Coutu Marie-France, Légaré France, Durand Marie-José, Corbière Marc, Stacey Dawn, Bainbridge Lesley, Labrecque Marie-Elise
Research Center - Hôpital Charles-Le Moyne, Université de Sherbrooke, 150, Place Charles LeMoyne, Longueuil, QC, J4K 0A8, Canada,
J Occup Rehabil. 2015 Mar;25(1):141-52. doi: 10.1007/s10926-014-9532-7.
The objective of this study was to design and operationalize shared decision making (SDM) rehabilitation model for worker rehabilitation programs. SDM has previously been shown to improve decision outcomes in patient-health care professional relationships. To date, SDM has not yet been adapted to work rehabilitation, although it could be a valuable approach to better understand and agree on return-to-work decisions.
We designed a preliminary model for return-to-work decisions for workers suffering from pain due to musculoskeletal injuries. We submitted the preliminary model and a questionnaire to expert health care professionals. Using the Technique for Research of Information by Animation of a Group of Experts method, a group consensus process was used to discuss and refine the experts' responses to operationalize a model adapted for rehabilitation.
Eleven occupational therapists (three were clinical coordinators) and four psychologists participated in three group consensus sessions. The final version of the model included one general longitudinal objective (the maintenance of a working alliance and assuring mutual comprehension among all stakeholders), and 11 specific objectives: establishing a working alliance, seven in the deliberation phase of the SDM process, and three in the implementation of the decision. Participants also reached consensus on between 1 and 8 indicators per objective.
We developed and operationalized an SDM rehabilitation model intended for a return-to-work implementation plan. The next step will be to document its feasibility among the main stakeholders (employer, union, insurer and worker) taking part in decisions about return to work.
本研究的目的是为工伤康复项目设计并实施共享决策（SDM）康复模型。此前已有研究表明，共享决策能够改善患者与医护人员关系中的决策结果。尽管共享决策可能是一种有助于更好地理解复工决策并就此达成共识的宝贵方法，但迄今为止，它尚未应用于工伤康复领域。
我们为因肌肉骨骼损伤而疼痛的工人设计了一个复工决策的初步模型。我们将初步模型和一份问卷提交给了专业医护人员。采用专家群体信息动态研究技术方法，通过群体共识过程来讨论并完善专家的回复，从而实施一个适用于康复的模型。
11名职业治疗师（其中3名是临床协调员）和4名心理学家参加了三次群体共识会议。该模型的最终版本包括一个总体纵向目标（维持工作联盟并确保所有利益相关者之间相互理解）和11个具体目标：建立工作联盟，在共享决策过程的审议阶段有7个目标，在决策实施阶段有3个目标。参与者还就每个目标1至8项指标达成了共识。
我们开发并实施了一个用于复工实施计划的共享决策康复模型。下一步将记录该模型在参与复工决策的主要利益相关者（雇主、工会、保险公司和工人）中的可行性。
