title: Implementation of shared decision making in physical therapy: observed level of involvement and patient preference.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  This was an observational study of real consultations in physical therapy.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  Only 13 out of 125 therapists who were personally contacted agreed to participate.
  
  
  CONCLUSIONS
  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.
authors: K. Dierckx, PT, MSc, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium-Artevelde University College, De Pintelaan 185, B9000 Ghent, Belgium.
authors: Katreine
authors: K
authors: Dierckx
authors: Myriam
authors: M
authors: Deveugele
authors: Philip
authors: P
authors: Roosen
authors: Ignaas
authors: I
authors: Devisch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D057240:Patient Preference; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D055815:Young Adult