Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands.
CAPHRI Research School, Maastricht University Medical Centre, Maastricht, the Netherlands.
Phys Ther. 2022 Jul 4;102(7). doi: 10.1093/ptj/pzac051.
Guidelines recommend supervised exercise therapy and lifestyle counseling by a physical therapist as initial treatment for patients with intermittent claudication. However, guidelines provide only a crude estimate of the outcomes that therapists and patients might expect from treatment. The purpose of this study was to explore the impact of personalized outcomes forecasts (POFs) on the decision-making process of physical therapists and to learn lessons on facilitating the use of forecasts in daily practice.
A vignette-based, think-aloud interview study design was used. The participants were physical therapists trained in treating patients with intermittent claudication. Vignettes described fictitious patients diagnosed with intermittent claudication and included POFs. A directed approach was used to code, organize, and describe the data. Transcripts were analyzed using a thematic approach.
Sixteen therapists participated in the study. Three themes were identified: (1) setting and contextualizing treatment expectations, (2) setting (shared) goals and (de)motivating the patient, and (3) establishing and monitoring the treatment plan. Therapists mentioned that POFs could be useful for setting expectations and realistic treatment goals, contextualizing expected treatment response, stimulating patients to achieve their goals, and deciding on treatment frequency and treatment timing. Therapists thought POFs would be of less use for changing treatment goals during follow-up visits or for establishing intensity or type of training.
To overcome challenges that may arise when adopting POFs in daily practice, adequate training of physical therapists should be conducted. Potential areas to address with training include statistical and data literacy as well as guidance on integrating POFs with existing treatment protocols.
The use of POFs by physical therapists might contribute to a more person-centered care approach. The insights provided by this study on the first use of POFs by physical therapists can serve as an example and lesson on how to optimally implement such supporting tools into daily practice.
指南建议由物理治疗师对间歇性跛行患者进行监督下的运动治疗和生活方式咨询，作为初始治疗。然而，指南仅对治疗师和患者可能期望的治疗结果进行粗略估计。本研究旨在探讨个性化结果预测（POF）对物理治疗师决策过程的影响，并了解促进在日常实践中使用预测的经验。
采用基于案例的、出声思考的访谈研究设计。参与者是接受过间歇性跛行治疗培训的物理治疗师。案例描述了患有间歇性跛行的虚构患者，并包括 POF。采用定向方法对数据进行编码、组织和描述。使用主题方法对转录本进行分析。
16 名治疗师参与了这项研究。确定了三个主题：（1）设定和背景化治疗期望，（2）设定（共同）目标和（使）患者失去动力，（3）建立和监测治疗计划。治疗师提到，POF 可用于设定期望和现实的治疗目标、使预期的治疗反应具体化、激励患者实现目标以及决定治疗频率和治疗时间。治疗师认为，POF 对在随访期间改变治疗目标或确定训练强度或类型的作用不大。
为了克服在日常实践中采用 POF 时可能出现的挑战，应对物理治疗师进行充分的培训。培训中可能需要涉及的领域包括统计和数据素养，以及将 POF 与现有治疗方案整合的指导。
物理治疗师使用 POF 可能有助于实现更以患者为中心的护理方法。本研究首次对物理治疗师使用 POF 提供的见解可以作为一个范例和经验，说明如何将此类支持工具最佳地应用于日常实践。
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