Deborah L. Wilkerson Award: Advancing Health Numeracy Through Data Visualizations for Clinicians and Scientists

Objective: Many rehabilitation practitioners struggle with “health numeracy” – the ability to interpret, apply, and communicate numerical data. This project aimed to develop an excel-based electronic application to support clinicians, researchers, and families in interpreting Coma Recovery Scale-Revised (CRS-R) clinical assessment data.

Design: Mixed methods were used, including focus groups for ideation and prototyping, and subsequently a rasch co-calibration for measurement validation
Setting: Post acute care facilities.
Participants: 19 practitioners and organizational leaders participated in focus groups. A Rasch co-calibration was performed using CRS-R data from 681 patients with disorders of consciousness.
Main Outcome Measures: CRS-R

Results: Focus group participants reported that while they had established CRS-R assessment routines, they felt the “Recovery Ruler” felt redundant or logistically inconvenient. They felt like the information on the Recovery Ruler was important for more novice practitioners and when family were present in the room. There was a strong preference for a digital version that could easily be used during assessments “to convey to the family and people making decisions”. Practitioners emphasized the importance of clear visualizations to convey clinical meaning and facilitate shared decision-making.

Using a larger dataset (6,023 CRS-R records), we established empirical cut-points to classify states of consciousness. CRS-R scores of 0-5 should reflect VS/UWS, 6-12 reflect MCS minus, 13-19 reflect MCS plus, and greater than 19 reflect eMCS. These thresholds were integrated into the 0 to 100 unit visual metric within the Excel-based electronic CRS-R Recovery Ruler application. The tools provides an immediate transformation to the 0 to 100 point scale, displays indices of responsiveness, and plots a visual representation of up to 2 assessment time points and graphs results over time.

Conclusions: Practitioners identified a clear need for a flexible, user-friendly digital version of the CRS-R Recovery Ruler that could seamlessly fit into clinical workflows. In response, we developed an Excel-based, person-centered decision support tool that incorporates advanced measurement science to improve diagnostic accuracy, support interdisciplinary communication, and guide individualized treatment planning. The CRS-R Recovery Ruler offers a practical solution to bridge gaps in health numeracy and enhance the utility of the CRS-R data in real-world clinical settings.
Disclosures: Dr. Weaver has received funding from the American Occupational Therapy Foundation, Department of Defense, and the NIH Loan Repayment Program to support this work. Dr. Weaver and Dr. Grady-Dominguez also received support from the ACRM Brain Injury ISIG.