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Title: The influence of patient treatment preference on outcome in clinical trials
Author: Jones, Elizabeth A.
ISNI:       0000 0004 2721 7250
Awarding Body: University of Aberdeen
Current Institution: University of Aberdeen
Date of Award: 2011
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Introduction/Background: Chronic widespread pain (CWP) affects around 11% of the population and while aetiology is well documented it has been difficult to translate this into effective management strategies. Patients in clinical trials are known to be different from the patient populations that they represent and treatment preference is one area where they may differ. Treatment preference may also influence outcome, particularly when participants cannot be blinded to treatment allocation. Aims: To assess whether patient treatment preference has an influence on 1. Recruitment, 2. Outcome, and 3. Adherence In a clinical trial of interventions for CWP. Methods: In the MUSICIAN trial, a 2x2 factorial trial of exercise and telephone cognitive behavioural therapy (T-CBT) for CWP, treatment preferences were recorded when eligibility was assessed using a population postal survey. Eligible individuals who did and did not go on to enter the trial were compared to address aim 1. Trial participants were followed up after 6 months of treatment and outcomes were compared according to whether they received their preferred treatment to address aim 2 and T-CBT and exercise logs were used to assess adherence to examine aim 3. Results: Eligible individuals were more likely to be randomised into the MUSICIAN trial if they expressed a treatment preference in the screening questionnaire (Relative Risk 1.46, 95% confidence interval 1.19-1.79). Treatment preferences were also associated with prognostic factors (anxiety and fear of movement). At follow-up participants were more likely to achieve a good outcome (global assessment of change) if they had received their preferred treatment (Relative Risk 2.50, 95% confidence interval 1.54-4.03)and this may be due to those individuals being more likely to adhere to treatment programmes. Conclusions: Wherever possible participant treatment preferences should be recorded prior to randomisation in clinical trials. Additional benefit may be gained in clinical practice by tailoring treatment to patients’ preferences.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Pain management ; Chronic pain ; Patient satisfaction