title: Using discrete choice experiments to inform randomised controlled trials: an application to chronic low back pain management in primary care.
abstract: Pain Management Programmes (PMPs) are a multi-disciplinary approach to the management of chronic low back pain (CLBP). Notwithstanding evidence of effectiveness, successful take-up of programmes requires acceptability to patients. We used a discrete choice experiment to investigate patient preferences for alternative PMPs for managing CLBP in primary care. Specifically, we estimated the probability of uptake of alternative configurations of PMPs. Potential attributes and associated levels influencing take-up were identified through a systematic literature review, survey of current PMPs, expert consultation, and focus groups. Five attributes were included: content; provider; schedule; group size; and travel time to clinic. Four hundred and fourteen questionnaires were mailed to patients attending clinics and 124 questionnaires were returned suitable for analysis. Method of delivery influenced probability of take-up, with small group sizes and low intensity programmes over a prolonged period increasing the probabilities. Travel time was also important. However, providers and contents of PMPs were not main drivers of preferences, though those with more severe pain did prefer PMPs provided by more specialists. Probability of take-up increases when PMPs better reflect patient preferences. Given preferences, resource constraints, and evidence on clinical outcomes of alternative configurations it is suggested more resource-intensive PMPs be reserved for those with the most severe and disabling pain and less intensive programmes delivered over a longer time period in smaller groups for those with less severe pain. These findings can inform future randomised trials to evaluate acceptable PMPs in primary care.
authors.affiliation: Health Economics Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, UK. d.yi@abdn.ac.uk
authors.forename: Deokhee
authors.initials: D
authors.lastname: Yi
authors.forename: Mandy
authors.initials: M
authors.lastname: Ryan
authors.forename: Susan
authors.initials: S
authors.lastname: Campbell
authors.forename: Alison
authors.initials: A
authors.lastname: Elliott
authors.forename: Nicola
authors.initials: N
authors.lastname: Torrance
authors.forename: Alastair
authors.initials: A
authors.lastname: Chambers
authors.forename: Marie
authors.initials: M
authors.lastname: Johnston
authors.forename: Philip
authors.initials: P
authors.lastname: Hannaford
authors.forename: Blair H
authors.initials: BH
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D002908:Chronic Disease; D005260:Female; D017144:Focus Groups; D006306:Health Surveys / Q000706:statistics & numerical data; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D018579:Patient Selection; D011320:Primary Health Care; D016730:Program Development; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D011795:Surveys and Questionnaires; D006113:United Kingdom; D055815:Young Adult