Originally posted by Pooka1
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In both studies treatment effectiveness does heavily influence decision making. Treatment effectiveness for bracing is deemed as avoiding surgery, i.e. reduction risk. Although in the second study it's defined as, brace failure = progression >=50°. All options are presented in the short-term. That is, reducing the risk for surgery before skeletal maturity. The first study used patients that were braced only, braced and then surgery, and surgery only. All three groups preferred their own treatment history. However, comfort was also a very important determinant.
From the study:
● Brace treatment effectiveness, brace comfort, total treatment duration, and visibility of the brace were all relevant to patients’ preferences for brace treatment.
● Effectiveness and comfortable wearing of a brace proved to be the most important determinants for IS patients’ preferences.
● Patients were prepared to initiate treatment with a Boston brace if the brace would reduce the need for surgery by 53%.
● Effectiveness and comfortable wearing of a brace proved to be the most important determinants for IS patients’ preferences.
● Patients were prepared to initiate treatment with a Boston brace if the brace would reduce the need for surgery by 53%.
This task asks the subject to consider possible surgical rates after observation and bracing, while considering the side effects and inconveniences of bracing. The baseline surgical rate for both treatments was set at 60%. The subjects were asked to choose their preferred treatment when surgical rates were equal, and then again as the surgical rate after bracing was decreased from 60% to 50%, 40%, 30%, 20%, 10%, and 0%. The surgical rate at which the subjects prefer bracing over observation is an estimate of their required risk reduction, given their perceptions of the bracing experience.
Both studies have a lot more data and stratification in them but I think highlights that "treatment effectiveness" is explicitly viewed and presented to patients and families as preventing progression and/or surgery before skeletal maturity. And I don't think that is the best way to present management options. As well, it's unclear exactly how surgery was presented in these studies. They are focused primarily on finding out what is important to make the decision to brace, not whether or not to have surgery. So it's weighted towards the negatives of bracing in an attempt to improve study recruitment, brace development, or study design.
One interesting thing from the Dolan paper:
It is reasonable to expect adolescents to overwhelmingly prefer observation to bracing. Wearing a brace is not fashionable and can cause skin irritation and other inconveniences. Even when adolescents believe in the relative benefit of bracing in terms of long-term health and appearance, they often value current comfort over some future benefit.
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