PloS one
2026-01-01
Wspólne podejmowanie decyzji w pediatrycznej fizjoterapii: badanie jakościowe wśród nastolatków, rodziców i fizjoterapeutów
Shared decision-making in pediatric physical therapy: A qualitative study among adolescents, parents, and physical therapists.
Recenzja AI
Cel badania
Celem badania było zbadanie, jak i kiedy stosować wspólne podejmowanie decyzji (SDM) w pediatrycznej fizjoterapii oraz zidentyfikowanie barier i czynników sprzyjających jego zastosowaniu.
Metoda
Badanie składało się z dwóch faz, w których przeprowadzono sześć grup fokusowych oraz walidację wyników za pomocą jakościowej ankiety wśród fizjoterapeutów.
Wyniki
Wyniki wskazują, że SDM może rozpocząć się już na etapie przyjęcia i ustalania celów, a kluczowe bariery to ograniczenia czasowe, podczas gdy sprzyjające czynniki to możliwość dostosowania rozmów SDM do potrzeb rodzin.
Znaczenie dla praktyki
Badanie dostarcza wytycznych do wdrażania SDM w pediatrycznej fizjoterapii w podstawowej opiece zdrowotnej, co może poprawić jakość opieki i zaangażowanie pacjentów oraz ich rodzin.
Abstrakt oryginalny
OBJECTIVE: Shared Decision Making (SDM) is a collaborative process between patients and clinicians. A structured approach for SDM in pediatric physical therapy is lacking. This two-phase study aimed to 1) explore how and when to apply SDM in pediatric physical therapy in primary healthcare, and to identify barriers and facilitators influencing its use, and 2) adapt an SDM model for use in pediatric physical therapy and propose strategies for implementation. METHODS: The study consisted of two phases. In Phase 1, six focus groups were conducted, two per participant group: adolescents (12-18y, n = 11), parents of children (4-18y, n = 9), and pediatric physical therapists (n = 6). A qualitative survey among 46 pediatric physical therapists validated focus group results. An inductive analysis explored how and when SDM should be applied, and a deductive analysis identified barriers and facilitators by linking codes to Consolidated Framework for Implementation Research (CFIR) domains. In Phase 2, the research team integrated results into an existing goal-based SDM-model, and implementation strategies were selected using the CFIR-Expert Recommendations for Implementing Change tool. RESULTS: SDM can begin at intake and goal setting, with ongoing, individualized involvement of children and parents throughout therapy. When comparing therapy options, treatment frequency, duration, homework, expectations, and possibilities at home can be discussed. Barriers included time constraints and the challenge of balancing multiple perspectives, while facilitators were the possibility to adapt SDM conversations per family and a supportive practice culture. A goal-based SDM-model was adapted for pediatric physical therapy. Implementation strategies identified were professional training, use of SDM tools, sufficient contact with parents, time to learn SDM, a supportive team culture, and empowering parents and children. DISCUSSION: This study provides guidelines for implementing SDM in pediatric physical therapy in primary care. A multifaceted implementation approach, guided by this study's implementation strategies, may enhance SDM integration into clinical practice.