Jeremy Graber1, Steven Lockhart2, Daniel D Matlock2,3,4, Jennifer Stevens-Lapsley1,3, Andrew J Kittelson5. 1. Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA. 2. Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado and Children's Hospital Colorado, Aurora, Colorado, USA. 3. VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA. 4. Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA. 5. School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA.
Abstract
PURPOSE: To understand patients' and physical therapists' perspectives related to decision making during outpatient rehabilitation after total knee arthroplasty (TKA), and to describe potential barriers and opportunities for shared decision making (SDM) in this setting. METHODS: A qualitative study examined the beliefs, thoughts, and experiences of patients and physical therapists regarding decision making in outpatient rehabilitation after TKA. Semi-structured interviews were conducted and analysed using directed content analysis. RESULTS: Thirty-five participants were interviewed (20 patients, 15 physical therapists). Three main themes emerged from the data: (1) there is variability among physical therapists in how patients are involved in care decisions, (2) several features of the outpatient care paradigm are not supportive of SDM, and (3) preoperative patient-clinician interactions may facilitate SDM in postoperative rehabilitation, but these interactions are not typically utilized. CONCLUSION: Physical therapists described using decision-making strategies with varying levels of patient involvement. Both patients and physical therapists described barriers to routine use of SDM in the outpatient setting. Several actionable strategies for overcoming these barriers were identified for providers and organizations seeking to consistently use SDM in outpatient TKA rehabilitation.
PURPOSE: To understand patients' and physical therapists' perspectives related to decision making during outpatient rehabilitation after total knee arthroplasty (TKA), and to describe potential barriers and opportunities for shared decision making (SDM) in this setting. METHODS: A qualitative study examined the beliefs, thoughts, and experiences of patients and physical therapists regarding decision making in outpatient rehabilitation after TKA. Semi-structured interviews were conducted and analysed using directed content analysis. RESULTS: Thirty-five participants were interviewed (20 patients, 15 physical therapists). Three main themes emerged from the data: (1) there is variability among physical therapists in how patients are involved in care decisions, (2) several features of the outpatient care paradigm are not supportive of SDM, and (3) preoperative patient-clinician interactions may facilitate SDM in postoperative rehabilitation, but these interactions are not typically utilized. CONCLUSION: Physical therapists described using decision-making strategies with varying levels of patient involvement. Both patients and physical therapists described barriers to routine use of SDM in the outpatient setting. Several actionable strategies for overcoming these barriers were identified for providers and organizations seeking to consistently use SDM in outpatient TKA rehabilitation.
Authors: Karen R Sepucha; Steven J Atlas; Yuchiao Chang; Andrew Freiberg; Henrik Malchau; Mahima Mangla; Harry Rubash; Leigh H Simmons; Thomas Cha Journal: Med Decis Making Date: 2018-11 Impact factor: 2.583
Authors: Andrew J Kittelson; Thomas J Hoogeboom; Margaret Schenkman; Jennifer E Stevens-Lapsley; Nico L U van Meeteren Journal: Phys Ther Date: 2020-01-23
Authors: Claire Tilbury; Tsjitske M Haanstra; Claudia S Leichtenberg; Suzan H M Verdegaal; Raymond W Ostelo; Henrica C W de Vet; Rob G H H Nelissen; Thea P M Vliet Vlieland Journal: J Arthroplasty Date: 2016-03-17 Impact factor: 4.757