Abstract：
BACKGROUND: Patient-centered treatment and research should focus on the outcomes that matter to patients. The primary aim of this study was to determine the outcome preferences of patients after musculoskeletal trauma. The secondary aim was to identify discrepancies between outcome preferences of surgeons and patients.
METHODS: A Best-worst scaling choice experiment survey was administered to patients with operative lower extremity injuries and orthopaedic surgeons who take trauma call. Participants completed 13 choice sets of 3 randomly-ordered outcomes, including: a full recovery (back to normal) without any problems; a problem that requires additional surgery or hospital stay versus medication or treatment in clinic/emergency department; minimal to moderate versus severe pain for 6 weeks; need for crutches/walker versus wheelchair for 6-12 weeks; being unable to work for 6-12 weeks; requiring 2-4 weeks in a facility; a perfect versus poor or worst-possible EuroQol 5 Dimension (EQ-5D) score at 1 year; and death. Within each set, participants ranked their \"most-preferred\" to \"least-preferred\" outcomes. Responses were aggregated to calculate the relative importance, or marginal utility, of each outcome stratified by respondent type.
RESULTS: Fifty-five patients and 65 surgeons participated. The most preferred outcome for patients and surgeons was a full recovery (back to normal) without any problems, followed by minimal to moderate pain for 6 weeks and a perfect EQ-5D score. The least preferred outcomes were death and the worst EQ-5D score, which had similar marginal utility, followed by a poor EQ-5D score and a problem that needs another surgery or stay at a hospital, which also had similar marginal utility. Surgeons, in comparison to patients, assigned a higher marginal utility to perfect EQ-5D scores at one year (3.55 vs. 2.03; p < 0.0001) and a 2-4 week stay in a facility (0.52 vs. -0.21; p = 0.001), and a lower marginal utility to severe pain for 6 weeks (-0.58 vs. -0.08; p = 0.04) and a poor EQ-5D score (-1.88 vs. -1.03; p = 0.02).
CONCLUSIONS: A full recovery (back to normal) without any problems was the most-preferred outcome for both patients and surgeons. Patient-centered care and research should focus on both patients\' return to baseline and the avoidance of complications.
METHODS: N/A.
METHODS: A Best-worst scaling choice experiment survey was administered to patients with operative lower extremity injuries and orthopaedic surgeons who take trauma call. Participants completed 13 choice sets of 3 randomly-ordered outcomes, including: a full recovery (back to normal) without any problems; a problem that requires additional surgery or hospital stay versus medication or treatment in clinic/emergency department; minimal to moderate versus severe pain for 6 weeks; need for crutches/walker versus wheelchair for 6-12 weeks; being unable to work for 6-12 weeks; requiring 2-4 weeks in a facility; a perfect versus poor or worst-possible EuroQol 5 Dimension (EQ-5D) score at 1 year; and death. Within each set, participants ranked their \"most-preferred\" to \"least-preferred\" outcomes. Responses were aggregated to calculate the relative importance, or marginal utility, of each outcome stratified by respondent type.
RESULTS: Fifty-five patients and 65 surgeons participated. The most preferred outcome for patients and surgeons was a full recovery (back to normal) without any problems, followed by minimal to moderate pain for 6 weeks and a perfect EQ-5D score. The least preferred outcomes were death and the worst EQ-5D score, which had similar marginal utility, followed by a poor EQ-5D score and a problem that needs another surgery or stay at a hospital, which also had similar marginal utility. Surgeons, in comparison to patients, assigned a higher marginal utility to perfect EQ-5D scores at one year (3.55 vs. 2.03; p < 0.0001) and a 2-4 week stay in a facility (0.52 vs. -0.21; p = 0.001), and a lower marginal utility to severe pain for 6 weeks (-0.58 vs. -0.08; p = 0.04) and a poor EQ-5D score (-1.88 vs. -1.03; p = 0.02).
CONCLUSIONS: A full recovery (back to normal) without any problems was the most-preferred outcome for both patients and surgeons. Patient-centered care and research should focus on both patients\' return to baseline and the avoidance of complications.
METHODS: N/A.
摘要：
背景：以患者为中心的治疗和研究应该关注对患者重要的结果。这项研究的主要目的是确定肌肉骨骼创伤后患者的预后偏好。次要目的是确定外科医生和患者的结果偏好之间的差异。
方法：对下肢手术损伤患者和接受创伤呼叫的整形外科医生进行了一项最佳-最差缩放选择实验调查。参与者完成了3个随机排序结果的13个选择集，包括：完全恢复（恢复正常），没有任何问题；需要额外的手术或住院时间，而不是在诊所/急诊科接受药物治疗的问题；6周的轻度至中度和重度疼痛；需要拐杖/助行器与轮椅6-12周；无法工作6-12周；在设施中需要2-4周；1年时，完美与不良或最差的EuroQol5维度（EQ-5D和得分）；在每一组中，参与者将他们的“最优选”结果排名为“最不优选”结果。汇总响应以计算相对重要性，或边际效用，按受访者类型分层的每个结果。
结果：有55名患者和65名外科医生参加。患者和外科医生最喜欢的结果是完全康复（恢复正常），没有任何问题，随后轻微至中度疼痛持续6周，并获得完美的EQ-5D评分。最不喜欢的结果是死亡和最差的EQ-5D得分，具有相似的边际效用，接着是一个糟糕的EQ-5D评分和一个需要再次手术或住院的问题，也有类似的边际效用。外科医生,与患者相比，在一年内分配更高的边际效用来完善EQ-5D分数(3.55与2.03；p<0.0001）和在设施中停留2-4周（0.52vs.-0.21；p=0.001），和6周内对严重疼痛的边际效用较低(-0.58vs.-0.08；p=0.04）和较差的EQ-5D得分（-1.88vs.-1.03；p=0.02）。
结论：对于患者和外科医生来说，完全康复（恢复正常）是最优选的结果。以患者为中心的护理和研究应关注患者恢复基线和避免并发症。
方法：不适用。
方法：对下肢手术损伤患者和接受创伤呼叫的整形外科医生进行了一项最佳-最差缩放选择实验调查。参与者完成了3个随机排序结果的13个选择集，包括：完全恢复（恢复正常），没有任何问题；需要额外的手术或住院时间，而不是在诊所/急诊科接受药物治疗的问题；6周的轻度至中度和重度疼痛；需要拐杖/助行器与轮椅6-12周；无法工作6-12周；在设施中需要2-4周；1年时，完美与不良或最差的EuroQol5维度（EQ-5D和得分）；在每一组中，参与者将他们的“最优选”结果排名为“最不优选”结果。汇总响应以计算相对重要性，或边际效用，按受访者类型分层的每个结果。
结果：有55名患者和65名外科医生参加。患者和外科医生最喜欢的结果是完全康复（恢复正常），没有任何问题，随后轻微至中度疼痛持续6周，并获得完美的EQ-5D评分。最不喜欢的结果是死亡和最差的EQ-5D得分，具有相似的边际效用，接着是一个糟糕的EQ-5D评分和一个需要再次手术或住院的问题，也有类似的边际效用。外科医生,与患者相比，在一年内分配更高的边际效用来完善EQ-5D分数(3.55与2.03；p<0.0001）和在设施中停留2-4周（0.52vs.-0.21；p=0.001），和6周内对严重疼痛的边际效用较低(-0.58vs.-0.08；p=0.04）和较差的EQ-5D得分（-1.88vs.-1.03；p=0.02）。
结论：对于患者和外科医生来说，完全康复（恢复正常）是最优选的结果。以患者为中心的护理和研究应关注患者恢复基线和避免并发症。
方法：不适用。
