Decision support in the management of musculoskeletal disorders: a qualitative study of physiotherapists' and patients' experiences.

BACKGROUND

Clinical decision support systems (CDSSs) present a paradigm shift in health care by assisting complex decision-making processes. While implementing such systems has considerable potential, they simultaneously influence clinical encounters by impacting decision-making authority. SupportPrim PT (physiotherapy) is a CDSS that uses artificial intelligence methods to provide personalised treatment recommendations to patients with musculoskeletal disorders based on similar successful patients. This study aimed to explore how the CDSS influences the decision-making process of physiotherapists and patients.

METHODS

This qualitative study is based on individual interviews with 11 patients with musculoskeletal disorders and 10 physiotherapists in Norwegian primary healthcare in 2021 who have used the SupportPrim PT CDSS. The interviews were analysed thematically, with a theoretical approach inspired by Actor-Network Theory.

RESULTS

First, both patients and physiotherapists valued the visualisation of patients' biopsychosocial health status. It helped address health issues and expand and align perceptions of relevant information, leading to trust in physiotherapists' clinical reasoning. Nevertheless, revealing health problems also occasionally created insecurity. Second, the physiotherapists mainly felt that the CDSS treatment decision screen supported their reasoning. For some, it served as a pedagogic tool, lending the physiotherapist authority by confirming the accuracy of their treatment suggestions. However, many found it redundant to use with patients, as they felt secure in how to proceed. Patient involvement was also challenged by occasional inappropriate treatment suggestions and abundant and complex information, diminishing therapists' trust in the CDSS.

CONCLUSION

CDSSs can prove valuable by cultivating trust in physiotherapists' clinical reasoning. However, this trust can simultaneously challenge shared decision-making with the patient. Other aspects influencing decision-making include expectations of the CDSS, its timing, and the content of treatment suggestions. The physiotherapists' ability and need to interpose between patients and the CDSS to counter inappropriate information also impede shared use. Future studies should investigate how such CDSSs can enhance patient agency by allowing access and addressing the changing role of the physiotherapist once a CDSS is introduced in the clinical encounter.