Since the preferences that motivate a patient’s choice of treatment following a limb-threatening injury were poorly understood, a team of researchers set out to determine what outcomes are most important, and if those preferences vary based on the patients’ treatment (salvage versus amputation), health, demographics, or time since injury.
Discrete choice experiments (DCEs), a survey methodology to quantify preferences, were used for the study. Patients with a history of traumatic limb-threatening injury from January 2010 to December 2020 completed a survey with the DCE and the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire.
The DCE attributes included recovery time, function, appearance, cost, and time in hospital. Researchers used conditional logit modeling to estimate the relative importance of each attribute on a scale of 0 to 100 percent, determine willingness to pay for improvements in the included attributes, and assess variation in preferences based on patient characteristics, including PROMIS score.
A total of 150 patients completed the survey (104 patients had limb salvage, 46 had an amputation; the mean age was 48 ± 16 years; and 79 percent were male). Regaining preinjury function and minimizing costs were of greatest importance. The relative importance of regaining function was 41 percent; 95 percent confidence interval (CI), 37 percent to 45 percent. The relative importance of minimizing cost was 24 percent; 95 percent CI, 21-28 percent. Changes in appearance were least important (7 percent; 95 percent CI, 5-9 percent).
The hierarchy of preferences did not vary between those who had limb salvage or amputation, but patient age, physical and mental health, and income were associated with preference variation.
The study, “What Outcomes Are Most Important to Patients Following a Lower Extremity Limb-threatening Injury?” was published in the journal The Annals of Surgery.