Preferences for Risks and Benefits of Treatment Outcomes for Chronic Low Back Pain: Choice-Based Conjoint Measure Development and Discrete Choice Experiment.

Understanding patient preferences for chronic low back pain (cLBP) outcomes is essential for targeting available therapeutic options. We developed and tested a choice-based conjoint (CBC) measure to elicit what outcomes cLBP patients want to achieve and avoid. We developed a survey based CBC measure to allow patients to make risk/benefit trade-off choices between possible treatment outcomes. After extensive literature, clinician, and patient input, our measure included seven attributes: fatigue, anxiety/depression, difficulty thinking/making decisions, pain intensity, physical abilities, change in pain, and ability to enjoy life despite pain. Each subject responded to 14 pairs of the same 7 attributes consisting of randomly selected levels within each attribute. Random-parameters logit models were used to estimate strength of preferences and latent class analysis was used to identify patient characteristics associated with distinct preference. Online study using the Sawtooth™ web-based platform. 211 individuals with cLBP recruited from online advertising and academic and private clinical sites. Not applicable. The most valued outcome was the highest level of physical activity (β=1.6-1.98;p<0.001), followed by avoiding cognitive difficulties (β=-1.48;p<0.001). Avoidance of severe pain was comparable to avoiding constant fatigue and near-constant depression/anxiety (β=-0.99,-1.02);p<0001). There was an association between preferences and current pain/disability status; patients with higher pain had a stronger preference to avoid severe pain, whereas those with higher disability stronger preferences for achieving physical activity. The latent class analysis identified two distinct groups: (1) more risk-seeking and willing to accept worse outcomes (56%); and (2) more risk-averse with a stronger preference for achieving maximum benefits (44%). Our study illuminated the heterogenous cLBP patient preferences for treatment outcomes. Patients stressed the importance of reaching high physical activity and avoiding cognitive declines, even over a desire to avoid pain. More work is needed to understand patient preferences. This article is protected by copyright. All rights reserved.

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This article is protected by copyright. All rights reserved.