American Physical Therapy Association Clinical Practice Guideline Facilitated Shared Decision Making for Patients With Low Back Pain: Feasibility and Acceptability in Outpatient Physical Therapy.

IMPORTANCE

The feasibility and acceptability of integrating shared decision making (SDM) for patients receiving physical therapy for low back pain (LBP) is unclear.

OBJECTIVE

This study assessed feasibility and acceptability of integrating SDM for intervention selection facilitated by American Physical Therapy Association clinical practice guidelines for patients with LBP.

DESIGN

This was a non-randomized pilot feasibility study.

SETTING

This study was conducted in outpatient physical therapy clinics.

PARTICIPANTS

Physical therapists (n = 10) and patients receiving care for LBP (n = 40) participated.

INTERVENTION: Physical therapists were non-randomly allocated to not receive (-SDM, n = 4) or receive (+SDM, n = 6) training to integrate SDM for patients with LBP.

MAIN OUTCOMES AND MEASURES: Feasibility of study procedures was assessed through recruitment, enrollment, and retention rates. Acceptability was assessed with standard measures for treatment acceptability (Short Assessment of Patient Satisfaction, SAPS), credibility-expectancy (Credibility-Expectancy Questionnaire, CEQ), therapeutic alliance (Work Alliance Inventory Short-Revised, WAI-SR), SDM occurrence (collaborRATE, and 9-item Shared Decision Making Questionnaire, SDM-Q-9) at 4 weeks. Patient-reported outcomes were described for pain intensity and interference (Pain, Enjoyment, General Activity, PEG), pain self-efficacy (4-item Pain Self Efficacy Questionnaire, PSEQ-4), and LBP disability (Oswestry Disability Index, ODI).

RESULTS

Of 68 patients that were eligible, 43 (63.2%) communicated with study coordinator, 40 (93.0%) were enrolled, and 24 (60.0%) completed 4-week follow-up. Patient acceptability outcome median scores for SAPS (-SDM = 24.0, +SDM = 24.0), CEQ-credibility (25.0, 26.0), CEQ-expectancy (21.0, 23.0), WAI-SR goal (20.0, 18.0), WAI-SR task (17.0, 18.0), and WAI-SR bond (16.0, 19.0) were observed. Top score rates for collaboRATE (-SDM = 53.8%, +SDM = 72.7%) and SDM-Q-9 (38.5%, 54.5%) were observed. Median within-participant change in PEG (-SDM = -0.7 points, +SDM = -2.0 points), PSEQ-4 (0.0, +2.0), and ODI (-4.0, -12.0) scores were observed with minimal important change rates for PEG (-SDM = 23.1%, +SDM = 54.5%), PSEQ-4 (30.8%, 63.7%), and ODI (38.5%, 63.6%) described.

CONCLUSIONS

Feasibility findings will inform future efficacy study planning with respect to recruitment, enrollment, and retention procedures. Future studies should consider assessing SDM from both patient and physical therapist perspectives while also evaluating how clinical practice guidelines may be used as resources to facilitate SDM for people with LBP.

RELEVANCE: These study findings have implications for SDM as a strategy to incorporate patient preferences into evidence-based clinical decision making for patients with LBP in outpatient physical therapy settings, however, larger scale studies are needed.