Montpellier Recherche en Economie, University of Montpellier, Montpellier, France.
CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada.
Health Expect. 2023 Feb;26(1):510-530. doi: 10.1111/hex.13685. Epub 2022 Dec 8.
This study aimed to assess patients' preferences of nonsurgical treatments for chronic low back pain (CLBP).
We conducted a discrete choice experiment (DCE) in Quebec, Canada, in 2018. Seven attributes were included: treatment modality, pain reduction, the onset of treatment efficacy, duration effectiveness, difficulties with daily activities, sleep problems, and knowledge of the patient's body and pain location. Treatment modalities were corticosteroid injections, supervised body-mind physical activities, supervised sports physical activities, physical manipulations, self-management courses, and psychotherapy. Utility levels were estimated using a logit model, a latent class model and a Bayesian hierarchical model.
Analyses were conducted on individuals. According to the Bayesian hierarchical model, the conditional relative importance weights of attributes were as follows: (1) treatment modality (34.79%), (2) pain reduction (18.73%), (3) difficulties with daily activities (11.71%), (4) duration effectiveness (10.06%), (5) sleep problems (10.05%), (6) onset of treatment efficacy (8.60%) and (7) knowledge of the patient's body and pain location (6.06%). According to the latent class model that found six classes of respondents with different behaviours (using Akaike and Bayesian criteria), the treatment modality was the most important attribute for all classes, except for class 4 for which pain reduction was the most important. In addition, classes 2 and 5 refused corticosteroid injections, while psychotherapy was preferred only in class 3.
Given the preference heterogeneity found in the analysis, it is important that patient preferences are discussed and considered by the physicians. This will help to improve the patient care pathway in a context of a patient-centred model for a disease with growing prevalence.
A small group of patients was involved in the conception, design and interpretation of data. Participants in the DCE were all CLBP patients.
本研究旨在评估慢性下腰痛（CLBP）非手术治疗的患者偏好。
我们于 2018 年在加拿大魁北克省进行了一项离散选择实验（DCE）。纳入了 7 个属性：治疗方式、疼痛减轻、治疗效果开始时间、疗效持续时间、日常活动困难、睡眠问题和对患者身体和疼痛位置的了解。治疗方式包括皮质类固醇注射、监督身心物理活动、监督运动物理活动、物理手法、自我管理课程和心理治疗。使用逻辑模型、潜在类别模型和贝叶斯层次模型估计效用水平。
对 个人进行了分析。根据贝叶斯层次模型，属性的条件相对重要性权重如下：（1）治疗方式（34.79%），（2）疼痛减轻（18.73%），（3）日常活动困难（11.71%），（4）疗效持续时间（10.06%），（5）睡眠问题（10.05%），（6）治疗效果开始时间（8.60%）和（7）对患者身体和疼痛位置的了解（6.06%）。根据发现 6 个不同行为类别的潜在类别模型（使用赤池信息量准则和贝叶斯准则），除第 4 类认为疼痛减轻最重要外，所有类别均认为治疗方式最重要。此外，第 2 类和第 5 类拒绝皮质类固醇注射，而心理治疗仅在第 3 类中受到青睐。
鉴于分析中发现的偏好异质性，医生讨论和考虑患者的偏好非常重要。这将有助于在以患者为中心的疾病模式下，改善患病率不断上升的疾病的患者护理路径。
一小部分患者参与了概念、设计和数据解释。DCE 的参与者均为慢性下腰痛患者。
