Shared Decision Making in Physical Therapist Care for People with Shoulder Problems: An Observer-Based Analysis of Audio-Recorded Consultations.

Abstract

Objective: Despite the substantial diagnostic and therapeutic uncertainties in the decision-making process, it remains largely unclear to what extent shared decision making is applied in physical therapist care for people with shoulder problems. The purpose of our study was to determine to what extent shared decision making is part of the decision-making process in initial physical therapist consultations of people with shoulder problems, and to identify factors associated with the level of shared decision making.

Methods: In this cross-sectional study, the level of shared decision making was measured by assessing audio-recorded initial physical therapist consultations of people with shoulder problems using the 5-item Observing Patient Involvement in Shared Decision Making tool (OPTION-5; 0-100, higher OPTION scores indicate higher level of shared decision making). Associations between the level of shared decision making and the characteristics of patients, physical therapists, and consultations were assessed using multilevel analysis.

Results: A total of 100 initial physical therapist consultations of 41 participating physical therapists were included. The mean OPTION-5 score was 27 (range 5-70). On none of the individual items of the OPTION-5 the highest score "exemplar effort" was observed. The multilevel analysis showed that 3 determinants were associated with higher level of shared decision making: younger age of the patient (b = -1.8; 95% CI = -3.1 to -0.4), longer duration of the consultation (b = 5.5; 95% CI = 2.7 to 8.3), and higher level of education of the physical therapist (b = 9.1; 95% CI = 2.7 to 15.4).

Conclusions: The level of shared decision making in daily physical therapist practice for people with shoulder problems leaves room for improvement. Future research should focus on strategies to improve the application of shared decision making in physical therapist care for people with shoulder problems. The determinants duration of the consultation, and the level of education of the physical therapist, might provide guidance in developing these strategies for improving the application of shared decision making.

Impact: The findings of this study give insight in the limited application of shared decision making in physical therapy for people with shoulder problems. Duration of the consultations and level of education of the physical therapist impact the level of shared decision making.