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  • Study: Personal Approach Is Important to Patients With Chronic Pain, but Partial Telerehab Could Offer Acceptable Alternatives

    In brief:

    • First telemedicine study to use discrete choice experiment to examine patient preferences and priorities.
    • Survey recipients included 300 chronic pain patients on a wait list for a rehab center in The Netherlands.
    • Experiment included 15 choice tasks combining 6 telerehab treatment characteristics.
    • Patients preferred face-to-face treatment and frequent physician consultation to web-based sessions.
    • Most-preferred scenario included 75% video instruction and infrequent physician consultation, accompanied by remote monitoring and feedback technology.

    While the emergence of telemedicine holds great promise for improving access to effective, cost-efficient care, its success depends on providers designing such services “with the patients’ perspective in mind,” say experts in a study in the Journal of Medical Internet Research. The Dutch researchers found that chronic pain patients were willing to forgo face-to-face time with physicians when “remote feedback and monitoring technology is offered.”

    Authors wanted to learn about chronic pain patient preferences for telerehabilitation, including how much human contact was important to recovery and what treatment characteristics were most valued by patients. Based on qualitative interviews and a focus group, they devised a “discrete choice experiment” to learn more about treatment characteristics such as amount of preferred human contact and treatment mode and location, as well as what type of “telerehabilitation scenario they are most likely to accept as an alternative to conventional rehabilitation.”

    Researchers randomly distributed 3 different versions of a survey questionnaire, each of which included 15 scenarios in which the patient had to choose rehab program A, B, or “I choose not to be treated.” Scenarios included either clinic-based or home-based rehab, and included varying levels of human contact, physician consultation, treatment mode and location, web-based and face-to-face instruction, feedback and monitoring technology, program flexibility, and health care premium reduction.

    From the results of the 103 survey responses, authors found that all 6 of the treatment attributes were “significant determinants” in patients’ preferences. Patients preferred face-to-face treatment over web-based sessions, and would choose physician contact every session, as opposed to only some sessions. Patients also preferred the use of feedback and monitoring technology, flexible exercise times over fixed times, and exercise at a gym rather than at home.

    The scenario patients were most “willing to accept” included individualized, gym-based exercise; 75% video instruction; consulting with a physician in 1 out of 4 sessions; use of feedback and monitoring technology; fixed sessions; and no health care premium reduction. Authors note: “Remarkably, [this scenario] is the only scenario that outweighs the utility of conventional care,” indicating patients’ willingness “to accept both a reduction in consulting frequency and face-to-face consulting when remote feedback and monitoring technology is offered.”

    The least-preferred scenario: home-based care with minimal physician contact and a high degree of self-management required, with patients consistently leaning toward conventional treatment over all home-based scenarios. Authors suggest that this desire for personal contact may be attributed in part to the psychosocial nature of treatment for chronic pain, in which “patient-provider communication plays such an important role” and “empathy and emotional support are considered essential.”

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Find out how a better understanding of pain can transform practice: join a March 16 live webinar on musculoskeletal pain principles presented by 2016 Maley Lecturer Steven George, PT, PhD.

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