Do patient preferences matter when clinical outcomes are the same?

Abstract

A Commentary on

Sinha A, Kumar S, Sargaiyan V, Kottapalli RH, Sharma D, Goyal A.

Comparative effectiveness of modified manual and powered toothbrushing interventions in individuals with disabilities: a randomized controlled trial assessing gingival health. J Pharm Bioallied Sci 2024; https://doi.org/10.4103/jpbs.jpbs_1171_24.

Data sources

This commentary draws on data from a randomized controlled trial by Sinha et al. (2024), which compared the clinical effectiveness of manual and powered toothbrushes among individuals with disabilities. Supplementary insights were integrated from behavioral, psychological, and health systems literature to contextualize the findings.

Study selection

The primary study was selected for its focus on a vulnerable population and its moderate GRADE rating, which indicates methodological robustness despite limited generalizability. Supporting studies were chosen for their relevance to patient-centered care frameworks and oral health behaviors.

Data extraction and synthesis

Clinical outcomes were extracted from Sinha et al. (2024), while behavioral and patient experience themes were synthesized from a range of models including Self-Determination Theory, the Health Belief Model, and Shared Decision-Making frameworks. Preference-related data were qualitatively integrated to highlight divergence from clinical parity.

Results

The referenced trial showed no significant difference in gingival health outcomes between manual and powered brushing. However, a notable preference emerged for powered toothbrushes among participants. This preference appears driven by perceived ease of use, sensory comfort, and enhanced autonomy. Literature indicates that honoring such preferences enhances adherence, satisfaction, and long-term oral health outcomes, especially in individuals with disabilities.

Conclusions

Clinical equivalence between interventions does not imply experiential equivalence. For individuals with disabilities, patient preferences are not secondary, they are central to sustainable, person-centered care. Future oral health promotion strategies should integrate preference-sensitive models to support autonomy, behavioral engagement, and equity in healthcare delivery.