How do physiotherapists include patients' perspectives into their decision making - cross-sectional study using the Four Habit Coding Scheme

OBJECTIVES: Patient-centered communication together with evidence-based practice is seen as the underlying pillars of shared decision making (SDM). However, the application of patient-centered communication in physiotherapy practice has not yet been studied from an observer-based point of view. The purpose was to determine to what extent physiotherapists use patient-centered communication in the first physiotherapy consultations of people with shoulder problems, and to what extent patient-centered communication is related to the level of SDM.

METHODS: In this secondary analysis, 100 audio-recorded initial physiotherapy consultations with people with shoulder problems, obtained through convenience sampling, were analyzed for the level of patient-centered communication using the Four Habit Coding Scheme (4HCS) (0-100, higher 4HCS scores indicate higher level of patient-centered communication). The relation between the level of patient-centered communication and the SDM was analysed in multiple steps.

RESULTS: A total of 100 initial physical therapy consultations of 41 participating physical therapists were included. The mean 4HCS score was 45(range 18-90). The correlation between the 4HCS and the OPTION-5 scores was 0.610(CI95 % 0.470 - 0.720). The four categories in the relation between patient-centered communication and SDM show that the most consultations are in the group of low patient-centered communication and low SDM and that there are only two consultations in the low patient-centered communication and high SDM.

CONCLUSION: Our results show that there is room for improvement in the application of patient-centered communication in physiotherapy practice although physiotherapists do apply patient-centered communication more than SDM. Patient-centered communication does not guarantee the application of SDM, although a higher level of SDM does indicate a higher degree of patient-centered communication. Practice implications This study offers clinical guidance on how to improve the integration of patient's perspective, values, and preferences in the decision making.