Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 1;24(8):963-973.
doi: 10.1093/pm/pnad038.

CAPER: patient preferences to inform nonsurgical treatment of chronic low back pain: a discrete-choice experiment

Leslie Wilson  1 , Patricia Zheng  1 , Yelena Ionova  1 , Alina Denham  2 , Connie Yoo  1 , Yanlei Ma  3 , Carol M Greco  4 , Janel Hanmer  4 , David A Williams  5 , Afton L Hassett  5 , Aaron Wolfe Scheffler  1 , Frank Valone  1 , Wolf Mehling  1 , Sigurd Berven  1 , Jeffrey Lotz  1 , Conor O'Neill  1
Affiliations

CAPER: patient preferences to inform nonsurgical treatment of chronic low back pain: a discrete-choice experiment

Leslie Wilson et al. Pain Med. .

Abstract

Objective: We developed and used a discrete-choice measure to study patient preferences with regard to the risks and benefits of nonsurgical treatments when they are making treatment selections for chronic low back pain.

Methods: "CAPER TREATMENT" (Leslie Wilson) was developed with standard choice-based conjoint procedures (discrete-choice methodology that mimics an individual's decision-making process). After expert input and pilot testing, our final measure had 7 attributes (chance of pain relief, duration of relief, physical activity changes, treatment method, treatment type, treatment time burden, and risks of treatment) with 3-4 levels each. Using Sawtooth software (Sawtooth Software, Inc., Provo, UT, USA), we created a random, full-profile, balanced-overlap experimental design. Respondents (n = 211) were recruited via an emailed online link and completed 14 choice-based conjoint choice pairs; 2 fixed questions; and demographic, clinical, and quality-of-life questions. Analysis was performed with random-parameters multinomial logit with 1000 Halton draws.

Results: Patients cared most about the chance of pain relief, followed closely by improving physical activity, even more than duration of pain relief. There was comparatively less concern about time commitment and risks. Gender and socioeconomic status influenced preferences, especially with relation to strength of expectations for outcomes. Patients experiencing a low level of pain (Pain, Enjoyment, and General Activity Scale [PEG], question 1, numeric rating scale score<4) had a stronger desire for maximally improved physical activity, whereas those in a high level of pain (PEG, question 1, numeric rating scale score>6) preferred both maximum and more limited activity. Highly disabled patients (Oswestry Disability Index score>40) demonstrated distinctly different preferences, placing more weight on achieving pain control and less on improving physical activity.

Conclusions: Individuals with chronic low back pain were willing to trade risks and inconveniences for better pain control and physical activity. Additionally, different preference phenotypes exist, which suggests a need for clinicians to target treatments to particular patients.

Keywords: choice-based conjoint; chronic low back pain; chronic low back pain treatment; decision-making; discrete-choice experiment; pain; patient preference.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
CAPER Treatment Survey—example choice task.
Figure 2.
Figure 2.
Patient preference utility scores for persons with cLBP (n = 211). Bolded numbers in red represent preference scores that are statistically significant (P values <.05). For more detailed breakdown of utility scores, see Supplementary Material.
Figure 3.
Figure 3.
Attribute importance score.
Figure 4.
Figure 4.
Patient preference utility scores of persons with cLBP analyzed by pain score. Bolded numbers in red represent preference scores that are statistically significant (P values <.05).
Figure 5.
Figure 5.
Patient preference utility scores of persons with cLBP analyzed by disability level. Bolded numbers in red represent preference scores that are statistically significant (P values <.05).
See this image and copyright information in PMC

References

    1. Gooch CL, Pracht E, Borenstein AR.. The burden of neurological disease in the United States: a summary report and call to action. Ann Neurol. 2017;81(4):479-484. - PubMed
    1. Airaksinen O, Brox JI, Cedraschi C, et al. ; COST B13 Working Group on Guidelines for Chronic Low Back Pain. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(suppl 2):S192-S300. - PMC - PubMed
    1. Deyo RA, Dworkin SF, Amtmann D, et al. Report of the NIH Task Force on Research Standards for Chronic Low Back Pain. Phys Ther. 2015;95(2):e1-e18. - PMC - PubMed
    1. Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP.. Low back pain. Lancet. 2021;398:78–92. - PubMed
    1. U.S. Food and Drug Administration. List of Patient Preference-Sensitive Priority Areas. Accessed June 27, 2021. https://www.fda.gov/about-fda/cdrh-patient-science-and-engagement-progra....

Publication types