Treatment Preference of People with Chronic Low Back Pain
We know that patient expectations and beliefs play a role in outcomes. Have you ever conversed about what interventions a patient expects to receive?
Shared decision making is one option that can help a clinician gain information about a patient's perception about available interventions.
In this study, I tend to think that patients preferred strength and flexibility exercises due to familiarity. Strengthening and stretching would be considered more mainstream to the typical patient. Granted, "familiarity" wasn't really a variable captured within this study - unless one considers "acceptability" and "appropriateness" as factors that sort of fall in the same line of thought as familiarity.
One important aspect of this study is that patients appreciate options that are convenient for them. Convenient may not only refer to the availability of resources but also to how easily it is to blend a home exercise program into one's daily activities.
You'll find the abstract to the recent study below.
A Cross-Sectional Study Assessing Treatment Preference of People with Chronic Low Back Pain.
To assess treatment preference and attributes of two exercise-based treatments for people with chronic low back pain (LBP).
Academic research setting.
Individuals (n=154) with chronic LBP.
MAIN OUTCOME MEASURE(S):
Participants completed a treatment preference assessment measure that described two treatments for chronic LBP [strength and flexibility (SF) and motor skill training (MST)]. Participants rated each treatment on four attributes: effectiveness, acceptability/logicality, suitability/appropriateness, and convenience. An overall score for each treatment was calculated as the mean of the four attribute ratings. The participants indicated either (1) no treatment preference or (2) preference for SF or MST.
One hundred four participants (67.5%) had a treatment preference; of those, 95 (91.3%) preferred SF and nine (8.7%) preferred MST. The SF preference group rated SF higher than MST overall and on all attributes (all ps < .01, ds ranged from .48-1.07). The MST preference group did not rate the treatments differently overall or on any of the attributes (all ps > .05, ds ranged from .43-.66). Convenience of SF (p = .05, d = .79) and effectiveness (d = 1.20), acceptability/logicality (d = 1.27), and suitability/appropriateness (d = 1.52) of MST (all ps < .01) were rated differently between the two preference groups.
When presented with two treatment options, a majority of patients preferred SF over MST. Convenience was a particularly important attribute impacting preference. Assessing treatment preference and attributes prior to treatment initiation allows the clinician to identify factors that may need to be addressed to enhance adherence to, and outcomes of, treatment.
Arch Phys Med Rehabil.2018 May 28. pii: S0003-9993(18)30318-6. doi: 10.1016/j.apmr.2018.04.027. [Epub ahead of print]