From January to June 2024, using the descriptive phenomenological research method, a semi-structured interview outline was developed based on a literature review and subject group discussions. A targeted sampling method was used to select and investigate and interviewed 11 patients (aged 18-65) who had suffered a stroke (1-12 months post-stroke) with motor and/or sensory impairments, without severe cognitive dysfunction (MoCA >18), as well as 6 physiotherapists with at least one year of experience working with stroke patients. Semi-structured interviews were conducted with each study participant to obtain information and explore their in-depth experiences with shared decision-making in therapy planning.
In the process of analyzing the interviews, 104 codes, 10 sub-themes, and three themes were identified: (1) knowledge of shared decision-making and its application in physiotherapy practice (theoretical knowledge, postgraduate and additional education, communication barriers), (2) the goal-setting process and therapy planning (patient’s wishes and engagement in the therapy planning process, cognitive impairments), and (3) daily communication with patients and healthcare professionals (experience, communication skills, involvement of colleagues). All the interviewed physiotherapists had heard of shared decision-making and applied it in their everyday practice. The main obstacles to integrating shared decision-making into physiotherapy practice were a lack of time and the patients' reluctance to participate. Physiotherapists typically create therapy plans together with patients, based on the patients’ wishes and needs. All study participants—stroke patients—were satisfied with the work and attitude of the physiotherapists and believed that their wishes were considered when creating a therapy plan. Awareness of the therapy plan was sufficient, and the patients noted that they trusted the physiotherapist with the creation of the therapy plan.
Physiotherapists who have been practicing at a specialized inpatient rehabilitation center for at least a year are familiar with the shared decision-making process and apply it in their clinical work. Stroke patients are satisfied with the physiotherapy plans explained by the physiotherapists and appreciate their attitude when discussing the implementation of the therapy plan. Stroke survivors believe that their wishes and expectations are taken into account when agreeing on physiotherapy, which in turn promotes their motivation to actively participate in the rehabilitation process.
As stroke can lead to chronic impairments requiring intensive and long-term rehabilitation, shared decision-making in physiotherapy is particularly beneficial as it can also improve adherence, motivation and satisfaction with therapy.
physiotherapy
stroke
