How do people feel about the possibility that a treatment might not outperform simulated and inert treatments?

BACKGROUND: Many treatments in common use are not proved better than simulated or inert treatments. While some clinicians express little concern about whether a particular treatment has a direct effect on the pathophysiology believed to be causing symptoms, we wonder if patients would agree. QUESTIONS/PURPOSES: Are there factors independently associated with the affirmation that it is OK if a treatment is proved not to outperform simulated or inert treatment (a placebo) measured on an 11-point ordinal scale, including the risk and invasiveness of the treatment? And, are there factors independently associated with the affirmation that the clinician should inform a patient about the degree to which a given treatment is known to outperform simulated or inert treatments? PATIENTS AND METHODS: We asked 763 English-speaking people their willingness to accept unproved treatment, depending on variations in risk, and invasiveness and their opinion regarding the importance of clinicians informing them whether a given treatment is proved to outperform simulated and inert (placebo) treatment. RESULTS: Acceptance of the unproved treatment was quite low, more so with greater risk and invasiveness. Lower acceptance of unproved treatment was associated with older age, more education, and unemployment. People rated it quite important (mean 7.3 out of 10) that clinicians inform patients if treatments are no better than placebo, no matter the risk of the treatment. CONCLUSIONS: People want to be informed if a treatment is not proved to outperform nonspecific effects such as the placebo effect. LEVEL OF EVIDENCE: Not applicable.

The impact of socioeconomic status and social deprivation on musculoskeletal limitations.

BACKGROUND: Objective (SES) and subjective socioeconomic status (SSS) affect symptom intensity and magnitude of limitations. Identification of potentially modifiable social risk factors might contribute to additional opportunities for optimizing musculoskeletal health. QUESTIONS/PURPOSES: (1) There are no correlations between magnitude of limitations (as measured with Patient-Reported Outcomes Measurement Information System Physical Function [PROMIS PF computer adaptive test]) and components of SES or SSS in people with musculoskeletal disease; (2) There are no factors (including level of social deprivation) independently associated with PROMIS PF. METHODS: One hundred and fifty-nine patients presenting to clinicians specializing in the treatment of a broad variety of musculoskeletal conditions were prospectively enrolled in the study. We recorded patient demographics and assessed patients' socioeconomic status using the MacArthur Sociodemographic questionnaire and physical disability rating using PROMIS PF. Patients deprivation index was retrieved using their 9-digit ZIP codes. We used bivariate analysis to determine correlations between magnitude of limitations and socioeconomic status. We created a stepwise backward multivariable linear regression model to assess factors independently associated with PROMIS PF. RESULTS: Weak correlations were found on bivariate analysis of PROMIS PF with SSS measured as "Place in community" (r 0.28; P < 0.001) and "Place in the United States of America" (r 0.25; P = 0.002). In the multivariable models, the area deprivation index was not independently associated with physical limitations. Male gender (beta regression coefficient [ß] 4.1; 95% CI 0.71 to 7.5; P = 0.018) and having net worth of $5000 - $19,999 (ß 6.3; 95% CI 0.35 to 12; P = 0.038) or $20,000 - $99,999 (ß 5.8; 95% CI 2.1 to 9.5; P = 0.003) when compared to having net worth of less than $4999 were independently associated with better physical function. Being unemployed or disabled and keeping house, being a student, or retired were independently associated with worse physical function (ß -12; 95% CI -18 to -7.0; P < 0.001; ß -5.6; 95% CI -9.9 to -1.4; P = 0.009, respectively), when compared to working full-time or part-time. CONCLUSIONS: Objective and subjective measures of socioeconomic status are associated with magnitude of physical limitations in patients with musculoskeletal illness. These factors should be considered when developing treatment plans for patients with musculoskeletal conditions. LEVEL OF EVIDENCE: Level II prognostic study.

Factors Associated with Patient Willingness to Conduct a Remote Video Musculoskeletal Consultation.

BACKGROUND: Remote video consultations on musculoskeletal illness are relatively convenient and accessible, and use fewer resources. However, there are concerns about technological and privacy issues, the possibility of missing something important, and equal access to all patients. We measured patient characteristics associated with willingness to conduct a remote video musculoskeletal upper extremity consultation. METHODS: One hundred and five patients seeking specialty musculoskeletal care completed questionnaires addressing (1) demographics, (2) access to a device, internet, and space to conduct a remote video consultation, (3) health literacy, (4) pain intensity, (5) magnitude of limitations of the upper extremity, (6) self-efficacy, and (7) rated willingness to conduct a remote video musculoskeletal consultation (11-point ordinal scale). A multivariable linear regression analysis sought factors independently associated with patient willingness to conduct remote video musculoskeletal upper extremity consultations. RESULTS: Patient education level (4 years of college) and accessibility to a space suitable for remote video consultations were independently associated with interest in remote video consultations. Sociodemographic factors, health literacy, accessibility to a device or internet, and amount of perceived pain and disability were not. CONCLUSION: We speculate that education level and suitable space might be surrogates for trust and privacy concerns. Future research might measure the ability of interventions to gain trust and ensure privacy to increase willingness to engage in remote video musculoskeletal consultations.