Shared decision-making conceptual models for physiotherapy: a theory analysis

Abstract

Objective: To conduct a theory analysis of shared decision-making (SDM) conceptual models relevant to physiotherapy (PT) to help understand theoretical foundations of SDM for the PT discipline.

Design: A systematic review was used and updated to select models. The theory analysis was conducted following Walker and Avant's approach and relevance to six PT competency domains.

Results: Of the 42 SDM models identified, three were eligible. One model (PT-SDM) is explicitly for PTs, one for multimorbidity with older patients (Dynamic Model-SDM), and one for multimorbidity and chronic care (Dual Layer-SDM). Models were published between 2016 and 2019, based on the literature and developed by a range of developers. All propose a schematic linear representation, but two models highlight SDM as an iterative process (PT-SDM, Dynamic Model-SDM). Two models (PT-SDM, Dynamic Model-SDM) are inductive, logical and clear, with the PT-SDM the most generalizable to different decision and setting. Strengths of models: a) all included key SDM elements; b) all involved a variety of stakeholders during development; c) all aimed to fill a gap in clinical practice; d) two are easier to use in clinical practice (PT-SDM, Dynamic Model-SDM); and e) all are generalizable to various healthcare professionals. Limitations of models: a) two poorly described the development process (PT-SDM, Dual Layer-SDM); b) none have been tested; c) none incorporated various actors despite acknowledging the importance of multidisciplinary teams; and d) one has an important logical fallacy (Dual Layer-SDM).

Conclusion: Two models could support physiotherapists intending to use SDM in clinical practice. CONTRIBUTION OF THE PAPER.

Keywords: Conceptual models; Physiotherapy; Shared decision-making; Theory analysis.