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FOTO Rehab Outcomes Blog

Does Shared Decision Making Matter?

For me, shared decision making is somewhat of an odd concept for rehabilitation professionals. First of all, the patient has 100% control in the decision making process. They either participate or refuse to participate. They either attend their visits or cancel or no show. If what is being provided doesn't meet a patient's expectations, how often will the patient continue to attend sessions?

I don't know about you all, but if I said, "would you like to lie on this table as I massage your leg OR would you like to do some squats?" the majority of the patients would love to lie around on the table, right? I'm pretty sure that even if I chose to explain the difference in outcomes, there'd be patients that would prefer to lie on the table. 

Patients already have an idea of what they want. Take for example yesterday. Yesterday I had a 75 year old female who was a previous patient. She really, really wanted kinesiotaping of her knee, back and ankle. I was pretty confident that she was dead set on this being the answer for her. She was willing to pay out of pocket just for the taping technique. I chose to assist her with her endeavor and found a therapist with a reputable company who would provide what this lady desired.  I wasn't going to make her happy OR meet her expectations. Was it a shared decision to assist her to find what she wanted? 

In order to truly have a shared decision making process, clinicians need data that contains both a predicted outcome and the processes and interventions involved in attaining the outcome.  Clinicians don't have all the data required for a full shared decision making process.

Looking at the parameters that needed to be met, I believe it is good that they found zero studies to evaluate. I'm not sure logistically how treatment decision making AND randomized controlled trial design could realistically happen in the real world. Patients are either included in the decision making or are not. And then, if they are... if they received the interventions they agreed upon, they'd know it - the flip side: not receiving the expected intervention would also be known.

Maybe in the rehabilitation world the shared decision is the patient chose to see a rehabilitation professional versus other options?

Below you will find a quick view of the abstract.


Does shared decision making result in better health related outcomes for individuals with painful musculoskeletal disorders? A systematic review.



Background: Shared Decision-Making (SDM) is a dynamic process by which the health care professional and the patient influence each other in making health-related choices or decisions. SDM is strongly embedded in today's health care approaches, and is advocated as an ideal model since it renders individuals more control towards the health care they choose to receive, and has been shown to improve patient outcomes. 

Objectives: The goal of this systematic review was to investigate the added-value of SDM on clinical health-related outcomes in patients with a variety of musculoskeletal conditions. 

Data sources: PubMed and CINAHL. 

Study selection: PRISMA guidelines were followed for this review. To be considered for review, the study had to meet all the following criteria: (1) prospective studies that involved treatment decision-making; (2) randomized controlled trial design; (3) involving patients faced with having to make a treatment decision; (4) comparing SDM with a control intervention and (5) including one or more of the following outcome measures: well-being, costs, health-related pain or disability measures, or quality of life. 

Study appraisal: A priori, we determined to perform methodological quality assessment using the Cochrane Risk of Bias tool for randomized controlled trials. 

Results: We did not find a single study that looked at the true effect of SDM on patient reported outcomes in a population with musculoskeletal pain. 

Conclusion: For the management of painful musculoskeletal conditions, in the light of the current evidence (none), we estimate that it would be wise to explore the effectiveness of SDM before forcing its large-scale implementation in rehabilitation.

 2017 Jul;25(3):144-150. doi: 10.1080/10669817.2017.1323607. Epub 2017 May 9.