Shared Decision Making in Physical Therapy

Shared decision making between a patient and health care provider is linked with improved patient satisfaction, adherence to treatment, and health outcomes. Involving a patient in decision making may also reduce anxiety and improve confidence in any physical therapy treatment plan. Traditional models of health care use a provider focused approach which does not always incorporate patient values or preferences. Shared decision making enhances the patient-doctor relationship by allowing “2-way traffic” or a balancing of power between a patient & his or her health care provider.

Charles & Colleagues have defined five characteristics of shared decision making

  1. At least 2 parties are involved: patient & therapist
  2. Both parties take steps to participate in the process of treatment decision making
  3. Information sharing between parties is a prerequisite to sharing decisions
  4. Deliberation takes place by discussing the treatment preference of both parties
  5. A treatment decision is made & both participants agree on the decision

Research has shown that most patients seeking health care prefer to share decisions with their provider. Studies have investigated patient involvement in general medicine, cardiology, oncology, and mental health. But how about patients seeking care from a physical therapist?

Research Supporting Patient Involvement in Physical Therapy

A 2013 study by Dierckx & colleagues1 showed that more than two-thirds of patients seeking care from a physical therapist prefer to be involved in the treatment decision making process. The majority of patients either wanted to share their opinions or be actively involved in establishing the treatment plan. However, most alarming from this study, was the fact that in most cases physical therapists falsely perceived that their patient did not want to share decision making. Many physical therapists assumed patients preferred to be passive in the decision making process but this was not the case as most patients preferred to be more involved. This study shows that most decision making in physical therapy continues to be based on a paternalistic approach whereby therapists act in ways they consider is best for their patient but ignoring the benefits of involving the patient more.

Implications for Promoting Shared Decision Making

Promoting a balancing of power in the patient-therapist relationship results in greater patient control over their problem. The patient is no longer a passive recipient of treatment but instead becomes actively involved. When exercise therapy is the treatment, the responsibility of success or failure has to be shared between the patient and the therapist. The patient must do their part. Most patients want to share decisions with their physical therapist and most want to express their opinion before a treatment decision is made. Physical therapists that are blind to patient preferences contribute to a lack of patient involvement in their care and promote dependence on the physical therapist. A wiser approach should seek to actively engage more with patients to achieve the goal of shared decision making.  This will promote patient empowerment and control over their pain or problem. For any successful outcome to be achieved in physical therapy, patients must gain a sense of control without dependence on others. Shared decision making is one step towards this outcome.

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  1. Dierckx K, Deveugele M, Roosen P, Devisch I. Implementation of shared decision making in physical therapy: observed level of involvement and patient preference. Phys Ther. 2013;93(10):1321-1330.