'What would sir like for his back pain this morning – some acupunture? – or perhaps a little manipulation?'
Another fascinating (and equally complex) study with accompanying editorial, this stime from the
BMJ, examined the effect of patient preferences for treatments for musculoskeletal disorders in randomised controlled trials. High-quality studies of treatments for musculoskeletal disorders tend to demonstrate rather modest benefits and cost-effectiveness over controls. This systematic review with meta-analysis looked at studies that had noted patient preferences for treatments. Without going into detail here, the study found that patients randomised to a treatment for which they expressed a preference achieved a significantly greater effect size than those who expressed no preference for that treatment. There was no apparent negative effect in patients randomised to a treatment they did not prefer. The implications of these findings are that overall a treatment might be shown to have modest benefits and cost-effectiveness, but in patients who express a preference for, and receive, their desired treatment, benefits and cost-effectiveness might be significant. 1,2
'Then the needles it is sir'