Stakeholders’ preferences for osteoarthritis interventions in health services: A cross-sectional study using multi-criteria decision analysis

Abstract

To combine cross-sectoral stakeholders' preferences over interventions for knee osteoarthritis (OA) with guideline recommendations and evidence about interventions, and to investigate if these preferences differ by stakeholder group. A survey based on multi-criteria decision analysis was implemented whereby the stakeholders revealed the relative importance, represented as weights, of eight criteria for choosing or recommending knee OA interventions. Using data from an OA clinical guideline, 15 recommended interventions were rated on the criteria and ranked by their total scores, calculated by summing the corresponding weights. Associations between the weights and stakeholder groups were explored using regression analysis. Participants comprised 58 consumers with OA, 5Māori health advocates, 79 healthcare providers, 24 policy-informants and 12 OA-researchers (N=178; 63% female, [mean age±SD] 54±13 years). Mean weights on the eight criteria, in decreasing order of importance, are: recommendation: 19.0%; quality of evidence: 17.7%; effectiveness: 15.0%; duration of effect: 13.2%; risk of serious harm: 12.8%; risk of mild/moderate side-effects: 9.4%; cost: 6.6%; and accessibility: 6.3%. For first-, second- and third-line OA interventions respectively, all land-based exercise (total score=71.7%), NSAIDs (topical) (74.2%) and total joint replacement (74.3%) were ranked first. At all care phases, the recommended core interventions of weight management and self-management education ranked between 11th and 15th (48.0%-56.0%). Regression analysis identified only small differences in weights (≤5.7%; p<0.01) between stakeholder groups. Not all recommended core interventions are preferred by cross-sectoral stakeholders, which may represent a barrier to their uptake. Stakeholders' preferences do not appreciably differ by stakeholder group.