Supplemental Digital Content 1. Time Trade-off Survey Injury Scenarios and Health State
Descriptions
Injury Scenario #1 (Display prior to scenarios A-I)
Imagine you are in an accident involving your writing
hand. Your index finger and middle fingers are completely
cut off at the base (first knuckle) as shown in the picture.
You have two options for treatment. For the first option the
surgeon does NOT reattach your fingers and stitches the
wounds closed. For the second option the surgeon
reattaches both fingers.
We will describe several scenarios related to both
treatments.
1
Health State A
Two finger (IF/MF) – Revision Amputation: No early complication
Imagine you have the treatment where your fingers are NOT reattached. You
will experience the following during treatment for about 3 months:
Treatment:


Your treatment takes place in the emergency department and you are sent home.
You will work with a hand therapist weekly and do hand exercises on your own several
times per day.
Physical Activity:


You are unable to use your injured hand for usual activities such as dressing yourself,
driving, household cleaning, or lifting heavy objects.
You are unable to work during treatment.
Symptoms:


You will feel pain at the injury site, similar to the level of pain with a severe headache
or severe arthritis.
You will feel some numbness and discomfort when the injury site is touched or exposed
to cold.
2
Health State B
Two finger (IF/MF) – Revision Amputation: No late complication
Imagine that 1 year has passed since you had the treatment where your fingers
were NOT reattached, and you have recovered from treatment. You will
experience the following for the rest of your life:
Physical Activity:


You are able to work, but you may need to change jobs if your job requires heavy use of
your hands.
You may have some permanent difficulty with use of your hand, such as handling small
objects, opening bottles, or doing heavy lifting because you have two missing fingers.
Symptoms:

You will still feel some numbness and discomfort when the injury site is touched or
exposed to cold. This will slowly improve over the next year but will not go away
completely.
3
Health State C
Two finger (IF/MF) – Revision Amputation: Painful neuroma
Imagine you had the treatment that does NOT reattach your fingers, but 3
months have passed since the injury and now you also have severe shooting pain
when the injury site is touched. You need another surgery to make the pain go
away. You will experience the following during treatment for about 2 more
months:
Treatment:


You will need an outpatient surgery to treat the nerve causing the pain.
You will need to work with a hand therapist at least weekly.
Physical Activity:


You will have difficulty using your injured hand for usual activities such as dressing
yourself or doing household cleaning.
You are unable to work during treatment.
Symptoms:

After surgery the severe shooting pain will gradually go away.
4
Health State D
Two finger (IF/MF) – Replantation: No early complication
Imagine you have the treatment where your fingers are reattached. You will
experience the following during treatment for about 4 months:
Treatment:


Your treatment requires inpatient surgery and you have to stay in the hospital about 3
– 7 days after surgery.
You will work with a hand therapist several times per week.
Physical Activity:


You are unable to use your injured hand for usual activities such as dressing yourself,
driving, household cleaning, or lifting heavy objects.
You are unable to work during treatment.
Symptoms:


You will feel pain at the injury site, similar to the level of pain with a severe headache
or severe arthritis, until healing is complete.
You will feel some numbness and discomfort when the injury site is touched or exposed
to cold.
5
Health State E
Two finger (IF/MF) – Replantation: Vascular complication
Imagine you have the treatment where your fingers were reattached, but while
still in the hospital you have a complication in the blood vessel of one of the
reattached fingers. You need another surgery to try to save the finger. You will
experience the following during treatment while in the hospital:
Treatment:

You have a second inpatient surgery and have to stay in the hospital for about 2 more
days, about 5-9 days in total.
Physical Activity:


You are unable to use your injured hand for usual activities such as dressing yourself,
driving, household cleaning, or lifting heavy objects.
You are unable to work during treatment.
Symptoms:

You will feel pain at the injury site, similar to the level of pain with a severe headache
or severe arthritis, until healing is complete.
6
Health State F
Two finger (IF/MF) – Replantation: No late complication
Imagine that 1 year has passed since you had the treatment where your fingers
were reattached, and you have recovered from treatment. You will experience
the following for the rest of your life:
Physical Activity:


You are able to work, but you may need to change jobs if your job requires heavy use of
your hands.
You may have some permanent difficulty with use of your hand, such as handling small
objects, making a fist, opening bottles, or doing heavy lifting because the injured fingers
are stiff and will not move as easily as before.
Symptoms:

You will still feel some numbness and discomfort when the injury site is touched or
exposed to cold. This will slowly improve over the next year but will not go away
completely.
7
Health State G
Two finger (IF/MF) – Replantation: Bone complication
Imagine you had the treatment where your fingers were reattached, but 3 months
have passed since the injury and now your doctor tells you that the bone is not
healing correctly. You need another surgery to treat the problem. You will
experience the following during treatment for about 4 more months:
Treatment:


You will need an outpatient surgery to correct the bone problem.
You will need to work with a hand therapist several times per week and do hand
exercises on your own.
Physical Activity:


You are unable to use your injured hand for usual activities such as dressing yourself,
driving, household cleaning, or lifting heavy objects.
You are unable to work during treatment.
Symptoms:

You will feel added pain in one finger due to the new surgery, similar to the level of
pain with a severe headache or severe arthritis, until healing is complete.
8
Health State H
Two finger (IF/MF) – Replantation: Tendon complication
Imagine you had the treatment where your fingers were reattached, but 4 months
have passed since the injury. Now you realize you are not improving with therapy
and your fingers are not moving. There is a problem with your tendon and you
need more surgeries to treat the problem. You will experience the following
during treatment for about 6 more months:
Treatment:


You will need two or more outpatient surgeries to correct the tendon problem.
You will need to work with a hand therapist several times per week and do hand
exercises on your own.
Physical Activity:


You are unable to use your injured hand for usual activities such as dressing yourself,
driving, household cleaning, or lifting heavy objects until the tendon heals.
You are unable to work during treatment.
Symptoms:

You will feel added pain in your fingers due to the new surgery, similar to the level of
pain with a moderate headache or moderate arthritis, until healing is complete.
9
Health State I
Two finger (IF/MF) – Chronic pain
Imagine that 1 year has passed since you injured your fingers, and you have
recovered from treatment. Now you also have mild to moderate discomfort that
did not go away after treatment. There is no surgery that can fix the pain. You
will experience the following for the rest of your life:
Treatment:

You may require non-prescription pain medications (such as Tylenol or Motrin) or
may need to see a pain doctor for the continued discomfort.
Physical Activity:


You may have some permanent difficulty with use of your hand, such as using a
computer or doing heavy lifting due to the discomfort.
You may need to change jobs due to the discomfort.
Symptoms:

You will have some discomfort in your fingers, similar to the level of pain with a mild
headache or mild arthritis, for the rest of your life.
10
Injury Scenario #2 (Display prior to Health States J-K)
Now imagine you are in a similar accident involving your
writing hand. This time just the fingertips were
completely cut off as shown in the picture.
You have the same two options for treatment.
11
Health State J
Two finger distal amputation (IF/MF) – Revision Amputation: No late complication
Imagine that 1 year has passed since you had the treatment where your fingertips
were NOT reattached, and you have recovered from treatment. You will
experience the following for the rest of your life:
Physical Activity:


You are able to work, but you may need to change jobs if your job requires heavy or
fine use of both hands.
You may have some permanent difficulty with use of your hand, such as handling small
objects or buttoning your shirt, because you have two shortened fingers.
Symptoms:

You will still feel some numbness and discomfort when the injury site is touched or
exposed to cold. This will slowly improve over the next year but will not go away
completely.
12
Health State K
Two finger distal amputation (IF/MF) – Replantation: No late complication
Imagine that 1 year has passed since you had the treatment where your fingertips
were reattached, and you have recovered from treatment. You will experience
the following for the rest of your life:
Physical Activity:


You are able to work, but you may need to change jobs if your job requires heavy or
fine use of both hands.
You may have some permanent difficulty with use of your hand, such as tightly
gripping objects or opening bottles because the injured fingertips are stiff and will not
move as easily as before.
Symptoms:

You will still feel some numbness and discomfort when the injury site is touched or
exposed to cold. This will slowly improve over the next year but will not go away
completely.
13
Injury Scenario #3 (Display prior to Health States L-M)
Imagine you are in an accident involving your writing hand.
Your thumb is completely cut off at the base (first knuckle)
as shown in the picture.
You have two options for treatment. For the first option the
surgeon does NOT reattach your thumb and stitches the
wounds closed. For the second option the surgeon reattaches
the thumb.
We will describe scenarios related to both treatments.
14
Health State L
Thumb – Revision Amputation: No late complication
Imagine that 1 year has passed since you had the treatment where your thumb was
NOT reattached, and you have recovered from treatment. You will experience
the following for the rest of your life:
Physical Activity:


You are able to work, but you will likely need to change jobs if your current job
requires use of both hands.
You will have permanent difficulty with use of your hand, such as pinching and gripping
objects, opening bottles, or doing heavy lifting because you are missing a thumb.
Symptoms:
 You will still feel some numbness and discomfort when the injury site is touched or
exposed to cold. This will slowly improve over the next year but will not go away
completely.
Treatment:

You may decide to have other procedures to improve your hand function because you
are missing a thumb.
15
Health State M
Thumb – Replantation: No late complication
Imagine that 1 year has passed since you had the treatment where your thumb was
reattached, and you have recovered from treatment. You will experience the
following for the rest of your life:
Physical Activity:


You are able to work, but you may need to change jobs if your job requires heavy use of
both hands.
You may have some permanent difficulty with use of your hand, such as tightly
gripping objects, making a fist, or opening bottles, because the injured thumb is stiff
and will not move as easily as before.
Symptoms:

You will still feel some numbness and discomfort when the injury site is touched or
exposed to cold. This will slowly improve over the next year but will not go away
completely.
16
Injury Scenario #4 (Display prior to Health States N-O)
Now imagine you are in a similar accident involving your
writing hand. This time just the fingertip of the thumb
was completely cut off as shown in the picture.
You have the same two options for treatment.
17
Health State N
Thumb distal amputation – Revision Amp: No late complication
Imagine that 1 year has passed since you had the treatment where the tip of your
thumb was NOT reattached, and you have recovered from treatment. You are
missing the tip of your thumb. You will experience the following for the rest of
your life:
Physical Activity:


You are able to work, but you may need to change jobs if your current job requires
heavy and fine use of both hands.
You may have some permanent difficulty with use of your hand, such as handling small
objects or buttoning your shirt, because you have a shortened thumb.
Symptoms:
 You will still feel some numbness and discomfort when the injury site is touched or
exposed to cold. This will slowly improve over the next year but will not go away
completely.
18
Health State O
Thumb distal amputation – Replantation: No late complication
Imagine that 1 year has passed since you had the treatment where the tip of your
thumb was reattached, and you have recovered from treatment. Only the tip of
your thumb is affected. You will experience the following for the rest of your life:
Physical Activity:


You are able to work, but you may need to change jobs if your current job requires
heavy and fine use of both hands.
You may have some permanent difficulty with use of your hand, such as handling small
objects or buttoning your shirt, because the injured thumb is stiff and will not move as
easily as before.
Symptoms:

You will still feel some numbness and discomfort when the injury site is touched or
exposed to cold. This will slowly improve over the next year but will not go away
completely.
19
Injury Scenario #5 (Display prior to Health States P-Q)
Now imagine you are in a similar accident involving your
writing hand. This time your index finger is completely
cut off at the base (first knuckle) as shown in the picture.
You have the same two options for treatment.
20
Health State P
Single finger (IF) – Revision Amputation: No late complication
Imagine that 1 year has passed since you had the treatment where your index
finger was NOT reattached, and you have recovered from treatment. Your index
finger is missing. You will experience the following for the rest of your life:
Physical Activity:


You are able to work, but you may need to change jobs if your current job requires
heavy and fine use of both hands.
You may have a small amount of difficulty with use of your hand, such as handling
small objects or buttoning your shirt, because you have a missing index finger.
Symptoms:

You will still feel some numbness and discomfort when the injury site is touched or
exposed to cold. This will slowly improve over the next year but will not go away
completely.
21
Health State Q
Single finger (IF) – Replantation: No late complication
Imagine that 1 year has passed since you had the treatment where the index finger
was reattached. Only the index finger is affected. You will experience the
following for the rest of your life:
Physical Activity:


You are able to work, but you may need to change jobs if your job requires heavy and
fine use of your hands.
You may have some permanent difficulty with use of your hand, such as handling small
objects, buttoning your shirt, making a fist, or opening bottles, because the injured
finger is stiff and will not move as easily as before.
Symptoms:

You will still feel some numbness and discomfort when the injury site is touched or
exposed to cold. This will slowly improve over the next year but will not go away
completely.
22
Injury Scenario #6 (Display prior to Health States R-S)
Now imagine you are in a similar accident involving your
writing hand. This time your index, middle, and ring fingers
are all completely cut off at the base (first knuckle) as shown
in the picture.
You have the same two options for treatment.
23
Health State R
Three finger (IF/MF/RF) – Revision Amp: No late complication
Imagine that 1 year has passed since you had the treatment where your fingers
were NOT reattached. You are missing three fingers. You will experience the
following for the rest of your life:
Physical Activity:


You are able to work, but you will likely need to change jobs if your job requires heavy
and fine use of both hands.
You will have some permanent difficulty with use of your hand, such as pinching and
gripping objects, making a fist, opening bottles, or doing heavy lifting, because you have
three missing fingers.
Symptoms:

You will still feel some numbness and discomfort when the injury site is touched or
exposed to cold. This will slowly improve over the next year but will not go away
completely.
24
Health State S
Three finger (IF/MF/RF) – Replantation: No late complication
Imagine that 1 year has passed since you had the treatment where your fingers
were reattached. Three fingers are affected. You will experience the following
for the rest of your life:
Physical Activity:


You are able to work, but you may need to change jobs if your job requires heavy use of
both hands.
You may have some permanent difficulty with use of your hand, such as handling small
objects, making a fist, opening bottles, or doing heavy lifting because the injured fingers
are stiff and will not move as easily as before.
Symptoms:

You will still feel some numbness and discomfort when the injury site is touched or
exposed to cold. This will slowly improve over the next year but will not go away
completely.
25
Injury Scenario #7 (Display prior to Health States T-U)
Now imagine you are in a similar accident involving your
writing hand. This time your index, middle, ring, and
small fingers are all completely cut off at the base (first
knuckle) as shown in the picture.
You have the same two options for treatment.
26
Health State T
Four finger (IF/MF/RF/SF) – Revision Amp: No late complication
Imagine that 1 year has passed since you had the treatment where your fingers
were NOT reattached. You are missing four fingers. You will experience the
following for the rest of your life:
Physical Activity:


You are able to work, but you will likely need to change jobs if your job requires heavy
and fine use of both hands.
You will have some permanent difficulty with use of your hand, such as handling small
objects, making a fist, opening bottles, or doing heavy lifting, because you have four
missing fingers.
Symptoms:

You will still feel some numbness and discomfort when the injury site is touched or
exposed to cold. This will slowly improve over the next year but will not go away
completely.
Treatment:

You may decide to have other procedures to improve your hand function because you
are missing four fingers.
27
Health State U
Four finger (IF/MF/RF/SF) – Replantation: No late complication
Imagine that 1 year has passed since you had the treatment where your fingers
were reattached. Four fingers are affected. You will experience the following for
the rest of your life:
Physical Activity:


You are able to work, but you may need to change jobs if your job requires heavy use of
both hands.
You will have some permanent difficulty with use of your hand, such as tightly gripping
objects, making a fist, opening bottles, or doing heavy lifting because the injured fingers
are stiff and will not move as easily as before.
Symptoms:

You will still feel some numbness and discomfort when the injury site is touched or
exposed to cold. This will slowly improve over the next year but will not go away
completely.
28