Impact of Personalized Outcomes Forecasts on Clinical Reasoning of Physical Therapists in Intermittent Claudication: A Vignette Study

Abstract

Objective Guidelines recommend supervised exercise therapy and lifestyle counseling by a physical therapist as initial treatment of 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. Methods 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. Results 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. Conclusion 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. Impact 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.

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Patient and Clinician Perceptions of a “People-Like-Me” Tool for Personalized Rehabilitation after Total Knee Arthroplasty: A Qualitative Interview Study

“…Similarly, in Sinnige et al's study, therapists perceived that providing patients with personalized recovery information could motivate patients to achieve therapy goals or could demotivate patients with a poor prognosis. 13 Some therapists from their study indicated they wouldn't provide personalized recovery information to individuals who were performing below predicted measurements. 13 Sinnige et al discussed that withholding information from patients because of a poor prognosis may be problematic given patients' right to know about their health, yet they also acknowledged that the use of clinical tools are often up to the discretion of clinicians.…”

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Evaluating the implementation of personalised outcomes forecasts to optimise supervised exercise therapy in patients with intermittent claudication in the Netherlands: a multimethods study

“…The POFs were implemented among physical and exercise therapists affiliated with ‘Chronic CareNet’, a Dutch nationwide network of specialised therapists providing community-based SET and lifestyle counselling to patients with non-communicable diseases like intermittent claudication 34. The study was conducted in the Netherlands from August 2019 to November 2021 (‘Netherlands Trial Register’ number: NL8838), and the study protocol has been described previously 35. The RECORD checklist was used as a guide in the reporting of this study 36…”

“…By informing patients of the expected course and outcome of therapy, POFs may help therapists to tailor care to the needs of the individual and thereby potentially improve patient outcomes 25. Moreover, we expect that POFs could enable therapists to improve patient engagement and shared decision-making (SDM) 21 26. The latter is noteworthy since the use of SDM is limited among physical therapists while it is considered a cornerstone of personalised care 27–31…”