title: Patients' preferences for scoliosis brace treatment: a discrete choice experiment.
abstract: METHODS
  Discrete choice experiment.
  
  
  OBJECTIVE
  To investigate the reduction in the risk of surgery that scoliosis patients would require in order to consider brace treatment as acceptable, and to elicit the trade-offs individuals make between characteristics of brace treatment.
  
  
  BACKGROUND
  The effectiveness of brace treatment in idiopathic scoliosis patients has not been established in randomized controlled trials (RCTs). Treatment with a brace can be quite bothersome. Patients' preferences for brace treatment are unknown. Insight into patients' preferences for (characteristics of) brace treatment will be useful for future trials and for the development of braces that may optimize compliance with brace treatment.
  
  
  METHODS
  A total of 197 patients who had completed treatment (brace and/or surgery) for scoliosis were approached for the study, of which 135 gave informed consent. A discrete choice experiment was designed in which patients had to choose between hypothetical brace treatment profiles that differed in following 4 treatment attributes: effectiveness, visibility, discomfort, and treatment duration. A multinomial logit model was used to analyze the relative importance of these attributes. Subgroup analyses were conducted for brace-only, brace-surgery, and surgery-only patients.
  
  
  RESULTS
  The response rate was 86% (116/135). All treatment attributes proved to be important for patients' choices. All subgroups were prepared to initiate treatment with a Boston brace if the brace would reduce the need for surgery by 53%. Risk reductions in a range of 32% to 74% were required for acceptance of a treatment duration of 3 years.
  
  
  CONCLUSIONS
  Scoliosis patients stated to be prepared to undergo brace treatment only if it provides sizeable reduction of the risk of surgery. Effectiveness and discomfort in wearing a brace were the most important determinants of the choices. These results are important if RCTs would conclusively establish that bracing is effective, and show directions for the further technical development of braces to increase the compliance with brace treatment.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Eveline M
authors.initials: EM
authors.lastname: Bunge
authors.forename: Esther W
authors.initials: EW
authors.lastname: de Bekker-Grob
authors.forename: Frans C
authors.initials: FC
authors.lastname: van Biezen
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Essink-Bot
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
mesh_terms: D000293:Adolescent; D001915:Braces; D002755:Choice Behavior; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D057240:Patient Preference / Q000523:psychology*; D017060:Patient Satisfaction; D012044:Regression Analysis; D012600:Scoliosis / Q000523:psychology / Q000628:therapy*; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D055815:Young Adult