This study aimed to examine how SDM relates to patient enablement in outpatient rehabilitation consultations.
This study involved 153 patients attending four outpatient rehabilitation facilities in Japan. Sociodemographic information, disease severity (modified Ranking Scale: mRS),treatment expectations,control preference scale (CPS), and communicative and critical health literacy (CCHL) were collected via self-administered questionnaires. After consultations with physical therapists, the extent to which SDM was achieved during the consultation was evaluated using the Shared decision-making in the Rehabilitation(SDM-Reha) and patient enablement was assessed using the Patient Enablement Instrument (PEI). The SDM-Reha score ranges from 0 to 100, with higher scores indicating greater achievement of shared decision-making. The PEI score ranges from 0 to 12 and reflects the extent to which patients understand and manage their condition, with higher scores indicating better understanding and coping. The multiple regression analysis was performed to examine the relationship of SDM-Reha with PEI controlling for other factors.
The mean age of the patients was 68.3 (SD: 12.5) years, and 50.5% were male. Patients with musculoskeletal disorders (18.2%), cerebrovascular diseases (46.2%), neuromuscular diseases (17.2%) and spinal cord diseases (16.1%) were included. In terms of severity, 56.9% of patients had mild disability according to the mRS, while 43.1% had moderate to severe disability. The mean SDM-Reha score was 77.6(SD13.8). Among the 9 items of SDM-Reha, scores were higher for items such as “explanation of disabilities or symptoms by the therapist”4.1(SD0.7) and “checking whether the patient had any questions when deciding on the rehabilitation plan” 4.1(SD: 0.9). However, the score was lower for the item “providing options when deciding on the rehabilitation plan” 3.3 (SD1.1). The average PEI score was 5.3 (SD3.1). Among the 6 items of PEI, “feeling able to understand my disability or symptoms” scored relatively high 1.3(SD0.5), whereas the item “feeling confident about my health” had a lower score 0.6(SD0.7). Regression analysis revealed a significant positive association between SDM-Reha score and PEI (β=0.290, p=0.005).
The results suggest that the SDM-Reha score has a statistically significant positive association with PEI, indicating that for each one-point increase in the SDM-Reha score, the PEI score increased by 0.29 points.This indicates that greater patient involvement in decision-making improves both their understanding of and ability to manage their condition. By sharing information and decision-making processes, patients might be able to understand various aspects of their treatment and reflect more thoroughly, which likely contributed to their understanding of their conditions and symptoms. Limitations of this study include small sample size and focus limited to chronic-phase rehabilitation. Further investigation is needed to explore the generalizability of our findings.
Implementing SDM in rehabilitation consultations may enhance patients’ ability to understand and manage their conditions.
Patient Enablement
chronic-phase rehabilitation
