Patient preferences for physical therapy programs after a lower extremity fracture: a discrete choice experiment

Abstract

ObjectiveTo quantify patients’ preferences for physical therapy programmes after a lower extremity fracture and determine patient factors associated with preference variation.DesignDiscrete choice experiment.SettingLevel I trauma centre.ParticipantsOne hundred fifty-one adult (≥18 years old) patients with lower extremity fractures treated operatively.InterventionPatients were given hypothetical scenarios and asked to select their preferred therapy course when comparing cost, mobility, long-term pain, session duration, and treatment setting.Main outcome measuresA multinomial logit model was used to determine the relative importance and willingness to pay for each attribute.ResultsMobility was of greatest relative importance (45%, 95% CI: 40% to 49%), more than cost (23%, 95% CI: 19% to 27%), long-term pain (19%, 95% CI: 16% to 23%), therapy session duration (12%, 95% CI: 9% to 5%) or setting (1%, 95% CI: 0.2% to 2%). Patients were willing to pay US$142 more per session to return to their preinjury mobility level (95% CI: US$103 to US$182). Willingness to pay for improved mobility was higher for women, patients aged 70 years and older, those with bachelor’s degrees or higher and those living in less-deprived areas. Patients were willing to pay US$72 (95% CI: US$50 to US$93) more per session to reduce pain from severe to mild. Patients were indifferent between formal and independent home therapy (willingness to pay: −US$12, 95% CI: −US$33 to US$9).ConclusionsPatients with lower extremity fractures highly value recovering mobility and are willing to pay more for postoperative physical therapy programmes that facilitate returning to their pre-injury mobility level. These patient preferences might be useful when prescribing and designing new techniques for postoperative therapy.

Factors that Promote and Protect Against Financial Toxicity after Orthopaedic Trauma: A Qualitative Study

“…In addition, tests and treatments should be organized around comprehensive care for the patient. Postoperative care options through telemedicine continue to advance, 30 and clinicians should consider remote clinical appointments and rehabilitation protocols that can be conducted independently 31 for their patients. If there are no pressing needs, putting off discretionary tests and treatments can benefit the patient's mental and social health.…”

“…Comparison with other research with similar eligibility criteria suggest a positive bias, underrepresenting those patients of lower socioeconomic status. 31 Furthermore, only English-speaking patients were eligible for the study, and this population might not fully represent the larger orthopaedic trauma population.…”