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Improving Visualization Methods of Utility-Weighted Disability Outcomes for Stroke Trials
BACKGROUND: The modified Rankin Scale (mRS) is the most common endpoint in acute stroke trials, but its power is limited when analyzed dichotomously and its indication of effect size is challenging to interpret when analyzed ordinally. To address these issues, the utility-weighted-mRS (UW-mRS) has b...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9136165/ https://www.ncbi.nlm.nih.gov/pubmed/35645952 http://dx.doi.org/10.3389/fneur.2022.875350 |
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author | Tokunboh, Ivie Sung, Eleanor Mina Chatfield, Fiona Gaines, Nathan Nour, May Starkman, Sidney Saver, Jeffrey L. |
author_facet | Tokunboh, Ivie Sung, Eleanor Mina Chatfield, Fiona Gaines, Nathan Nour, May Starkman, Sidney Saver, Jeffrey L. |
author_sort | Tokunboh, Ivie |
collection | PubMed |
description | BACKGROUND: The modified Rankin Scale (mRS) is the most common endpoint in acute stroke trials, but its power is limited when analyzed dichotomously and its indication of effect size is challenging to interpret when analyzed ordinally. To address these issues, the utility-weighted-mRS (UW-mRS) has been developed as a patient-centered, linear scale. However, appropriate data visualizations of UW-mRS results are needed, as current stacked bar chart displays do not convey crucial utility-weighting information. DESIGN/METHODS: Two UW-mRS display formats were devised: (1) Utility Staircase charts, and (2) choropleth-stacked-bar-charts (CSBCs). In Utility Staircase displays, mRS segment height reflects the utility value of each mRS level. In CSBCs, mRS segment color intensity reflects the utility of each mRS level. Utility Staircase and CSBC figures were generated for 15 randomized comparisons of acute ischemic/hemorrhagic stroke therapies, including fibrinolysis, endovascular reperfusion, blood pressure moderation, and hemicraniectomy. Display accuracy in showing utility outcomes was assessed with the Tufte-lie-factor and ease-of-use assessed by formal ratings completed by a panel of 4 neurologists and emergency physicians and one nurse-coordinator. RESULTS: The Utility Staircase and CSBC displays rapidly conveyed patient-centered valuation of trial outcome distributions not available in conventional ordinal stacked bar charts. Tufte-lie-factor (LF) scores indicated “substantial distortion” of utility-valued outcomes for 93% (14/15) of conventional stacked bar charts, vs. “no distortion” for all Utility Staircase and CSBC displays. Clinician ratings on the Figural Display Questionnaire indicated that utility information encoded in row height (Utility Staircase display) was more readily assimilated than that conveyed in segment hue intensity (CSBC), both superior to conventional stacked bar charts. CONCLUSIONS: Utility Staircase displays are an efficient graphical format for conveying utility weighted–modified Rankin Scale primary endpoint results of acute stroke trials, and choropleth-stacked-bar-charts a good alternative. Both are more accurate in depicting quantitative, health-related quality of life results and preferred by clinician users for utility results visualization, compared with conventional stacked bar charts. |
format | Online Article Text |
id | pubmed-9136165 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-91361652022-05-28 Improving Visualization Methods of Utility-Weighted Disability Outcomes for Stroke Trials Tokunboh, Ivie Sung, Eleanor Mina Chatfield, Fiona Gaines, Nathan Nour, May Starkman, Sidney Saver, Jeffrey L. Front Neurol Neurology BACKGROUND: The modified Rankin Scale (mRS) is the most common endpoint in acute stroke trials, but its power is limited when analyzed dichotomously and its indication of effect size is challenging to interpret when analyzed ordinally. To address these issues, the utility-weighted-mRS (UW-mRS) has been developed as a patient-centered, linear scale. However, appropriate data visualizations of UW-mRS results are needed, as current stacked bar chart displays do not convey crucial utility-weighting information. DESIGN/METHODS: Two UW-mRS display formats were devised: (1) Utility Staircase charts, and (2) choropleth-stacked-bar-charts (CSBCs). In Utility Staircase displays, mRS segment height reflects the utility value of each mRS level. In CSBCs, mRS segment color intensity reflects the utility of each mRS level. Utility Staircase and CSBC figures were generated for 15 randomized comparisons of acute ischemic/hemorrhagic stroke therapies, including fibrinolysis, endovascular reperfusion, blood pressure moderation, and hemicraniectomy. Display accuracy in showing utility outcomes was assessed with the Tufte-lie-factor and ease-of-use assessed by formal ratings completed by a panel of 4 neurologists and emergency physicians and one nurse-coordinator. RESULTS: The Utility Staircase and CSBC displays rapidly conveyed patient-centered valuation of trial outcome distributions not available in conventional ordinal stacked bar charts. Tufte-lie-factor (LF) scores indicated “substantial distortion” of utility-valued outcomes for 93% (14/15) of conventional stacked bar charts, vs. “no distortion” for all Utility Staircase and CSBC displays. Clinician ratings on the Figural Display Questionnaire indicated that utility information encoded in row height (Utility Staircase display) was more readily assimilated than that conveyed in segment hue intensity (CSBC), both superior to conventional stacked bar charts. CONCLUSIONS: Utility Staircase displays are an efficient graphical format for conveying utility weighted–modified Rankin Scale primary endpoint results of acute stroke trials, and choropleth-stacked-bar-charts a good alternative. Both are more accurate in depicting quantitative, health-related quality of life results and preferred by clinician users for utility results visualization, compared with conventional stacked bar charts. Frontiers Media S.A. 2022-05-13 /pmc/articles/PMC9136165/ /pubmed/35645952 http://dx.doi.org/10.3389/fneur.2022.875350 Text en Copyright © 2022 Tokunboh, Sung, Chatfield, Gaines, Nour, Starkman and Saver. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neurology Tokunboh, Ivie Sung, Eleanor Mina Chatfield, Fiona Gaines, Nathan Nour, May Starkman, Sidney Saver, Jeffrey L. Improving Visualization Methods of Utility-Weighted Disability Outcomes for Stroke Trials |
title | Improving Visualization Methods of Utility-Weighted Disability Outcomes for Stroke Trials |
title_full | Improving Visualization Methods of Utility-Weighted Disability Outcomes for Stroke Trials |
title_fullStr | Improving Visualization Methods of Utility-Weighted Disability Outcomes for Stroke Trials |
title_full_unstemmed | Improving Visualization Methods of Utility-Weighted Disability Outcomes for Stroke Trials |
title_short | Improving Visualization Methods of Utility-Weighted Disability Outcomes for Stroke Trials |
title_sort | improving visualization methods of utility-weighted disability outcomes for stroke trials |
topic | Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9136165/ https://www.ncbi.nlm.nih.gov/pubmed/35645952 http://dx.doi.org/10.3389/fneur.2022.875350 |
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