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Imbergamo C, Zhang G, Yohe G, Sanniec K, Fong A, Giladi AM. Open Versus Endoscopic Carpal Tunnel Release: A Decision Tool Guided by Multi-Criteria Decision Analysis Incorporating Patient-Reported Outcomes, Complications, and Cost. J Hand Surg Am 2025:S0363-5023(25)00213-8. [PMID: 40434328 DOI: 10.1016/j.jhsa.2025.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 02/25/2025] [Accepted: 04/02/2025] [Indexed: 05/29/2025]
Abstract
PURPOSE The purpose of this work was to develop a multi-criteria decision analysis model guided in part by early postoperative patient-reported data to compare open (OCTR) and endoscopic carpal tunnel release (ECTR) and create an interactive platform in the shared decision-making process. Our null hypothesis was that there would be no difference in patient-reported outcomes following OCTR or ECTR, and with all variables weighted equally, OCTR would be the preferred procedure, owing primarily to its lesser cost. METHODS Data from patients who underwent OCTR or ECTR at an institution from 2018 to 2023 were collected. Patient-reported outcome data used in this study to reflect early postoperative experiences/value were collected in real time at the 2-week postoperative time point. Institutional financial data were collected. Complication data were pulled from the existing literature. Multi-criteria decision analysis modeling was then used to create an interface whereby patients and providers can manually adjust weights for each variable based on individual priorities. RESULTS Nine hundred and eight patient encounters were included for data set modeling. When preferentially weighting transient nerve injury, recurrence, or patient cost as variables of importance, OCTR is the preferred procedure. When weighing permanent nerve injury, infection, or early improvement in pain/function, ECTR is the preferred procedure. The Curtis National Hand Center Carpal Tunnel Decision Matrix was subsequently created to provide real time results as the weight of each variable is adjusted. CONCLUSIONS This study presents a model guided by patient-reported outcome data as a reflection of the patient experience surrounding carpal tunnel release surgery. This decision aid tool is intended to be used for individual patient-level knowledge and decision-making as a reflection of patient attitudes. LEVEL OF EVIDENCE/TYPE OF STUDY Decision analysis IV.
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Affiliation(s)
- Casey Imbergamo
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; MedStar Orthopaedic Institute, MedStar Union Memorial Hospital, Baltimore, MD
| | - Gongliang Zhang
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; MedStar Health Research Institute, Hyattsville, MD
| | - Gabriel Yohe
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; MedStar Health Research Institute, Hyattsville, MD
| | - Kyle Sanniec
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Allan Fong
- MedStar Health Research Institute, Hyattsville, MD
| | - Aviram M Giladi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
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Campbell G, Settumba S, Hopkins R, Nielsen S, Larance B, Bruno R, Cohen M, Degenhardt L, Shanahan M. A discrete choice experiment: Understanding patient preferences for managing chronic non-cancer pain. Eur J Pain 2025; 29:e4760. [PMID: 39601351 DOI: 10.1002/ejp.4760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 10/17/2024] [Accepted: 11/04/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND The management of chronic non-cancer pain (CNCP) is complex. Concerns about adverse effects associated with opioid pain medications and a lack of funding for holistic programs present challenges for decision-making among clinicians and patients. Discrete choice experiments (DCE) are one way of assessing and valuing patient treatment preferences. METHOD DCE attributes and levels were generated through qualitative research and included number of medicines, side effects from medicines, pain interference, care management, risk of addiction, activity goals, preferred source of information on pain management and willingness to pay. The survey was administered to participants with CNCP recruited through an existing cohort study (n = 442) and a sample of people living with CNCP recruited through Australia's leading pain advocacy body (Painaustralia) (n = 256). RESULTS The median age of participants was 58 years (SD 12.0), the majority were female. The analysis revealed two latent demographic classes: a younger group with higher levels of private health insurance and an older group with lower levels of private health insurance coverage. There were notable differences in preference. The younger cohort exhibited a greater willingness-to-pay to reduce pain interference, whereas the older group prioritized GP management, preferred more medicines and expressed fewer addiction concerns. CONCLUSION Patients' treatment preferences diverged based on age and insurance status, underscoring the importance of understanding patient perspectives in treatment communication and care coordination. These findings provide insight into patient decision-making, which is important for promoting access to quality healthcare and engagement with evidence-based treatment of CNCP. SIGNIFICANCE STATEMENT A discrete choice experiment identified two groups: younger, with more private insurance, and older, with less private health insurance, each with unique pain management preferences. Clinicians should be aware that age and private health insurance may have an impact on a patient's preferences for CNCP management.
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Affiliation(s)
- Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Stella Settumba
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Ria Hopkins
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
- Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Raimondo Bruno
- School of Psychology, University of Tasmania, Hobart, Tasmania, Australia
| | - Milton Cohen
- Independent Scholar, Mosman, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
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French HP, Cunningham J, Bennett K, Cadogan CA, Clyne B, Doyle F, Moriarty F, Ryan JM, Smith SM, Passos VL. Patterns of pain medication usage and self-reported pain in older Irish adults with osteoarthritis: A latent class analysis of data from the Irish Longitudinal Study on Ageing. BMC Musculoskelet Disord 2024; 25:773. [PMID: 39358713 PMCID: PMC11447940 DOI: 10.1186/s12891-024-07854-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 09/06/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND This study aimed to identify and describe links between pain medication use and self-reported pain among people aged ≥ 50 years with osteoarthritis (OA) in an Irish population, and to examine the relationships between pain, medication usage and socioeconomic and clinical characteristics. METHODS Secondary data analysis of wave 1 cross-sectional data from The Irish Longitudinal Study on Ageing (TILDA) was undertaken of 1042 people with self-reported doctor-diagnosed OA. We examined use of medications typically included in OA clinical guidelines, including non-opioid analgesics (e.g. paracetamol), topical and oral non-steroidal anti-inflammatory drugs (NSAIDs), opioids and nutraceuticals. Latent Class Analysis (LCA) was used to identify underlying clinical subgroups based on medication usage patterns, and self-reported pain severity. Multinomial logistic regression was used to explore sociodemographic and clinical characteristic links to latent class membership. RESULTS A total of 358 (34.4%) of the 1042 people in this analysis were taking pain medications including oral NSAIDs (17.5%), analgesics (11.4%) and opioids (8.7%). Nutraceutical (glucosamine/chondroitin) use was reported by 8.6% and topical NSAID use reported by 1.4%. Three latent classes were identified: (1) Low medication use/no pain (n = 382, 37%), (2) low medication use/moderate pain (n = 523, 50%) and (3) moderate medication use/high pain (n = 137, 13%). Poorer self-rated health and greater sleep disturbance were associated with classes 2 and 3; depressive symptoms and female gender were associated with class 2, and retirement associated with class 3. CONCLUSIONS Whilst pain medication use varied with pain severity, different medication types reported broadly aligned with OA guidelines. The two subgroups exhibiting higher pain levels demonstrated poorer self-rated health and greater sleep disturbance.
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Affiliation(s)
- H P French
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
| | - J Cunningham
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - K Bennett
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - C A Cadogan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - B Clyne
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - F Doyle
- Department of Health Psychology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - F Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - J M Ryan
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - S M Smith
- Discipline of Public Health and Primary Care, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - V Lima Passos
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Jolliffe L, Christie LJ, Fearn N, Nohrenberg M, Liu R, Williams JF, Parsons MW, Pearce AM. A systematic review of discrete choice experiments in stroke rehabilitation. Top Stroke Rehabil 2024; 31:632-643. [PMID: 38372124 DOI: 10.1080/10749357.2024.2312641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/27/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES Existing research qualitatively explores consumer preferences for stroke rehabilitation interventions. However, it remains unclear which intervention characteristics are most important to consumers, and how these preferences may influence uptake and participation. Discrete choice experiments (DCE) provide a unique way to quantitatively measure preferences for health and health care. This study aims to explore how DCEs have been used in stroke rehabilitation and to identify reported consumer preferences for rehabilitation interventions. MATERIAL AND METHODS A systematic review of published stroke rehabilitation DCEs was completed (PROSPERO registration: CRD42021282578). Six databases (including CINAHL, MEDLINE, EconLIT) were searched from January 2000-March 2023. Data extracted included topic area, sample size, aim, attributes, design process, and preference outcomes. Descriptive and thematic analyses were conducted, and two methodological checklists applied to review quality. RESULTS Of 2,446 studies screened, five were eligible. Studies focused on exercise preference (n = 3), the structure and delivery of community services (n = 1), and self-management programs (n = 1). All had small sample sizes (range 50-146) and were of moderate quality (average score of 77%). Results indicated people have strong preferences for one-to-one therapy (over group-based), light-moderate intensity of exercise, and delivery by qualified therapists (over volunteers). CONCLUSIONS Few DCEs have been conducted in stroke rehabilitation, suggesting consumer preferences could be more rigorously explored. Included studies were narrow in the scope of attributes included, limiting their application to practice and policy. Further research is needed to assess the impact of differing service delivery models on uptake and participation.
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Affiliation(s)
- Laura Jolliffe
- Department of Occupational Therapy, Peninsula Health, Melbourne, Australia
- Department of Occupational Therapy, Monash University, Melbourne, Australia
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
| | - Lauren J Christie
- Allied Health Research Unit, St Vincent's Health Network Sydney, Darlinghurst, Australia
- Nursing Research Institute, Australian Catholic University, Sydney, Australia
| | - Nicola Fearn
- Allied Health Research Unit, St Vincent's Health Network Sydney, Darlinghurst, Australia
| | - Michael Nohrenberg
- School of Public Health, The University of Sydney, Camperdown, Australia
| | - Rasia Liu
- School of Public Health, The University of Sydney, Camperdown, Australia
| | - Julie F Williams
- Walter McGrath Library, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Mark W Parsons
- Department of Neurology, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, Australia
- School of Medicine and Health, UNSW, Sydney, Australia
- Sydney Brain Centre, Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Alison M Pearce
- School of Public Health, The University of Sydney, Camperdown, Australia
- The Daffodil Centre, a joint venture between Cancer Council NSW and the University of Sydney, The University of Sydney, Sydney, Australia
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Xia Q, Kularatna M, Virdun C, Button E, Close E, Carter HE. Preferences for Palliative and End-of-Life Care: A Systematic Review of Discrete Choice Experiments. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1795-1809. [PMID: 37543206 DOI: 10.1016/j.jval.2023.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/20/2023] [Accepted: 07/22/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES Understanding what matters most to patients and their caregivers is fundamental to delivering high-quality care. This systematic review aimed to characterize and appraise the evidence from discrete choice experiments eliciting preferences for palliative care. METHODS A systematic literature search was undertaken for publications up until August 2022. Data were synthesized narratively. Thematic analysis was applied to categorize attributes into groups. Attribute development, frequency, and relative importance were analyzed. Subgroup analyses were conducted to compare outcomes between patient and proxy respondents. RESULTS Seventeen studies spanning 11 countries were included; 59% of studies solely considered preferences for patients with cancer. A range of respondent groups were represented including patients (76%) and proxies (caregivers [35%], health providers [12%], and the public [18%]). A total of 117 individual attributes were extracted and thematically grouped into 8 broad categories and 21 subcategories. Clinical outcomes including quality of life, length of life, and pain control were the most frequently reported attributes, whereas attributes relating to psychosocial components were largely absent. Both patients and proxy respondents prioritized pain control over additional survival time. Nevertheless, there were differences between respondent cohorts in the emphasis on other attributes such as access to care, timely information, and low risk of adverse effects (prioritized by patients), as opposed to cost, quality, and delivery of care (prioritized by proxies). CONCLUSIONS Our review underscores the vital role of pain control in palliative care; in addition, it shed light on the complexity and relative strength of preferences for various aspects of care from multiple perspectives, which is useful in developing personalized, patient-centered models of care for individuals nearing the end of life.
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Affiliation(s)
- Qing Xia
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Mineth Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Claudia Virdun
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Elise Button
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Eliana Close
- Australian Centre for Health Law Research, School of Law, Faculty of Business and Law (Close), Queensland University of Technology, Brisbane, QLD, Australia
| | - Hannah E Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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Al-Omari B, Farhat J, Khan M, Grancharov H, Zahr ZA, Hanna S, Alrahoomi A. Exploring patient treatment decision making for osteoarthritis in the UAE: a cross-sectional adaptive choice-based conjoint study. BMC Public Health 2023; 23:1542. [PMID: 37573337 PMCID: PMC10423421 DOI: 10.1186/s12889-023-16490-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/09/2023] [Indexed: 08/14/2023] Open
Abstract
OBJECTIVE To assess osteoarthritis (OA) patients' preferences for pharmaceutical treatment via Adaptive Choice-Based Conjoint (ACBC) method. METHODS A United Arab Emirates (UAE) based Patient and Public Involvement (PPI) group designed the ACBC questionnaire with 10 attributes and 34 levels. The questionnaire was developed using Sawtooth Software and analyzed through Hierarchical Bayesian (HB). Results were standardized using Z-score via SPSS. RESULTS Study participants were 1030 OA patients, 83.6% aged 50 or older and 83.4% female. The avoidance of medication's side effects accounted for 66% relative importance compared to 6% relative importance for the medication's benefits. The "way of taking the medicine" attribute had the highest coefficient of variation (70%) and the four side effect attributes "risk of gastric ulcer, addiction, kidney and liver impairment, and heart attacks and strokes" had a coefficient of variation from 18 to 21%. CONCLUSIONS Arab OA patients are similar to other ethnic groups in trading-off benefits and side effects and consistently prioritizing the avoidance of medications' side effects. Although the "Way of taking medicine" was the least important attribute it was associated with the highest variation amongst patients. OA patients also prefer prescribed medications to internet-purchased and over-the-counter options.
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Affiliation(s)
- Basem Al-Omari
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, P.O. Box 127788, Abu Dhabi, United Arab Emirates.
| | - Joviana Farhat
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, P.O. Box 127788, Abu Dhabi, United Arab Emirates
| | - Mumtaz Khan
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, P.O. Box 127788, Abu Dhabi, United Arab Emirates
- Department of Rheumatology, Sheikh Shakhbout Medical City (SSMC), P.O. Box 11001, Abu Dhabi, United Arab Emirates
| | - Hristo Grancharov
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, P.O. Box 127788, Abu Dhabi, United Arab Emirates
- Department of Orthopedics & Sports Medicine, Healthpoint Hospital, P.O. Box 112308, Abu Dhabi, United Arab Emirates
| | - Zaki Abu Zahr
- Department of Rheumatology, Healthpoint Hospital, P.O. Box 112308, Abu Dhabi, United Arab Emirates
| | - Sammy Hanna
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, P.O. Box 127788, Abu Dhabi, United Arab Emirates
- Department of Orthopedics & Sports Medicine, Healthpoint Hospital, P.O. Box 112308, Abu Dhabi, United Arab Emirates
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Whitechapel, London, E1 2AD, UK
| | - Abdulla Alrahoomi
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, P.O. Box 127788, Abu Dhabi, United Arab Emirates
- Department of Orthopedics & Sports Medicine, Healthpoint Hospital, P.O. Box 112308, Abu Dhabi, United Arab Emirates
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Luksameesate P, Tanavalee A, Ngorsuraches S, Taychakhoonavudh S. Using a discrete choice experiment to elicit patients' preferences and willingness-to-pay for knee osteoarthritis treatments in Thailand. Sci Rep 2023; 13:12154. [PMID: 37500677 PMCID: PMC10374609 DOI: 10.1038/s41598-023-39264-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 06/29/2023] [Indexed: 07/29/2023] Open
Abstract
Osteoarthritis is the most common type of joint disease among elderly patients around the world. In response to the need for patient-centered care, patients' and physicians' preferences for knee osteoarthritis treatments have been studied in multiple countries, but not in Thailand. The objective of this study was to investigate Thai patients' preferences and their willingness to pay (WTP) for knee osteoarthritis treatments by using a discrete choice experiment (DCE). Six knee osteoarthritis treatment attributes, including pain relief, delayed disease progression, gastrointestinal side effects, kidney side effects, cardiovascular side effects, and cost, were used to develop a paper-based, DCE questionnaire survey. Patients with knee osteoarthritis, who were at least 18 years old and who provided written informed consent, were recruited from the orthopedic department in a tertiary care hospital in Thailand via convenience sampling. The conditional logit model was used to determine patients' preferences and WTP. The Institutional Review Board at Chulalongkorn University approved this study before it started. A total of 232 patients were collected and analyzed in this study. Patients preferred treatments with a higher efficacy (pain relief and delayed disease progression), a lower probability of side effects (gastrointestinal, kidney, and cardiovascular side effects), and a lower cost. Regarding efficacy and side effects, the patients weighted the importance of a 1% change in cardiovascular side effects (- 0.08) more heavily than 1% changes in kidney (- 0.07) and gastrointestinal (- 0.02) side effects, delayed disease progression (0.02), and pain relief (0.01). Patients were willing to pay 29.56 Thai Baht (THB) and 41.84 THB per month for every 1% increase in pain relief and delayed disease progression, respectively. Conversely, patients were willing to pay 52.04 THB, 145.18 THB and 164.23 THB per month for every 1% decrease in gastrointestinal, kidney, and cardiovascular side effects, respectively. In conclusion, pain relief, delayed disease progression, gastrointestinal side effects, kidney side effects, cardiovascular side effects, and the cost of treatment were significant factors among patients undergoing knee osteoarthritis treatment. Additionally, patients had a higher WTP for delayed disease progression than pain relief and a higher WTP for a reduced probability of cardiovascular side effects than gastrointestinal and kidney side effects. These findings could be used to support treatment decisions for knee osteoarthritis patients in Thailand.
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Affiliation(s)
- Parnnaphat Luksameesate
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Aree Tanavalee
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Surachat Ngorsuraches
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Alabama, USA.
| | - Suthira Taychakhoonavudh
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.
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Stothers Rosenberg S, Ng X, Mansfield C, Poulos C, Peay H, Lee TH, Irony T, Ho M. Adaptation of the WOMAC for Use in a Patient Preference Study. Ther Innov Regul Sci 2023; 57:702-711. [PMID: 37061632 PMCID: PMC10105612 DOI: 10.1007/s43441-023-00510-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/07/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVES To adapt a patient-reported outcome (PRO) measure, the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), into efficacy attributes for a discrete choice experiment (DCE) survey designed to quantify the relative importance of endpoints commonly used in knee osteoarthritis (KOA) trials. METHODS The adaptation comprised four steps: (1) selecting domains of interest; (2) determining presentation and framing of selected attributes; (3) determining attribute levels; and (4) developing choice tasks. This process involved input from multiple stakeholders, including regulators, health preference researchers, and patients. Pretesting was conducted to evaluate if patients comprehended the adapted survey attributes and could make trade-offs among them. RESULTS The WOMAC pain and function domains were selected for adaption to two efficacy attributes. Two versions of the discrete choice experiment (DCE) instrument were created to compare efficacy using (1) total domain scores and (2) item scores for "walking on a flat surface." Both attributes were presented as improvement from baseline scores by levels of 0%, 30%, 50%, and 100%. Twenty-six participants were interviewed in a pretest of the instrument (average age 60 years; 58% female; 62% had KOA for ≥ 5 years). The participants found both versions of attributes meaningful and relevant for treatment decision-making. They demonstrated willingness and ability to tradeoff improvements in pain and function separately, though many perceived them as inter-related. CONCLUSIONS This study adds to the growing literature regarding adapting PRO measures for patient preference studies. Such adaptation is important for designing a preference study that can incorporate a clinical trial's outcomes with PRO endpoints.
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Affiliation(s)
- Sarah Stothers Rosenberg
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Xinyi Ng
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
| | | | | | - Holly Peay
- RTI International, Research Triangle Park, NC, USA
| | - Ting-Hsuan Lee
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Telba Irony
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Martin Ho
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
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Lila AM, Alekseeva LI, Baranov AA, Taskina EA, Kashevarova NG, Lapkina NA, Trofimov EA. Chondroitin sulfate and glucosamine combination in patients with knee and hip osteoarthritis: A long-term observational study in Russia. World J Orthop 2023; 14:443-457. [PMID: 37377986 PMCID: PMC10292059 DOI: 10.5312/wjo.v14.i6.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/19/2023] [Accepted: 05/12/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Oral treatment of glucosamine (GA) combined with chondroitin sulfate (CS) was reportedly effective for pain relief and function improvement in osteoarthritis patients with moderate to severe knee pain in clinical trials. While the effectiveness of GA and CS on both clinical and radiological findings has been demonstrated, only a few high-quality trials exist. Therefore, controversy regarding their effectiveness in real-world clinical practice remains.
AIM To investigate the impact of GA + CS on clinical outcomes of patients with knee and hip osteoarthritis in routine clinical practice.
METHODS A multicenter prospective observational cohort study included 1102 patients of both genders with knee or hip osteoarthritis (Kellgren & Lawrence grades I-III) in 51 clinical centers in the Russian Federation from November 20, 2017, to March 20, 2020, who had started to receive oral capsules of glucosamine hydrochloride 500 mg and CS 400 mg according to the approved patient information leaflet starting from 3 capsules daily for 3 wk, followed by a reduced dosage of 2 capsules daily before study inclusion (minimal recommended treatment duration is 3-6 mo). Changes in subscale scores [Pain, Symptoms, Function, and Quality of Life (QOL)] of the Knee Injury and Osteoarthritis Outcome Score (KOOS)/Hip Disability and Osteoarthritis Outcome Score (HOOS) questionnaires during the observational period (up to 54-64 wk with a total of 4 visits). Patients’ treatment satisfaction, data on the combined oral use of glucosamine hydrochloride and CS, concomitant use of non-steroidal anti-inflammatory drugs (NSAIDs), and adverse events (AEs) were also evaluated.
RESULTS A total of 1102 patients with knee and hip osteoarthritis were included in the study. The mean patient age was 60.4 years, most patients were women (87.8%), and their average body mass index was 29.49 kg/m2. All subscale scores (Pain, Symptoms, Function, and QOL) of the KOOS and HOOS demonstrated clinically and statistically significant improvements. In patients with knee osteoarthritis, the mean score increases from baseline to the end of Week 64 were 22.87, 20.78, 16.60, and 24.87 on Pain, Symptoms, Physical Function (KOOS-PS), and QOL subscales (P < 0.001 for all), respectively. In patients with hip osteoarthritis, the mean score increases were 22.81, 19.93, 18.77, and 22.71 on Pain, Symptoms, Physical Function (HOOS-PS), and QOL subscales (P < 0.001 for all), respectively. The number of patients using any NSAIDs decreased from 43.1% to 13.5% (P < 0.001) at the end of the observation period. Treatment-related AEs occurred in 2.8% of the patients and mainly included gastrointestinal disorders [25 AEs in 24 (2.2%) patients]. Most patients (78.1%) were satisfied with the treatment.
CONCLUSION Long-term oral GA + CS was associated with decreased pain, reduced concomitant NSAID therapy, improved joint function and QOL in patients with knee and hip osteoarthritis in routine clinical practice.
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Affiliation(s)
- Alexander M Lila
- Director, Research Institute of Rheumatology Named after VA Nasonova, Moscow 115522, Moscow, Russia
| | - Lyudmila I Alekseeva
- Bone and Joints Metabolic Diseases Laboratory, Research Institute of Rheumatology Named after VA Nasonova, Moscow 115522, Moscow, Russia
| | - Andrey A Baranov
- Department of Therapy, Clinical Laboratory Diagnostics and Medical Biochemistry, Yaroslavl State Medical University, Yaroslavl 150000, Yaroslavl, Russia
| | - Elena A Taskina
- Bone and Joints Metabolic Diseases Laboratory, Research Institute of Rheumatology Named after VA Nasonova, Moscow 115522, Moscow, Russia
| | - Natalya G Kashevarova
- Bone and Joints Metabolic Diseases Laboratory, Research Institute of Rheumatology Named after VA Nasonova, Moscow 115522, Moscow, Russia
| | - Natalia A Lapkina
- Department of Therapy, Clinical Laboratory Diagnostics and Medical Biochemistry, Yaroslavl State Medical University, Yaroslavl 150000, Yaroslavl, Russia
| | - Evgeny A Trofimov
- Department of Therapy and Rheumatology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg 191015, St. Petersburg, Russia
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Zhu M, Dong D, Lo HHM, Wong SYS, Mo PKH, Sit RWS. Patient preferences in the treatment of chronic musculoskeletal pain: a systematic review of discrete choice experiments. Pain 2023; 164:675-689. [PMID: 36149784 PMCID: PMC10026832 DOI: 10.1097/j.pain.0000000000002775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/14/2022] [Accepted: 08/22/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chronic musculoskeletal pain (CMP) is a preference-sensitive condition for which numerous treatment options are available, each with benefits and risks. Thus, patient preferences play a critical role in decision making. This study summarized evidence from discrete choice experiments (DCEs) to quantify patient preferences for CMP treatment and identified important treatment attributes. A systematic review of DCEs on patient preferences for CMP treatment was conducted. Studies were included if they used DCE to determine patient preferences for CMP. A previously described methodological assessment tool was used to assess the risk of bias. The treatment attributes were summarized and sorted according to the frequency of citation and relative weight. Subgroup analyses were conducted to explore the intervention-specific attributes. A total of 15 eligible studies with 4065 participants were included. We identified "capacity to realize daily life activities," "risk of adverse events," "effectiveness in pain reduction," and "out-of-pocket cost" as important attributes. Although "treatment frequency" and "onset of treatment efficacy" were less frequently mentioned, they were also important attributes. The attribute of "risk of adverse events" was especially important for drug treatment. The "out-of-pocket cost" and "treatment location and mode" were important attributes of exercise therapy. The attributes identified in this review will inform the design of future DCE studies, facilitate the translation of measurement-based care to value-based care, and provide the rationale to promote shared decision making and patient-centered care.
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Affiliation(s)
- Mengting Zhu
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Dong Dong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Hermione Hin-Man Lo
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Samuel Yeung-Shan Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Phoenix Kit-Han Mo
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Regina Wing-Shan Sit
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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11
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Al-Omari B, Farhat J, Shraim M. The Role of Web-Based Adaptive Choice-Based Conjoint Analysis Technology in Eliciting Patients' Preferences for Osteoarthritis Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3364. [PMID: 36834057 PMCID: PMC9959784 DOI: 10.3390/ijerph20043364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/02/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To assess the feasibility of using adaptive choice-based conjoint (ACBC) analysis to elicit patients' preferences for pharmacological treatment of osteoarthritis (OA), patients' satisfaction with completing the ACBC questionnaire, and factors associated with questionnaire completion time. METHODS Adult patients aged 18 years and older with a medical diagnosis of OA, experiencing joint pain in the past 12 months, and living in the Northeast of England participated in the study. The participants completed a web-based ACBC questionnaire about their preferences regarding pharmaceutical treatment for OA using a touchscreen laptop independently, and accordingly, the questionnaire completion time was measured. Moreover, the participants completed a pen-and-paper feedback form about their experience in completing the ACBC questionnaire. RESULTS Twenty participants aged 40 years and older, 65% females, 75% had knee OA, and suffering from OA for more than 5 years participated in the study. About 60% of participants reported completing a computerized questionnaire in the past. About 85% of participants believed that the ACBC task helped them in making decisions regarding their OA medications, and 95% agreed or strongly agreed that they would be happy to complete a similar ACBC questionnaire in the future. The average questionnaire completion time was 16 min (range 10-24 min). The main factors associated with longer questionnaire completion time were older age, never using a computer in the past, and no previous experience in completing a questionnaire. CONCLUSIONS The ACBC analysis is a feasible and efficient method to elicit patients' preferences for pharmacological treatment of OA, which could be used in clinical settings to facilitate shared decision-making and patient-centered care. The ACBC questionnaire completion consumes a significantly longer time for elderly participants, who never used a computer, and never completed any questionnaire previously. Therefore, the contribution of patients and public involvement (PPI) group in the development of the ACBC questionnaire could facilitate participants' understanding and satisfaction with the task. Future research including patients with different chronic conditions may provide more useful information about the efficiency of ACBC analysis in eliciting patients' preferences for osteoarthritis treatment.
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Affiliation(s)
- Basem Al-Omari
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates
- Faculty of Health and Life Sciences, The University of Northumbria, Benton, Newcastle upon Tyne NE7 7XA, UK
| | - Joviana Farhat
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates
| | - Mujahed Shraim
- Department of Public Health, College of Health Sciences, Qatar University, QU Health, Doha P.O. Box 2713, Qatar
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12
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Choudhary D, Thomas M, Pacheco-Barrios K, Zhang Y, Alonso-Coello P, Schünemann H, Hazlewood G. Methods to Summarize Discrete-Choice Experiments in a Systematic Review: A Scoping Review. THE PATIENT 2022; 15:629-639. [PMID: 35829927 DOI: 10.1007/s40271-022-00587-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Systematic reviews of discrete-choice experiments (DCEs) are being increasingly conducted. The objective of this scoping review was to identify and describe the methodologies that have been used to summarize results across DCEs. METHODS We searched the electronic databases MEDLINE and EMBASE from inception to March 18, 2021, to identify English-language systematic reviews of patient preferences that included at least two DCEs and extracted data on attribute importance. The methods used to summarize results across DCEs were classified into narrative, semi-quantitative, and quantitative (meta-analytic) approaches and compared. Approaches to characterize the extent of preference heterogeneity were also described. RESULTS From 7362 unique records, we identified 54 eligible reviews from 2010 to Mar 2021, across a broad range of health conditions. Most (83%) used a narrative approach to summarize findings of DCEs, often citing differences in studies as the reason for not formally pooling findings. Semi-quantitative approaches included summarizing the frequency of the most important attributes, the frequency of attribute statistical significance, or tabulated comparisons of attribute importance for each pair of attributes. One review conducted a meta-analysis using the maximum acceptable risk. While reviews often commented on the heterogeneity of patient preferences, few (6%) addressed this systematically across studies. CONCLUSION While not commonly used, several semi-quantitative and one quantitative approach for synthesizing results of DCEs were identified, which may be useful for generating summary estimates across DCEs when appropriate. Further work is needed to assess the validity and usefulness of these approaches.
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Affiliation(s)
- Daksh Choudhary
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Megan Thomas
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA, USA
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Sintesis de Evidencias en Salud, Lima, Peru
| | - Yuan Zhang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Pablo Alonso-Coello
- Instituto de Investigación Biomédica (IIB Sant Pau), Centro Cochrane Iberoamericano, Barcelona, Spain
| | - Holger Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Glen Hazlewood
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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Issa R, Al-Homedi Z, Syed DH, Aziz W, Al-Omari B. Surpass Evolve Flow Diverter for the Treatment of Intracranial Aneurysm: A Systematic Review. Brain Sci 2022; 12:810. [PMID: 35741695 PMCID: PMC9221455 DOI: 10.3390/brainsci12060810] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE This systematic review aims to summarize the evidence investigating the effectiveness and safety of the Surpass Evolve-Flow Diverter (SE-FD) to treat brain aneurysms. METHOD We searched MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane Library from January 2019 to 29 March 2022. Terms related to the "intracranial aneurysm" and "surpass evolve flow diverter" concepts were used to search the databases; Medical Subject Headings (MeSH) and reference hand search were also utilized. RESULTS The searches primarily identified 1586 documents. A total of five studies (four case series and one cohort) were included in this review. In the included studies, 192 (74 male and 118 females) patients with 198 aneurysms were involved. In total, 153 SE-FDs were used to treat 145 aneurysms. Complete occlusion was achieved in 69/145 (48%) cases and near-complete occlusion in 24/145 (17%) cases from aneurysms treated with SE-FD. Reported postoperative complications included stent thrombosis (n = 4 patients), hemorrhage (n = 5 patients), ischemia (n = 9 patients), and neurological complications (n = 12 patients). In total, four deaths were reported with only one related to the SE-FD procedure. CONCLUSION The results of this review are based on observational data, due to the absence of clinical trials. The findings of the included studies suggest that the effectiveness of the SE-FD procedure is lower than previous FDs but the safety is similar. The included studies also suggested that SE-FD has navigability and resistance to twisting, which makes the procedure an easier method to treat aneurysms that are proximal and distal to the circle of Willis deployment. This review highlights the urgency to conduct clinical trials to confirm these suggestions.
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Affiliation(s)
- Rania Issa
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates; (R.I.); (Z.A.-H.); (D.H.S.)
| | - Zahrah Al-Homedi
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates; (R.I.); (Z.A.-H.); (D.H.S.)
| | - Dawood Hasan Syed
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates; (R.I.); (Z.A.-H.); (D.H.S.)
| | - Waseem Aziz
- Department of Neurosurgery, Sheikh Shakhbout Medical City, Abu Dhabi P.O. Box 11001, United Arab Emirates;
- Department of Neurosurgery, Alexandria University School of Medicine, Alexandria 21526, Egypt
| | - Basem Al-Omari
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates; (R.I.); (Z.A.-H.); (D.H.S.)
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates
- KU Research and Data Intelligence Support Center (RDISC) AW 8474000331, Khalifa University of Science and Technology, Abu Dhabi P.O. Box 127788, United Arab Emirates
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Al-Omari B, Farhat J, Ershaid M. Conjoint Analysis: A Research Method to Study Patients' Preferences and Personalize Care. J Pers Med 2022; 12:274. [PMID: 35207762 PMCID: PMC8879380 DOI: 10.3390/jpm12020274] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/29/2022] [Accepted: 02/10/2022] [Indexed: 02/01/2023] Open
Abstract
This article aims to describe the conjoint analysis (CA) method and its application in healthcare settings, and to provide researchers with a brief guide to conduct a conjoint study. CA is a method for eliciting patients' preferences that offers choices similar to those in the real world and allows researchers to quantify these preferences. To identify literature related to conjoint analysis, a comprehensive search of PubMed (MEDLINE), EMBASE, Web of Science, and Google Scholar was conducted without language or date restrictions. To identify the trend of publications and citations in conjoint analysis, an online search of all databases indexed in the Web of Science Core Collection was conducted on the 8th of December 2021 without time restriction. Searching key terms covered a wide range of synonyms related to conjoint analysis. The search field was limited to the title, and no language or date limitations were applied. The number of published documents related to CA was nearly 900 during the year 2021 and the total number of citations for CA documents was approximately 20,000 citations, which certainly shows that the popularity of CA is increasing, especially in the healthcare sciences services discipline, which is in the top five fields publishing CA documents. However, there are some limitations regarding the appropriate sample size, quality assessment tool, and external validity of CA.
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Affiliation(s)
- Basem Al-Omari
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates; (J.F.); (M.E.)
- KU Research and Data Intelligence Support Center (RDISC) AW 8474000331, Khalifa University of Science and Technology, Abu Dhabi P.O. Box 127788, United Arab Emirates
| | - Joviana Farhat
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates; (J.F.); (M.E.)
| | - Mai Ershaid
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates; (J.F.); (M.E.)
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Stem Cells in Autologous Microfragmented Adipose Tissue: Current Perspectives in Osteoarthritis Disease. Int J Mol Sci 2021; 22:ijms221910197. [PMID: 34638538 PMCID: PMC8508703 DOI: 10.3390/ijms221910197] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 12/13/2022] Open
Abstract
Osteoarthritis (OA) is a chronic debilitating disorder causing pain and gradual degeneration of weight-bearing joints with detrimental effects on cartilage volume as well as cartilage damage, generating inflammation in the joint structure. The etiology of OA is multifactorial. Currently, therapies are mainly addressing the physical and occupational aspects of osteoarthritis using pharmacologic pain treatment and/or surgery to manage the symptomatology of the disease with no specific regard to disease progression or prevention. Herein, we highlight alternative therapeutics for OA specifically considering innovative and encouraging translational methods with the use of adipose mesenchymal stem cells.
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