Related Experiment Video
Updated: Jun 15, 2026
Mobile Game-based Virtual Reality Program for Upper Extremity Stroke Rehabilitation
Published on: March 8, 2018
Patients' preferences for occupational therapy after upper extremity fractures: a discrete choice experiment
Joshua Kyle Napora1, Haley Demyanovich2, Alexandra Mulliken2
1Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA jknapora@gmail.com.
Objective:
Occupational therapy is often prescribed after the acute treatment of upper extremity fractures. However, high out-of-pocket expenses and logistical constraints can reduce access to formal therapy services. We aimed to quantify preferences of patients with upper extremity fracture for attending occupational therapy, when considering possible differences in clinical outcomes.
Design:
Discrete choice experiment.
Setting:
Level 1 trauma centre in Baltimore, Maryland, USA.
Participants:
134 adult patients with upper extremity fractures.
Primary Outcome Measures:
The scenarios were described with five attributes: cost, duration of therapy session, location of therapy, final range of motion and pain. We report the relative importance of each attribute as a proportion of total importance, and the willingness to pay for benefits of the therapy services.
Results:
Of the 134 study participants, the mean age was 47 years and 53% were men. Cost (32%) and range of motion (29%) were the attributes of greatest relative importance. Pain (17%), duration of therapy (13%) and location of therapy (8%) were of lesser importance. Patients were willing to pay $85 more per therapy session for a 40% improvement in their range of motion. Patients were willing to pay $43 more per therapy session to improve from severe pain to mild pain. Patients were indifferent to whether the therapy treatment was home-based or in a clinical environment.
Conclusions:
When deciding on an upper extremity fracture therapy programme, out-of-pocket costs are a paramount consideration of patients. Improvements in range of motion are of greater importance than residual pain, the duration of therapy sessions and the location of service provision. Patients with upper extremity fracture should be prescribed occupational therapy services that align with these patients' preferences.
