University of Warwick, Coventry, West Midlands, UK.
Arthritis Care Res (Hoboken). 2014 Jun;66(6):925-33. doi: 10.1002/acr.22252.
To develop a decision support package for people with low back pain (LBP) referred for physiotherapy.
We used a program of exploratory work, including literature reviews, a Delphi study, a nominal group with physiotherapists, focus groups with patients, and secondary analysis of existing interview data.
We developed an information booklet describing the evidence-based treatment modalities available in a physiotherapy department. This includes data on likely benefits and risks and how the intervention is delivered. The booklet specifically addresses questions identified as important in our exploratory work. Space is provided for patients to note down the pros and cons of each treatment and what matters to them when choosing treatments. The patient is subsequently directed to a section that explores any gaps in knowledge, values, support, and choice before finally clarifying if a treatment decision is possible. At this stage they are encouraged to note down any questions or concerns they have to be discussed at the first physiotherapy consultation. This overall package includes patient material in the form of a booklet posted prior to their consultation, plus the enhanced consultation with the specially trained physiotherapist. Patients then receive their chosen treatment. In addition we developed a training package for physiotherapists that explains the content of the booklet and supports them in using informed, shared decision making in their consultation.
This package has the potential to improve effectiveness of treatments and patient satisfaction for LBP by facilitating patient choice and therefore matching patients more effectively to different treatments.
为接受物理治疗的腰痛患者开发决策支持包。
我们采用了一项探索性工作方案，包括文献回顾、德尔菲研究、与物理治疗师的名义小组、患者焦点小组以及对现有访谈数据的二次分析。
我们开发了一本小册子，介绍物理治疗部门提供的基于证据的治疗方式。其中包括有关可能的益处和风险的信息，以及干预措施的实施方式。该小册子专门针对我们在探索性工作中确定的重要问题。为患者提供了空间，让他们记录每种治疗方法的优缺点，以及在选择治疗方法时对他们重要的因素。然后，患者将被引导至一个部分，探讨知识、价值观、支持和选择方面的任何差距，最后明确是否可以做出治疗决策。在这一阶段，鼓励他们记录在首次物理治疗咨询时需要讨论的任何问题或疑虑。该综合方案包括在咨询前邮寄给患者的小册子形式的患者资料，以及经过特别培训的物理治疗师提供的增强型咨询。患者随后接受他们选择的治疗。此外，我们还为物理治疗师开发了一个培训包，解释小册子的内容，并支持他们在咨询中使用知情、共同决策。
通过促进患者选择，从而更有效地将患者与不同的治疗方法相匹配，该方案有可能提高腰痛治疗的效果和患者满意度。
