Patients’ Preferences for Scoliosis Brace Treatment: A Discrete Choice Experiment.
Introduction: Scoliosis is an abnormal curvature of the spine. This disorder, which usually originates in adolescence, generally has two treatment options: an invasive surgery known as spinal fusion, or a back brace. The back brace, which comes in many different styles/types, is designed to deter the spinal curve from further growth so that surgery isn’t necessary. This experiment was done in Rotterdam, The Netherlands by the Department of Public Health Erasmus University Medical Center. It tested what requirements would be needed for Scoliosis patients to consider brace treatment as an alternative for surgery. It investigated which factors were most important to patients in regard to bracing and how these factors would affect their decision whether to engage in brace treatment or not.
1. Contact 197 patients who had already undergone treatment for scoliosis. (135 gave informed consent).
2. Design a discrete choice experiment by creating a type of questionnaire simulation that makes it easy for participants to give answers easily and honestly. Consider factors that are of importance to brace-wearing patients.
3. Instruct patients to complete experiment by choosing between hypothetical brace treatment profiles that offer differing attributes. These attributes include: effectiveness (will it prevent surgery? By how much?), visibility (how noticeable will the brace be? Is it unflattering?), discomfort (will wearing the brace hurt or cause discomfort? How comfortable does the brace feel?), and treatment duration (How long will the brace be worn?)
4. Analyze results. Consider the response rate of participants as well as the range of percentages related to patient compliance.
5. Analyze subgroup data. Consider the same factors.
- Response rate = 86% (116/153)
- Attributes proven to be important for patients’ choice to undergo bracing treatment = All (effectiveness, visibility, discomfort, treatment duration)
- All subgroups would undergo bracing treatment if it reduced surgery risk by an average of 53% for a three year duration of treatment. Range of 32% to 74%.
Discussion: Through the experiment, it was made clear that patients are only willing to undergo bracing as a treatment option if it decreases the likelihood of surgery by a sizable amount. All factors that were put into consideration (effectiveness, visibility, discomfort, and treatment duration) proved to be important to patients. This demonstrates that the issue of scoliosis bracing is a highly complex one with many facets. Through these results, the experiment has also shown that doctors must take these aspects into consideration in order to increase patient’s compliance.
Exploration and Discovery
Asking questions: The scientists wondered how different factors affect patient’s compliance during brace treatment.
Finding Inspiration: The scientists were inspired by the many people, especially young people, who struggle with their scoliosis and treatment, and wanted to help make things easier.
Gathering data: The discrete choice experiment was conducted on participants.
Interpreting data: The data showed that the likelihood of the treatment avoiding surgery increased patient compliance.
Community Analysis and Feedback
Publication: The study was published on PubMed.gov.
Theory Building: The theory that patient compliance is directly related to a high chance of success is built upon.
Benefits and Outcomes
Build knowledge: Knowledge is gained on patient compliance in regard to bracing as well as which factors prove to be important when considering treatment options.
Satisfy curiosity: The scientists satisfy their curiosity concerning patient’s preferences during bracing.
Department of Public Health, Erasmus, MC. (2010). Patients’ preferences for scoliosis brace
treatment: a discrete choice experiment. PubMed.gov. Retrieved October 29, 2013, from http://www.ncbi.nlm.nih.gov/pubmed/20023605