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

Abstract

AbstractIntroductionUnderstanding patient preferences for chronic low back pain (cLBP) outcomes is essential for targeting available therapeutic options.ObjectiveWe developed and tested a choice‐based conjoint (CBC) measure to elicit what outcomes cLBP patients want to achieve and avoid.DesignWe 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.SettingOnline study using the Sawtooth™ web‐based platform.Participants211 individuals with cLBP recruited from online advertising and academic and private clinical sites.InterventionsNot applicable.ResultsThe 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%).ConclusionsOur 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.