title: Toward Patient-Centered Telerehabilitation Design: Understanding Chronic Pain Patients' Preferences for Web-Based Exercise Telerehabilitation Using a Discrete Choice Experiment.
abstract: Patient-centered design that addresses patients' preferences and needs is considered an important aim for improving health care systems. At present, within the field of pain rehabilitation, patients' preferences regarding telerehabilitation remain scarcely explored and little is known about the optimal combination between human and electronic contact from the patients' perspective. In addition, limited evidence is available about the best way to explore patients' preferences. Therefore, the assessment of patients' preferences regarding telemedicine is an important step toward the design of effective patient-centered care.
  
  
  
  To identify which telerehabilitation treatment options patients with chronic pain are most likely to accept as alternatives to conventional rehabilitation and assess which treatment attributes are most important to them.
  
  
  
  A discrete choice experiment with 15 choice tasks, combining 6 telerehabilitation treatment characteristics, was designed. Each choice task consisted of 2 hypothetical treatment scenarios and 1 opt-out scenario. Relative attribute importance was estimated using a bivariate probit regression analysis. One hundred and thirty surveys were received, of which 104 were usable questionnaires; thus, resulting in a total of 1547 observations.
  
  
  
  Physician communication mode, the use of feedback and monitoring technology (FMT), and exercise location were key drivers of patients' treatment preferences (P<.001). Patients were willing to accept less frequent physician consultation offered mainly through video communication, provided that they were offered FMT and some face-to-face consultation and could exercise outside their home environment at flexible exercise hours. Home-based telerehabilitation scenarios with minimal physician supervision were the least preferred. A reduction in health care premiums would make these telerehabilitation scenarios as attractive as conventional clinic-based rehabilitation.
  
  
  
  "Intermediate" telerehabilitation treatments offering FMT, some face-to-face consulting, and a gym-based exercise location should be pursued as promising alternatives to conventional chronic pain rehabilitation. Further research is necessary to explore whether strategies other than health care premium reductions could also increase the value of home telerehabilitation treatment.
authors.affiliation: Roessingh Research and Development, Telemedicine group, Enschede, Netherlands.
authors.forename: Karlijn
authors.identifier: 0000-0002-9967-1167
authors.initials: K
authors.lastname: Cranen
authors.affiliation: Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands.
authors.forename: Catharina Gm
authors.identifier: 0000-0002-4875-5379
authors.initials: CG
authors.lastname: Groothuis-Oudshoorn
authors.affiliation: Ziekenhuisgroep Twente, Almelo, Netherlands.|Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, University of Twente, Enschede, Netherlands.
authors.forename: Miriam Mr
authors.identifier: 0000-0001-8730-1487
authors.initials: MM
authors.lastname: Vollenbroek-Hutten
authors.affiliation: Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands.
authors.forename: Maarten J
authors.identifier: 0000-0001-5788-5805
authors.initials: MJ
authors.lastname: IJzerman
mesh_terms: D000328:Adult; D002755:Choice Behavior; D059350:Chronic Pain / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D057240:Patient Preference; D018802:Patient-Centered Care / Q000379:methods*; D011795:Surveys and Questionnaires; D000069350:Telerehabilitation / Q000379:methods*
keywords: choice behavior; chronic disease; chronic pain; decision making; decision support techniques; exercise therapy; patient acceptance of health care; patient compliance; patient preference; telerehabilitation