Preferences for risks and benefits of treatment outcomes for chronic low back pain: Choice-based conjoint measure development and discrete choice experiment

Leslie Wilson; Alina Denham; Yelena Ionova; Conor O'Neill; Carol M Greco; Afton L Hassett; Janel Hanmer; Sana Shaikh; Mehling Wolf; Sigurd Berven; David Williams; Yanlei Ma; Jeffrey Lotz; Patricia Zheng

doi:10.1002/pmrj.13112

Preferences for risks and benefits of treatment outcomes for chronic low back pain: Choice-based conjoint measure development and discrete choice experiment

PM R. 2023 Dec 1. doi: 10.1002/pmrj.13112. Online ahead of print.

Authors

Affiliations

¹ Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA.
² Department of Family, Population and Preventive Medicine, Program in Public Health, Stony Brook University, San Francisco, Stony Brook, USA.
³ Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁴ Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
⁵ Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
⁶ Department of Medicine, Cornell University, Ithaca, New York, USA.

PMID: 38040670
DOI: 10.1002/pmrj.13112

Abstract

Introduction: Understanding individual patient preferences for chronic low back pain (cLBP) outcomes is essential for targeting available therapeutic options; yet tools to elicit patient outcome preferences are limited.

Objective: To develop and test a choice-based conjoint (CBC) measure, commonly used in behavioral economics research, to elicit what outcomes patients with cLBP want to achieve and avoid.

Design: 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. 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.

Setting: Online study using the Sawtooth web-based platform.

Participants: Two hundred eleven individuals with cLBP recruited from online advertising as well as at clinical sites across multiple academic and private institutions.

Interventions: Not applicable.

Results: The most valued outcome was the highest level of physical activity (β = 1.6-1.98; p < .001), followed by avoiding cognitive difficulties (β = -1.48; p < .001). Avoidance of severe pain was comparable to avoiding constant fatigue and near-constant depression/anxiety (β = -0.99, -1.02); p < .001). 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 have 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%).

Conclusions: Our study illuminated cLBP patient preferences for treatment outcomes and heterogeneity in these preferences. 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 to aid informed, shared decisions.

Abstract

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