Abstract
BackgroundPatient-centered design that addresses patients’ preferences and needs is considered an important aim for improving health care systems. At present, within the field of pain rehabilitation, patients’ preferences regarding telerehabilitation remain scarcely explored and little is known about the optimal combination between human and electronic contact from the patients’ perspective. In addition, limited evidence is available about the best way to explore patients’ preferences. Therefore, the assessment of patients’ preferences regarding telemedicine is an important step toward the design of effective patient-centered care.ObjectiveTo identify which telerehabilitation treatment options patients with chronic pain are most likely to accept as alternatives to conventional rehabilitation and assess which treatment attributes are most important to them.MethodsA discrete choice experiment with 15 choice tasks, combining 6 telerehabilitation treatment characteristics, was designed. Each choice task consisted of 2 hypothetical treatment scenarios and 1 opt-out scenario. Relative attribute importance was estimated using a bivariate probit regression analysis. One hundred and thirty surveys were received, of which 104 were usable questionnaires; thus, resulting in a total of 1547 observations.ResultsPhysician communication mode, the use of feedback and monitoring technology (FMT), and exercise location were key drivers of patients’ treatment preferences (P<.001). Patients were willing to accept less frequent physician consultation offered mainly through video communication, provided that they were offered FMT and some face-to-face consultation and could exercise outside their home environment at flexible exercise hours. Home-based telerehabilitation scenarios with minimal physician supervision were the least preferred. A reduction in health care premiums would make these telerehabilitation scenarios as attractive as conventional clinic-based rehabilitation.Conclusions“Intermediate” telerehabilitation treatments offering FMT, some face-to-face consulting, and a gym-based exercise location should be pursued as promising alternatives to conventional chronic pain rehabilitation. Further research is necessary to explore whether strategies other than health care premium reductions could also increase the value of home telerehabilitation treatment.
Highlights
Chronic Pain and TreatmentChronic pain is considered a major public health problem
The use of the latest technology translates into “quality of care,” as some patients expect that the use of remote monitoring and feedback could provide even more accurate feedback than a therapist [47]. These results suggest that the lack of experience with the technology does not impede the acceptance of telerehabilitation and that, on the contrary, the use of innovative technology can be used as a way to increase acceptance of home telerehabilitation
A central aim of this study was to assess which treatment attributes were most important to chronic pain patients and to explore which telerehabilitation treatment was the most preferred
Summary
Chronic pain is considered a major public health problem. Breivik et al [1] explored the prevalence of chronic pain in 15 European countries and Israel and found that 19% (N=8.815) of their study sample suffered from chronic pain varying from moderate to severe intensity. In addition to the physical and emotional burden chronic pain brings, it accounts for considerable direct health care costs, including costs related to tests, medication, and treatment, as well as indirect costs such as lost income and reduced work productivity [6]. Patient-centered design that addresses patients’ preferences and needs is considered an important aim for improving health care systems. The assessment of patients’ preferences regarding telemedicine is an important step toward the design of effective patient-centered care
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