Shared decision-making in physical therapy: a cross-sectional observational study

The Practice of Shared Decision-Making Among Physiotherapists and Patients with Musculoskeletal Conditions

Purpose

Shared decision-making (SDM) may be interpreted as a set of core values rather than as a consensus definition. This study aimed to explore how SDM between patients and physiotherapists may lead to patient satisfaction.

Patients and Methods

A cross-sectional study was conducted to examine the relationship between SDM and patient satisfaction. The study targeted physiotherapists and patients with musculoskeletal pain or disorders. A structured questionnaire (the nine-item Shared Decision-Making Questionnaire) was developed to show the extent to which patients felt involved in the process by scoring nine items from 0 to 5 on a six-point scale. t-tests were performed to estimate differences in SDM perceptions between patients and physiotherapists, and regression analyses were performed to estimate the best predictors of SDM.

Results

The questionnaire was completed by a total of 106 patients and nine physiotherapists. The demographic information of the samples was presented with frequency analysis. This study's findings demonstrate no variations in the final SDM perceptions between patients and physiotherapists, but when SDM was contrasted step-by-step (as items), many variances were discovered. These distinctions reinforce the notion that regardless of the end outcome, the process of reaching a consensus has a distinct profile depending on the type of medical care. Therapists emphasize the first steps, possibly because there is sufficient evidence to make a therapeutic decision. However, patients highlight the final steps, perhaps because the moment for a decision based on the consultation's nature is approaching.

Conclusion

This study demonstrates that SDM is a complex process that must be examined in multiple stages. However, in physiotherapy contexts, this process exhibits extremely different patterns, reflecting a significantly different perspective of the decision-making process.

Patient involvement in medical decisions: a survey of shared decision making during physical therapy consultations

INTRODUCTION

Shared decision making (SDM) is widely affirmed as an ethical principle in healthcare; underpinned by both evidence of its positive outcomes among patients and strong inducements for its adoption by health professionals. This study investigated patients' involvement in SDM, determined its association with their personal characteristics and identified factors influencing their participation.

METHOD

A cross-sectional survey was executed among 148 consenting patients, who were recruited using convenience sampling technique and invited to complete self-report questionnaires on SDM. Data were analyzed via descriptive and inferential statistics.

RESULTS

Only 14 patients (9.5%) were involved in SDM whilst most patients (88.5%) had passive roles during consultation. SDM involvement had significant associations with age (p = .006) and educational status (p = .021). Most patients (67.6%) identified 'Doubt towards SDM,' as a factor that could hinder this collaborative process. Similarly, majority of the patients acknowledged the relevance of the influential factors: 'Physiotherapist's support' (83.7%) and 'Adequate health Information' (75%), toward promoting involvement in SDM.

CONCLUSION

Patient involvement in SDM was low in this study. Older and less/uneducated patients exhibited an increased tendency of noninvolvement. Key influential factors that either facilitate or hinder patients' involvement in SDM were revealed. There is a need to curtail drawbacks to SDM and promote its execution in physical therapy as well as general clinical practice.

Person-centered care for musculoskeletal pain: Putting principles into practice

Person-centered care specifically focuses on the whole person and is an important component of contemporary care for people with musculoskeletal pain conditions. Evidence suggests however, that some clinicians experience difficulties with integrating person-centered care principles into their clinical practice. Therefore, the purpose of this masterclass is to provide a framework that enables clinicians to incorporate person-centered principles in their management of people with musculoskeletal pain conditions. To support clinicians in overcoming some of the reported obstacles, we provide practical recommendations aimed at putting principles of person-centered care into practice. The framework supporting clinicians' delivery of person-centered care in practice consists of three key-principles: A) a biopsychosocial understanding of the person's experience; B) person-focused communication; and C) supported self-management. The framework includes three phases: 1) identification and goal setting, 2) coaching to self-management, and 3) evaluation. Building a therapeutic relationship underpins these phases and is an overarching element that weaves through the key-principles and phases of the framework. We use a clinical case to illustrate the practical implementation of these recommendations.

People's Experience of Shared Decision Making in Musculoskeletal Physiotherapy: A Systematic Review and Thematic Synthesis

(1) Shared decision making (SDM) has been advocated as a way of improving prudency in healthcare and has been linked to self-efficacy and empowerment of service users. The evaluation of its use in musculoskeletal (MSK) physiotherapy has been vague, but articles suggest that trust and communication are integral. (2) ENTREQ guidelines informed this systematic review and thematic synthesis. PRISMA recommendations steered a systematic literature search of AHMED, CINAHL, MEDLNE, EMBASE and Cochrane databases from inception to September 2021. COREQ was used for quality appraisal of articles alongside critical discussions. Analysis and synthesis included five stages: outlining study characteristics, coding of data, development of descriptive themes, development of analytical themes and integration and refinement. The review aim was to explore people’s experiences of SDM in MSK physiotherapy and to inform our understanding of the conditions needed for successful SDM. (3) Out of 1508 studies, 9 articles were included. Four main themes (trust, communication, decision preferences and decision ability) demonstrated that the majority of people want to participate in decision-making. As described in the capacity and capability model, three core conditions were needed to facilitate someone’s’ ability to participate. (4) People want to be involved in SDM in MSK physiotherapy. For successful SDM, physiotherapists should look to develop mutual trust, utilise two-way communication and share power.