Comparing consumer and clinician values for alternative functional states: Application of a new feature trade-off consensus building tool

Abstract

Objective: To present the Features-Resource Trade-Off Game (Features Game) as a new method for comparing preferences for alternative outcomes among different groups of people. Design: The Features Game is illustrated by comparing preferences for recovery among the 18 functional status items making up the Functional Independence Measure. Methods involved trading levels of independence (resources) across the different items (features). Setting: Ten community-dwelling consumers with physical disabilities and 10 rehabilitation clinicians participated in four separate expert panels—two in Houston and two in Philadelphia. Main Outcome Measures: Five sets of hierarchical stages defined by the four separate panels specifying the profiles of function believed to most foster independent living. Results: Cognitive and communication skills were selected preferentially over the recovery of physical tasks by all panels, but, in comparison to clinicians, consumers were more willing to accept mild deficits in cognitive skills as trade for realizing earlier recovery of physical abilities. Conclusion: The overwhelming choice of cognitive and communication abilities over physical abilities suggests a need to enhance therapeutic efforts in those areas. More subtle differences in consumer and clinician preferences emphasize the importance of establishing consumer-oriented goals.