People’s Experience of Shared Decision Making in Musculoskeletal Physiotherapy: A Systematic Review and Thematic Synthesis

Abstract

(1) Shared decision making (SDM) has been advocated as a way of improving prudency in healthcare and has been linked to self-efficacy and empowerment of service users. The evaluation of its use in musculoskeletal (MSK) physiotherapy has been vague, but articles suggest that trust and communication are integral. (2) ENTREQ guidelines informed this systematic review and thematic synthesis. PRISMA recommendations steered a systematic literature search of AHMED, CINAHL, MEDLNE, EMBASE and Cochrane databases from inception to September 2021. COREQ was used for quality appraisal of articles alongside critical discussions. Analysis and synthesis included five stages: outlining study characteristics, coding of data, development of descriptive themes, development of analytical themes and integration and refinement. The review aim was to explore people’s experiences of SDM in MSK physiotherapy and to inform our understanding of the conditions needed for successful SDM. (3) Out of 1508 studies, 9 articles were included. Four main themes (trust, communication, decision preferences and decision ability) demonstrated that the majority of people want to participate in decision-making. As described in the capacity and capability model, three core conditions were needed to facilitate someone’s’ ability to participate. (4) People want to be involved in SDM in MSK physiotherapy. For successful SDM, physiotherapists should look to develop mutual trust, utilise two-way communication and share power.

“Please listen to me, I want to know what is wrong with my shoulder”: A qualitative study exploring patients’ expectations and experiences with primary care management.

“…58 This, again, can only be achieved when there is a strong therapeutic relationship between the patient and his care provider and with shared decision making. 58,59 Strengths and limitations…”

“…These skills could be enabled by properly training clinicians. 59 Moreover, a strong therapeutic relationship and more time with the patient could give primary care clinicians the opportunity to discuss the cause of shoulder pain with their patients and provide a management plan that meets evidence-based recommendations. Since most participants also mentioned that they expected a physical examination, it seems important to help clinicians achieving the skills to e ciently perform patients' assessment in the situation in which they face limited time with the patient.…”

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“…Previous research strongly suggests that patient–physical therapist interactions in musculoskeletal practices are often physical therapist-led, with physical therapists’ (often biologically focused) plans frequently determining the narrative. 13 , 14 , 42 Such potentially paternalistic practices require physical therapists to reflect on how to better share power, a key aspect in shared decision-making, 43 and foster a deeper ethical awareness of power asymmetries during clinical encounters. 44 Our analysis from the current study suggests that Johnstone’s theory of improvisation 28 may help provide physical therapists with some suggestions on how to shift this pattern by accepting patient offers.…”

Frühzeitige Operation oder Training und Edukation bei Meniskusrissen im jungen Erwachsenenalter

“…Skou et al betonen, dass durch die scheinbare Gleichwertigkeit der Therapieoptionen die Präferenzen der Patient*innen stärker beachtet und einbezogen werden könnten. Viele Patient*innen wünschen sich, in Entscheidungen zur muskuloskelettalen Therapie mehr einbezogen zu werden [9]. Medizinische Fachpersonen sollten Therapiemöglichkeiten daher mit Patient*innen so verständlich kommunizieren, dass diese mitentscheiden können.…”