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Implementation of shared decision making in physical therapy: observed level of involvement and patient preference

Katreine Dierckx (UGent) , Myriam Deveugele (UGent) , Philip Roosen (UGent) and Ignaas Devisch (UGent)
(2013) PHYSICAL THERAPY. 93(10). p.1321-1330
Author
Organization
Abstract
Shared decision making (SDM) reduces the asymmetrical power between the therapist and the patient. Patient involvement improves patient satisfaction, adherence, and health outcomes and is a prerequisite for good clinical practice. The opportunities for using SDM in physical therapy have been previously considered. OBJECTIVE: The objective of this study was to examine the status of SDM in physical therapy, patients' preferred levels of involvement, and the agreement between therapist perception and patient preferred level of involvement. DESIGN: This was an observational study of real consultations in physical therapy. METHODS: In total, 237 consultations, undertaken by 13 physical therapists, were audiorecorded, and 210 records were analyzed using the Observing Patient Involvement (OPTION) instrument. Before the consultation, the patient and therapist completed the Control Preference Scale (CPS). Multilevel analysis was used to study the association between individual variables and the level of SDM. Agreement on preferences was calculated using kappa coefficients. RESULTS: The mean OPTION score was 5.2 (SD=6.8), out of a total score of 100. Female therapists achieved a higher OPTION score (b=-0.86, P=0.01). In total, 36.7% of the patients wanted to share decisions, and 36.2% preferred to give their opinion before delegating the decisions. In the majority of cases, therapists believed that they had to decide. The kappa coefficient for agreement was poor at .062 (95% confidence interval=-.018 to .144). LIMITATIONS: Only 13 out of 125 therapists who were personally contacted agreed to participate. CONCLUSION: Shared decision making was not applied; although patients preferred to share decisions or at least provide their opinion about the treatment, physical therapists did not often recognize this factor. The participating physical therapists were more likely to make decisions in the best interest of their patients; that is, these therapists tended to apply a paternalistic approach rather than involving the patient.
Keywords
autonomy, shared decision making, HEALTH-PROFESSIONALS PERCEPTIONS, LOW-BACK-PAIN, PRIMARY-CARE, OPTION SCALE, CLINICAL-PRACTICE, COMMUNICATION, CONSULTATION, DEPRESSION, AUTONOMY, OUTCOMES

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Citation

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MLA
Dierckx, Katreine, Myriam Deveugele, Philip Roosen, et al. “Implementation of Shared Decision Making in Physical Therapy: Observed Level of Involvement and Patient Preference.” PHYSICAL THERAPY 93.10 (2013): 1321–1330. Print.
APA
Dierckx, K., Deveugele, M., Roosen, P., & Devisch, I. (2013). Implementation of shared decision making in physical therapy: observed level of involvement and patient preference. PHYSICAL THERAPY, 93(10), 1321–1330.
Chicago author-date
Dierckx, Katreine, Myriam Deveugele, Philip Roosen, and Ignaas Devisch. 2013. “Implementation of Shared Decision Making in Physical Therapy: Observed Level of Involvement and Patient Preference.” Physical Therapy 93 (10): 1321–1330.
Chicago author-date (all authors)
Dierckx, Katreine, Myriam Deveugele, Philip Roosen, and Ignaas Devisch. 2013. “Implementation of Shared Decision Making in Physical Therapy: Observed Level of Involvement and Patient Preference.” Physical Therapy 93 (10): 1321–1330.
Vancouver
1.
Dierckx K, Deveugele M, Roosen P, Devisch I. Implementation of shared decision making in physical therapy: observed level of involvement and patient preference. PHYSICAL THERAPY. 2013;93(10):1321–30.
IEEE
[1]
K. Dierckx, M. Deveugele, P. Roosen, and I. Devisch, “Implementation of shared decision making in physical therapy: observed level of involvement and patient preference,” PHYSICAL THERAPY, vol. 93, no. 10, pp. 1321–1330, 2013.
@article{4173504,
  abstract     = {Shared decision making (SDM) reduces the asymmetrical power between the therapist and the patient. Patient involvement improves patient satisfaction, adherence, and health outcomes and is a prerequisite for good clinical practice. The opportunities for using SDM in physical therapy have been previously considered. OBJECTIVE: The objective of this study was to examine the status of SDM in physical therapy, patients' preferred levels of involvement, and the agreement between therapist perception and patient preferred level of involvement. DESIGN: This was an observational study of real consultations in physical therapy. METHODS: In total, 237 consultations, undertaken by 13 physical therapists, were audiorecorded, and 210 records were analyzed using the Observing Patient Involvement (OPTION) instrument. Before the consultation, the patient and therapist completed the Control Preference Scale (CPS). Multilevel analysis was used to study the association between individual variables and the level of SDM. Agreement on preferences was calculated using kappa coefficients. RESULTS: The mean OPTION score was 5.2 (SD=6.8), out of a total score of 100. Female therapists achieved a higher OPTION score (b=-0.86, P=0.01). In total, 36.7% of the patients wanted to share decisions, and 36.2% preferred to give their opinion before delegating the decisions. In the majority of cases, therapists believed that they had to decide. The kappa coefficient for agreement was poor at .062 (95% confidence interval=-.018 to .144). LIMITATIONS: Only 13 out of 125 therapists who were personally contacted agreed to participate. CONCLUSION: Shared decision making was not applied; although patients preferred to share decisions or at least provide their opinion about the treatment, physical therapists did not often recognize this factor. The participating physical therapists were more likely to make decisions in the best interest of their patients; that is, these therapists tended to apply a paternalistic approach rather than involving the patient.},
  author       = {Dierckx, Katreine and Deveugele, Myriam and Roosen, Philip and Devisch, Ignaas},
  issn         = {0031-9023},
  journal      = {PHYSICAL THERAPY},
  keywords     = {autonomy,shared decision making,HEALTH-PROFESSIONALS PERCEPTIONS,LOW-BACK-PAIN,PRIMARY-CARE,OPTION SCALE,CLINICAL-PRACTICE,COMMUNICATION,CONSULTATION,DEPRESSION,AUTONOMY,OUTCOMES},
  language     = {eng},
  number       = {10},
  pages        = {1321--1330},
  title        = {Implementation of shared decision making in physical therapy: observed level of involvement and patient preference},
  url          = {http://dx.doi.org/10.2522/ptj.20120286},
  volume       = {93},
  year         = {2013},
}

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