Abstract
Objective
To conduct a theory analysis of shared decision-making (SDM) conceptual models relevant to physiotherapy (PT) to help understand theoretical foundations of SDM for the PT discipline.
Design
A systematic review was used and updated to select models. The theory analysis was conducted following Walker and Avant’s approach and relevance to six PT competency domains.
Results
Of the 42 SDM models identified, three were eligible. One model (PT-SDM) is explicitly for PTs, one for multimorbidity with older patients (Dynamic Model-SDM), and one for multimorbidity and chronic care (Dual Layer-SDM). Models were published between 2016 and 2019, based on the literature and developed by a range of developers. All propose a schematic linear representation, but two models highlight SDM as an iterative process (PT-SDM, Dynamic Model-SDM). Two models (PT-SDM, Dynamic Model-SDM) are inductive, logical and clear, with the PT-SDM the most generalizable to different decision and setting. Strengths of models: a) all included key SDM elements; b) all involved a variety of stakeholders during development; c) all aimed to fill a gap in clinical practice; d) two are easier to use in clinical practice (PT-SDM, Dynamic Model-SDM); and e) all are generalizable to various healthcare professionals. Limitations of models: a) two poorly described the development process (PT-SDM, Dual Layer-SDM); b) none have been tested; c) none incorporated various actors despite acknowledging the importance of multidisciplinary teams; and d) one has an important logical fallacy (Dual Layer-SDM).
Conclusion
Two models could support physiotherapists intending to use SDM in clinical practice.
Contribution of the Paper
- Out of 42 SDM conceptual models identified, only one was specifically developed for physiotherapists. The PT-SDM contributes explicitly on how SDM fits within physiotherapy practice.
- The roles and contributions toward SDM for physiotherapists in the PT-SDM are similar to the other conceptual models. Yet, PTs are more likely to recognize their role in the conceptual model that explicitly targets them.
- The PT-SD and DM-SDM could support physiotherapists intending to use SDM in clinical practice.