Evidence map›Paper›PMID 29654012›Full record

ArticleBMJ open2018

Patient preferences for nutritional supplementation to improve fracture healing: a discrete choice experiment.

Elizabeth Nichols, Nathan N O'Hara, Yasmin Degani, Sheila A Sprague, Jonathan D Adachi, Mohit Bhandari, Michael F Holick, Daniel W Connelly, Gerard P Slobogean

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In one paragraph

Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Elizabeth NicholsDepartment of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD.
Nathan N O'HaraDepartment of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD.
Yasmin DeganiDepartment of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD.
Sheila A SpragueDepartment of Surgery, McMaster University, Hamilton, Ontario, Canada.
Jonathan D AdachiDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Mohit BhandariDepartment of Surgery, McMaster University, Hamilton, Ontario, Canada.
Michael F HolickDepartment of Medicine Endocrinology, Diabetes & Nutrition, Boston University, Boston, Massachusetts, USA.
Daniel W ConnellyDepartment of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD.
Gerard P SlobogeanDepartment of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD.ORCID 0000-0002-9111-9239

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveVitamin D is often prescribed as an adjuvant therapy to aid fracture healing due to its biological role in bone health. However, the optimal frequency, dosage and duration of vitamin D supplementation for non-osteoporotic fracture healing has not been established. The objective of this study was to determine patient preferences for fracture healing relative to hypothetical vitamin D supplementation dosing options.

designDiscrete choice experiment.

settingLevel 1 trauma centre in Baltimore, Maryland, USA.

participants199 adult (18-60 years) patients with a fracture. PRIMARY OUTCOME MEASURES: Parameter estimates of utility for fracture healing relative to dosing regimens were analysed using hierarchical Bayesian modelling.

resultsA reduced risk of reoperation (34.3%) and reduced healing time (24.4%) were the attributes of greatest relative importance. The highest mean utility estimates were for a one-time supplementation dose (ß=0.71, 95% CI 0.41 to 1.00) followed by a reduced risk of reoperation (ß=0.41 per absolute % reduction, 95% CI 0.0.36 to 0.46). Supplementation for 24 weeks in duration (ß=-0.83, 95% CI -1.00 to -0.67) and a daily supplement (ß=-0.29, 95% CI -0.47 to -0.11) had the lowest mean utilities. The 'no supplement' option had a large negative value suggesting supplementation was generally desirable in this sample population. Among other possible clinical scenarios, patients expected a 2% reduction in the absolute risk of reoperation or a 3.1-week reduction in healing time from the baseline to accept a treatment regimen requiring two separate doses of supplementation, two blood tests and a cost of $20 within 3 months of injury.

conclusionsPatients with orthopaedic trauma demonstrated strong willingness to take a vitamin D supplement that would decrease risk of reoperation and reduce healing time. Furthermore, these findings specify the required decrease in reoperation risk and reduction in healing time patients would expect to adhere to possible vitamin D dosing regimens.

Indexed as

Dietary SupplementsPatient PreferenceAdolescentAdultBayes TheoremChoice BehaviorDose-Response Relationship, DrugFemaleFracture HealingFractures, BoneHumansMaleMiddle AgedRetrospective StudiesVitamin DYoung AdultVitamin Ddiscrete choice experimentfracturepreferencesvitamin D

Identifiers

PMID29654012
PMCPMC5898332

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LicenceCC BY-NC
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.