Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo-Cho, Kitakatsuragi-Gun, Nara, 635-0832, Japan.
Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, 3-2-2 Sasayuridai, Kanmaki-Cho, Kitakatsuragi-Gun, Nara, 639-0218, Japan.
BMC Med Inform Decis Mak. 2023 Jul 24;23(1):135. doi: 10.1186/s12911-023-02208-1.
Evidence-based medicine education has not focused on how clinicians involve patients in decision-making. Although shared decision-making (SDM) has been investigated to address this issue, there are insufficient data on SDM in physiotherapy. This study aimed to clarify the issues concerning patient involvement in Japan, and to examine whether SDM is related to perceptions of patient involvement in decision-making.
The study participants were recruited from among acute and sub-acute inpatients and community residents receiving physiotherapy outpatient care, day care, and/or home rehabilitation. The Control Preference Scale (CPS) was used to measure the patients' involvement in decision-making. The nine-item Shared Decision-Making Questionnaire (SDM-Q-9) was used to measure SDM. In analysis I, we calculated the weighted kappa coefficient to examine the congruence in the CPS between the patients' actual and preferred roles. In analysis II, we conducted a logistic regression analysis using two models to examine the factors of patient involvement.
Analysis I included 277 patients. The patients' actual roles were as follows: most active (4.0%), active (10.8%), collaborative (24.6%), passive (35.0%), and most passive (25.6%). Their preferred roles were: most active (3.3%), active (18.4%), collaborative (39.4%), passive (24.5%), and most passive (14.4%). The congruence between actual and preferred roles by the kappa coefficient was 0.38. Analysis II included 218 patients. The factors for patient involvement were the clinical environment, the patient's preferred role, and the SDM-Q-9 score.
The patients in Japan indicated a low level of decision-making involvement in physiotherapy. The patients wanted more active involvement than that required in the actual decision-making methods. The physiotherapist's practice of SDM was revealed as one of the factors related to perceptions of patient involvement in decision-making. Our results demonstrated the importance of using SDM for patient involvement in physiotherapy.
循证医学教育并未关注临床医生如何让患者参与决策。虽然已经研究了共同决策（SDM）来解决这个问题，但物理治疗中关于 SDM 的数据不足。本研究旨在阐明日本患者参与的问题，并研究 SDM 是否与患者对决策参与的看法有关。
研究参与者从接受物理治疗门诊、日间护理和/或家庭康复的急性和亚急性住院患者和社区居民中招募。使用控制偏好量表（CPS）衡量患者对决策的参与程度。使用九项共同决策问卷（SDM-Q-9）衡量 SDM。在分析 I 中，我们计算加权kappa 系数以检验患者实际和期望角色之间 CPS 的一致性。在分析 II 中，我们使用两个模型进行逻辑回归分析，以检验患者参与的因素。
分析 I 纳入 277 名患者。患者的实际角色如下：最积极（4.0%）、积极（10.8%）、协作（24.6%）、被动（35.0%）和最被动（25.6%）。他们期望的角色是：最积极（3.3%）、积极（18.4%）、协作（39.4%）、被动（24.5%）和最被动（14.4%）。kappa 系数的实际和期望角色之间的一致性为 0.38。分析 II 纳入 218 名患者。患者参与的因素包括临床环境、患者的期望角色和 SDM-Q-9 评分。
日本患者在物理治疗中表现出较低的决策参与度。患者希望更积极地参与，而不是实际决策方法所要求的。物理治疗师实践 SDM 被揭示为与患者对决策参与的看法有关的因素之一。我们的结果表明，在物理治疗中使用 SDM 让患者参与的重要性。
