Fostering shared decision making by occupational therapists and workers involved in accidents resulting in persistent musculoskeletal disorders: a study protocol.

Marie-France Coutu,Dawn Stacey,Marc Corbière,Patrick Loisel,France Légaré,Lesley Bainbridge,Marie-José Durand

doi:10.1186/1748-5908-6-22

Abstract

BackgroundFrom many empirical and theoretical points of view, the implementation of shared decision making (SDM) in work rehabilitation for pain due to a musculoskeletal disorder (MSD) is justified but typically the SDM model applies to a one on one encounter between a healthcare provider and a patient and not to an interdisciplinary team.ObjectivesTo adapt and implement an SDM program adapted to the realities of work rehabilitation for pain associated with a MSD. More specific objectives are to adapt an SDM program applicable to existing rehabilitation programs, and to evaluate the extent of implementation of the SDM program in four rehabilitation centres.MethodFor objective one, we will use a mixed perspective combining a theory-based development program/intervention and a user-based perspective. The users are the occupational therapists (OTs) and clinical coordinators. The strategies for developing an SDM program will include consulting the scientific literature and group consensus with clinicians-experts. A sample of convenience of eight OTs, four clinical coordinators and four psychologists all of whom have been working full-time in MSD rehabilitation for more than two years will be recruited from four collaborating rehabilitation centres. For objective two, using the same criteria as for objective one, we will first train eight OTs in SDM. Second, using a descriptive design, the extent to which the SDM program has been implemented will be assessed through observations of the SDM process. The observation data will be triangulated with the dyadic working alliance questionnaire, and findings from a final individual interview with each OT. A total of five patients per trained OT will be recruited, for a total of 40 patients. Patients will be eligible if they have a work-related disability for more than 12 weeks due to musculoskeletal pain and plan to start their work rehabilitation programs.DiscussionThis study will be the first evaluation of the program and it is expected that improvements will be made prior to a broader-scale implementation. The ultimate aim is to improve the quality of decision making, patients' quality of life, and reduce the duration of their work-related disability by improving the services offered during the rehabilitation process.

Highlights

From many empirical and theoretical points of view, the implementation of shared decision making (SDM) in work rehabilitation for pain due to a musculoskeletal disorder (MSD) is justified but typically the SDM model applies to a one on one encounter between a healthcare provider and a patient and not to an interdisciplinary team
The ultimate aim is to improve the quality of decision making, patients’ quality of life, and reduce the duration of their work-related disability by improving the services offered during the rehabilitation process
For individuals having a persistent work disability due pain associated with a musculoskeletal disorder (MSD), a return to work (RTW) will depends on the complex interaction among several types of factors: biological (e. g., medical status, physical capacities), psychological, and social [1,2]

Summary

Introduction

From many empirical and theoretical points of view, the implementation of shared decision making (SDM) in work rehabilitation for pain due to a musculoskeletal disorder (MSD) is justified but typically the SDM model applies to a one on one encounter between a healthcare provider and a patient and not to an interdisciplinary team. In the absence of agreement, the clinician and patient were not focused on the same action plan and did not use the same criteria for evaluating treatment efficacy [3,4]. This paradigm change has important implications for clinical practice and for the establishment of an alliance with the patient/injured worker because the gap between workers expectancies and what is being offered has evidence-based treatment can be significant. This review brought to light the three main barriers to implementing SDM, namely, time constraints and problems in applying the process due to the patients’ characteristics or to those of the clinical setting [6]. These findings highlight the importance of including the practice settings in the different steps involved in implementing an SDM process

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Conclusion