Patient Preferences for Next Generation Neural Prostheses to Restore Bladder Function

STUDY DESIGN: A survey administered to 66 individuals with SCI implementing a Choice Based Conjoint (CBC) analysis. Six attributes with three levels each were defined and used to generate choice sets with treatment scenarios. Patients were asked to choose the scenario that they preferred most. OBJECTIVE: To determine utility weights for treatment characteristics as well as the overall preference for three types of Neural Prostheses (NP), i.e. Brindley, Rhizotomy free Brindley and pudendal nerve stimulation. Previous studies have revealed the importance of restoration of bladder function, but no studies have been performed to determine importance of NP features. SETTING: Two academic affiliated medical systems' SCI outpatient and inpatient rehabilitation programs, Cleveland Ohio. METHODS: Choice based conjoint analysis followed by multinomial logit modeling. Individual part-worth utilities were estimated using Hierarchical Bayes. RESULTS: Side effects had the greatest significant impact on subject choices, followed by the effectiveness on continence and voiding. NPs with rhizotomy-free sacral root stimulation were preferred (45% first choice) over pudendal afferent nerve stimulation (39% second choice) and sacral root stimulation with rhizotomy (53% third choice). Almost twenty percent did not want to have a NP at all times. CONCLUSION: CBC has shown to be a valuable tool to support design choices. The data showed that persons would prefer a bladder NP with minimally invasive electrodes, that would give them complete bladder function, with no side effects and that can be operated by pushing a button and they do not have to recharge themselves.