Patient preferences for physical therapy programs after a lower extremity fracture: a discrete choice experiment

Abstract

Objective: To quantify patients' preferences for physical therapy programmes after a lower extremity fracture and determine patient factors associated with preference variation.

Design: Discrete choice experiment.

Setting: Level I trauma centre.

Participants: One hundred fifty-one adult (≥18 years old) patients with lower extremity fractures treated operatively.

Intervention: Patients were given hypothetical scenarios and asked to select their preferred therapy course when comparing cost, mobility, long-term pain, session duration, and treatment setting.

Main outcome measures: A multinomial logit model was used to determine the relative importance and willingness to pay for each attribute.

Results: Mobility was of greatest relative importance (45%, 95% CI: 40% to 49%), more than cost (23%, 95% CI: 19% to 27%), long-term pain (19%, 95% CI: 16% to 23%), therapy session duration (12%, 95% CI: 9% to 5%) or setting (1%, 95% CI: 0.2% to 2%). Patients were willing to pay US$142 more per session to return to their preinjury mobility level (95% CI: US$103 to US$182). Willingness to pay for improved mobility was higher for women, patients aged 70 years and older, those with bachelor's degrees or higher and those living in less-deprived areas. Patients were willing to pay US$72 (95% CI: US$50 to US$93) more per session to reduce pain from severe to mild. Patients were indifferent between formal and independent home therapy (willingness to pay: -US$12, 95% CI: -US$33 to US$9).

Conclusions: Patients with lower extremity fractures highly value recovering mobility and are willing to pay more for postoperative physical therapy programmes that facilitate returning to their pre-injury mobility level. These patient preferences might be useful when prescribing and designing new techniques for postoperative therapy.

Keywords: adult orthopaedics; orthopaedic & trauma surgery; physical therapy modalities; trauma management.