician and WATT recommendations was low to moderate. The WATT did not improve upon clinician recommendations	Unclear