Quality and visual assessment of decision aids for patients with low back pain: a scoping review

Conduct a scoping review to identify existing low back pain (LBP) patient decision aids (PtDAs) and assess their use of visual aids. LBP PtDAs were identified using the Ottawa Health Research Institute (OHRI) PtDA database and PubMed. Three interdisciplinary reviewers assessed understandability and actionability using the Patient Educational Materials Assessment Tool (PEMAT), with readability evaluated via the Flesch-Kincaid Grade Level test. Six LBP PtDAs were found in the OHRI database and three in PubMed, for a total of nine. The mean PEMAT understandability score was 85%, while the mean PEMAT actionability was 68% (adequacy threshold for each section = 70%). Most used tables and scales (8/9), while fewer used pictographs (2/9), photographs (1/9), bar and pie charts (1/9), or illustrated diagrams (1/9). The mean reading level was Grade 5. Existing LBP PtDAs prioritise text over visuals and perform well on understandability and grade reading level, but less effectively on actionability. These findings highlight the need for interdisciplinary approaches to PtDA conceptualization, design, and evaluation to create tools that are relevant and impactful to patients and caregivers.