Patient Preferences for Treatment of Low Back Pain—A Discrete Choice Experiment

Kløjgaard, Mirja Elisabeth; Manniche, Claus; Pedersen, Line Bjørnskov; Bech, Mickael; Søgaard, Rikke

doi:10.1016/j.jval.2014.01.005

Cited by 42 publications

(61 citation statements)

References 53 publications

(55 reference statements)

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“…Unsurprisingly, majority of the respondents prefer nonsurgical interventions, but patients are willing to wait for more ideal outcomes and preferred interventions. The attributes for eliciting patients’ preference between invasive surgery and conservative non-surgical treatments, including risk of relapse, reduction in pain, and expected increase in the ability to perform activities of daily living, are different from our study that explored choices between non-surgical treatments, and hence the results are not comparable [ 52 ].…”

Section: Discussionmentioning

confidence: 90%

Acupuncture or Low Frequency Infrared Treatment for Low Back Pain in Chinese Patients: A Discrete Choice Experiment

et al. 2015

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Acupuncture is a popular but controversial treatment option for low back pain. In China, it is practised as traditional Chinese medicine; other treatment strategies for low back pain are commonly practised as Western medicine. Research on patient preference for low back-pain treatment options has been mainly conducted in Western countries and is limited to a willingness-to-pay approach. A stated-preference, discrete choice experiment was conducted to determine Chinese patient preferences and trade-offs for acupuncture and low frequency infrared treatment in low back pain from September 2011 to August 2012 after approval from the Department of Scientific Research in the study settings. Eight-six adult outpatients who visited the ‘traditional medicine department’ at a traditional Chinese medicine hospital and the ‘rehabilitation department’ at a Western medicine hospital in Guangdong Province of China for chronic low back pain during study period participated in an interview survey. A questionnaire containing 10 scenarios (5 attributes in each scenario) was used to ask participants' preference for acupuncture, low frequency infrared treatment or neither option. Validated responses were analysed using a nested-logit model. The decision on whether to receive a therapy was not associated with the expected utility of receiving therapy, female gender and higher out-of-pocket payment significantly decreased chance to receive treatments. Of the utility of receiving either acupuncture or low frequency infrared treatment, the treatment sensation was the most important attribute as an indicator of treatment efficacy, followed by the maximum efficacy, maintenance duration and onset of efficacy, and the out-of-pocket payment. The willingness-to-pay for acupuncture and low frequency infrared treatment were about $618.6 and $592.4 USD per course respectively, demonstrated patients' demand of pain management. The treatment sensation was regarded as an indicator of treatment efficacy and the most important attribute for choosing acupuncture or low frequency infrared treatment. The high willingness-to-pay demonstrated patients' demand of pain management. However, there may be other factors influencing patients' preference to receive treatments.

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Section: Discussionmentioning

confidence: 90%

Acupuncture or Low Frequency Infrared Treatment for Low Back Pain in Chinese Patients: A Discrete Choice Experiment

et al. 2015

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“…The duration of back pain was either undefined or mixed in 39 (78%) studies[ 24 , 25 , 37 – 43 , 45 – 47 , 50 , 51 , 55 – 65 , 67 – 69 , 72 – 77 , 79 – 81 , 83 , 84 ] . While 11 (22%) studies reported on chronic back pain (>12 weeks duration)[ 44 , 48 , 49 , 52 – 54 , 66 , 70 , 71 , 78 , 82 ].there were no studies on acute back pain alone (<6 weeks duration).…”

Section: Resultsmentioning

confidence: 99%

“…There were 35 qualitative studies[ 25 , 37 , 38 , 40 – 46 , 48 – 54 , 59 – 61 , 65 – 69 , 71 , 74 , 75 , 77 – 79 , 81 – 84 ] with participant numbers ranging from 7 to 110, with a median of 23. There were 14 quantitative studies[ 24 , 39 , 47 , 55 – 58 , 62 – 64 , 70 , 72 , 73 , 76 , 80 ], with a median participant number of 628 (range 124–1555). Mixed methods were utilised in 1 study[ 70 ], which had 348 participants.…”

Section: Resultsmentioning

confidence: 99%

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Patients’ perceived needs for medical services for non-specific low back pain: A systematic scoping review

et al. 2018

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BackgroundAn improved understanding of patients’ perceived needs for medical services for low back pain (LBP) will enable healthcare providers to better align service provision with patient expectations, thus improving patient and health care system outcomes. Thus, we aimed to identify the existing literature regarding patients’ perceived needs for medical services for LBP.MethodsA systematic scoping review was performed of publications identified from MEDLINE, EMBASE, CINAHL and PsycINFO (1990–2016). Descriptive data regarding each study, its design and methodology were extracted and risk of bias assessed. Aggregates of patients’ perceived needs for medical services for LBP were categorised.Results50 studies (35 qualitative, 14 quantitative and 1 mixed-methods study) from 1829 were relevant. Four areas of perceived need emerged: (1) Patients with LBP sought healthcare from medical practitioners to obtain a diagnosis, receive management options, sickness certification and legitimation for their LBP. However, there was dissatisfaction with the cursory and superficial approach of care. (2) Patients had concerns about pharmacotherapy, with few studies reporting on patients’ preferences for medications. (3) Of the few studies which examined the patients’ perceived need of invasive therapies, these found that patients avoided injections and surgeries (4) Patients desired spinal imaging for diagnostic purposes and legitimation of symptoms.ConclusionsAcross many different patient populations with data obtained from a variety of study designs, common themes emerged which highlighted areas of patient dissatisfaction with the medical management of LBP, in particular, the superficial approach to care perceived by patients and concerns regarding pharmacotherapy. Patients perceive unmet needs from medical services, including the need to obtain a diagnosis, the desire for pain control and the preference for spinal imaging. These issues need to be considered in developing approaches for the management of LBP in order to improve patient outcomes.

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“…It is also a reasonable assumption that patient expectations and preference for a specific treatment are closely related, however involve complex interactions that require further investigation through adequately powered studies 16,17. These findings also reinforce the important role health care providers have when communicating clinical decision-making processes with patients in regard to expected outcomes and personal preferences as conflicts have potential to influence outcomes 14,15,18…”

Section: Treatment Preference and Experienced Pain Reliefmentioning

confidence: 74%

The influence of clinical equipoise and patient preferences on outcomes of conservative manual interventions for spinal pain: an experimental study

Bishop¹,

Bialosky²,

Penza³

et al. 2017

JPR

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BackgroundExpected pain relief from treatment is associated with positive clinical outcomes in patients with musculoskeletal pain. Less studied is the influence on outcomes related to the preference of patients and providers for a specific treatment.ObjectivesWe sought to determine how provider and patient preferences for a manual therapy intervention influenced outcomes in individuals with acutely induced low back pain (LBP).Participants and methodsPain-free participants were randomly assigned to one of two manual therapies (joint biased [JB] or constant touch [CT]) 48 hours after completing an exercise protocol to induce LBP. Expectations for pain relief and preferences for treatment were collected at baseline, prior to randomization. Pain relief was assessed using a 100 mm visual analog scale. All study procedures were conducted in a private testing laboratory at the University of Florida campus.ResultsSixty participants were included in this study. After controlling for preintervention pain intensity, the multivariate model included only preintervention pain (B=0.12, p=0.07) and provider preference (B=3.05, p<0.0001) and explained 35.8% of the variance in postintervention pain. When determining whether a participant met his or her expected pain relief, receiving an intervention from a provider with a strong preference for that intervention increased the odds of meeting a participant’s expected pain relief 68.3 times (p=0.013) compared to receiving any intervention from a provider with no preference. Receiving JB intervention from any provider increased the odds of meeting expected relief 29.7 times (p=0.023). The effect of a participant receiving an intervention they preferred was retained in the model but did not meet the criteria for a significant contribution.ConclusionOur primary findings were that participant and provider preferences for treatment positively influence pain outcomes in individuals with acutely induced LBP, and joint-biased interventions resulted in a greater chance of meeting participants’ expected outcomes. This is contrary to our hypothesis that the interaction of receiving an intervention for which a participant had a preference would result in the best outcome.

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Patient Preferences for Treatment of Low Back Pain—A Discrete Choice Experiment

Cited by 42 publications

References 53 publications

Acupuncture or Low Frequency Infrared Treatment for Low Back Pain in Chinese Patients: A Discrete Choice Experiment

Acupuncture or Low Frequency Infrared Treatment for Low Back Pain in Chinese Patients: A Discrete Choice Experiment

Patients’ perceived needs for medical services for non-specific low back pain: A systematic scoping review

The influence of clinical equipoise and patient preferences on outcomes of conservative manual interventions for spinal pain: an experimental study

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