K. Dierckx, PT, MSc, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium-Artevelde University College, De Pintelaan 185, B9000 Ghent, Belgium.
Phys Ther. 2013 Oct;93(10):1321-30. doi: 10.2522/ptj.20120286. Epub 2013 May 2.
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.
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.
This was an observational study of real consultations in physical therapy.
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.
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).
Only 13 out of 125 therapists who were personally contacted agreed to participate.
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.
共同决策（SDM）减少了治疗师和患者之间的不对称权力。患者参与度的提高可以提高患者的满意度、依从性和健康结果，并且是良好临床实践的前提。先前已经考虑过在物理治疗中使用 SDM 的机会。
本研究旨在检查物理治疗中的 SDM 现状、患者的偏好参与程度以及治疗师的感知与患者的偏好参与程度之间的一致性。
这是一项对物理治疗实际咨询的观察性研究。
共对 13 名物理治疗师进行的 237 次咨询进行了录音，并使用观察患者参与度（OPTION）工具分析了 210 个记录。在咨询之前，患者和治疗师完成了控制偏好量表（CPS）。使用多水平分析来研究个体变量与 SDM 水平之间的关联。使用 Kappa 系数计算偏好的一致性。
平均 OPTION 得分为 5.2（SD=6.8），满分 100 分。女性治疗师的 OPTION 得分更高（b=-0.86，P=0.01）。总共 36.7%的患者希望共同决策，36.2%的患者希望在委托决策之前发表意见。在大多数情况下，治疗师认为他们必须做出决定。治疗师的一致性 Kappa 系数较差，为.062（95%置信区间=-.018 至.144）。
只有 125 名直接联系的治疗师中的 13 名同意参与。
没有实施共同决策；尽管患者希望共同决策或至少对治疗发表意见，但物理治疗师并没有经常认识到这一点。参与的物理治疗师更有可能为患者的最佳利益做出决策；也就是说，这些治疗师倾向于采用家长式的方法，而不是让患者参与进来。
