Patient preferences for treatment of achilles tendon pain: results from a discrete-choice experiment.

BACKGROUND: Discrete-choice experiments are based on the premise that any good or service can be described by its characteristics (or attributes), and the extent to which an individual values a good or service depends on the levels of these characteristics. Little is known about patient preferences for treatment of chronic musculoskeletal pain such as Achilles tendinopathy. METHODS: A discrete-choice experiment was conducted in 58 adults with a history of Achilles tendon pain at the conclusion of a three-arm randomized clinical trial. Participants were asked to complete a questionnaire consisting of ten hypothetical treatment scenarios and some sociodemographic questions. For each scenario, participants were asked to choose which option they would prefer if seeking treatment for their painful Achilles tendon. A mixed logit model was estimated to quantify subject preferences and marginal willingness to pay for the treatment attributes. RESULTS: A response rate of 62% was achieved. A significant positive impact on utility was observed for chance of treatment success. A significant negative impact on utility was observed for cost, weeks before exercise can be completed free of pain, chance of side effects (p = 0.06), and injections as a stand-alone treatment. Respondents were willing to pay Australian dollars ($A)238 (95% CI -312, 788) for a 10% increase in the chance of treatment success. CONCLUSIONS: Study participants with Achilles tendon pain who had either participated or expressed an interest in participating in a randomized trial prefer a treatment that costs less, has a greater chance of success, has a shorter duration before being able to exercise free of pain, and has less likelihood of side effects. On average, participants preferred exercises over injections as a stand-alone treatment. Further research is required to confirm the findings in patients outside of the trial setting. Nevertheless, this study contributes to an area that is deficient in research by identifying priorities and marginal willingness to pay for attributes related to Achilles tendinopathy.

Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: a randomised trial.

OBJECTIVE: To compare the effectiveness and cost-effectiveness of eccentric loading exercises (ELE) with prolotherapy injections used singly and in combination for painful Achilles tendinosis. DESIGN: A single-blinded randomised clinical trial. The primary outcome measure was the VISA-A questionnaire with a minimum clinically important change (MCIC) of 20 points. SETTING: Five Australian primary care centres. PARTICIPANTS: 43 patients with painful mid-portion Achilles tendinosis commenced and 40 completed treatment protocols. INTERVENTIONS: Participants were randomised to a 12-week program of ELE (n=15), or prolotherapy injections of hypertonic glucose with lignocaine alongside the affected tendon (n=14) or combined treatment (n=14). MAIN OUTCOME MEASUREMENTS: VISA-A, pain, stiffness and limitation of activity scores; treatment costs. RESULTS: At 12 months, proportions achieving the MCIC for VISA-A were 73% for ELE, 79% for prolotherapy and 86% for combined treatment. Mean (95% CI) increases in VISA-A scores at 12 months were 23.7 (15.6 to 31.9) for ELE, 27.5 (12.8 to 42.2) for prolotherapy and 41.1 (29.3 to 52.9) for combined treatment. At 6 weeks and 12 months, these increases were significantly less for ELE than for combined treatment. Compared with ELE, reductions in stiffness and limitation of activity occurred earlier with prolotherapy and reductions in pain, stiffness and limitation of activity occurred earlier with combined treatment. Combined treatment had the lowest incremental cost per additional responder ($A1539) compared with ELE. CONCLUSIONS: For Achilles tendinosis, prolotherapy and particularly ELE combined with prolotherapy give more rapid improvements in symptoms than ELE alone but long-term VISA-A scores are similar. TRIAL REGISTRATION NUMBER: ACTRN: 12606000179538.