Preference Trials: An Underexplored Design in Musculoskeletal Research

BACKGROUND: Incorporating patients’ preferences into randomized controlled trials (RCTs) enhances the relevance and applicability of research findings to clinical practice. Person- and patient-centered care are fundamental principles in modern musculoskeletal pain management, requiring consideration of treatment preferences during research endeavors to guide clinical practice. CLINICAL QUESTION: How can RCT designs account for patients’ preferences in musculoskeletal pain management research, and what are potential benefits of doing so? KEY RESULTS: Despite the importance of patient preferences in musculoskeletal pain management, few RCTs adequately integrate these preferences into their designs. This article discusses several methodological strategies for including patient preferences in RCTs. Proposed designs include modifications to conventional trials, comprehensive cohort designs, partially randomized preference designs, and 2-stage randomized preference designs. Each design is assessed for its ability to address real-world clinical questions, with strengths and limitations highlighted. CLINICAL APPLICATION: Trialists must carefully consider whether adapting their study design to include patient preferences is necessary for answering their research questions and improving outcomes for patients with musculoskeletal pain. JOSPT Methods 2025;1(2):44-55. Epub 4 March 2025. doi:10.2519/josptmethods.2025.0129