+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Will shared decision making between patients with chronic musculoskeletal pain and physiotherapists, osteopaths and chiropractors improve patient care?



Will shared decision making between patients with chronic musculoskeletal pain and physiotherapists, osteopaths and chiropractors improve patient care?



Family Practice 29(2): 203-212



Chronic musculoskeletal pain (CMP) is treated in primary care by a wide range of health professionals including chiropractors, osteopaths and physiotherapists. To explore patients and chiropractors, osteopaths and physiotherapists' beliefs about CMP and its treatment and how these beliefs influenced care seeking and ultimately the process of care. Depth interviews with a purposive sample of 13 CMP patients and 19 primary care health professionals (5 osteopaths, 4 chiropractors and 10 physiotherapists). Patients' models of their CMP evolved throughout the course of their condition. Health professionals' models also evolved throughout the course of their treatment of patients. A key influence on patients' consulting behaviour appeared to be finding someone who would legitimate their suffering and their condition. Health professionals also recognized patients' need for legitimation but often found that attempts to explore psychological factors, which may be influencing their pain could be construed by patients as delegitimizing. Patients developed and tailored their consultation strategies throughout their illness career but not always in a strategic fashion. Health professionals also reflected on how patients' developing knowledge and changing beliefs altered their expectations. Therefore, overall within our analysis, we identified three themes: 'the evolving nature of patients and health professionals models of understanding CMP'; 'legitimating suffering' and 'development and tailoring of consultation and treatment strategies throughout patients' illness careers'. Seeking care for any condition is not static but a process particularly for long-term conditions such as CMP. This may need to be taken into account by both CMP patients and their treating health professionals, in that both should not assume that their views about causation and treatment are static and that instead they should be revisited on a regular basis. Adopting a shared decision-making approach to treatment may be useful particularly for long-term conditions; however, in some cases, this may be easier said than done due to both patients' and health professionals' sometimes discomfort with adopting such an approach. Training and support for both health professionals and patients may be helpful in facilitating a shared decision-making approach.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 056950635

Download citation: RISBibTeXText

PMID: 21982810

DOI: 10.1093/fampra/cmr083


Related references

The effectiveness of a posted information package on the beliefs and behavior of musculoskeletal practitioners: the UK Chiropractors, Osteopaths, and Musculoskeletal Physiotherapists Low Back Pain ManagemENT (COMPLeMENT) randomized trial. Spine 35(8): 858-866, 2010

Testing the effectiveness of an innovative information package on practitioner reported behaviour and beliefs: the UK Chiropractors, Osteopaths and Musculoskeletal Physiotherapists Low back pain ManagemENT (COMPLeMENT) trial [ISRCTN77245761. Bmc Musculoskeletal Disorders 6: 41, 2005

Shared decision making (SDM) with chronic pain patients. The patient as a partner in the medical decision making process. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 47(10): 985-991, 2004

Persistent back pain--why do physical therapy clinicians continue treatment? A mixed methods study of chiropractors, osteopaths and physiotherapists. European Journal of Pain 10(1): 67-76, 2006

Is patient behavior during consultation associated with shared decision-making? A study of patients' questions, cues and concerns in relation to observed shared decision-making in a cancer outpatient clinic. Patient Education and Counseling 101(3): 399-405, 2018

A Prospective Evaluation of Shared Decision-making Regarding Analgesics Selection for Older Emergency Department Patients With Acute Musculoskeletal Pain. Academic Emergency Medicine 23(3): 306-314, 2016

Shared Decision Making: Partnering With Patients to Improve Cardiovascular Care and Outcomes. Journal of Cardiovascular Nursing 33(4): 301-303, 2018

Using Shared Decision-Making Tools to Improve Care for Patients with Disorders of Sex Development. Advances in Pediatrics 63(1): 473-480, 2016

President's page: employing shared decision-making models to improve care and patient value: a cardiovascular professional initiative. Journal of the American College of Cardiology 56(24): 2046-2048, 2011

Shared Decision Making in Prostate Cancer Care-Encouraging Every Patient to be Actively Involved in Decision Making or Ensuring the Patient Preferred Level of Involvement?. Journal of Urology 200(3): 582-589, 2018

A study of referral patterns among Queensland general medical practitioners to chiropractors, osteopaths, physiotherapists and others. Journal of Manipulative and Physiological Therapeutics 21(4): 225-231, 1998

Patient-provider interactions in the management of chronic pain: current findings within the context of shared medical decision making. Pain Medicine 8(1): 25-35, 2007

Complaints about chiropractors, osteopaths, and physiotherapists: a retrospective cohort study of health, performance, and conduct concerns. Chiropractic and Manual Therapies 26: 12, 2018

Preferences for shared decision making in chronic pain patients compared with patients during a premedication visit. Acta Anaesthesiologica Scandinavica 50(8): 1019-1026, 2006

The process of shared decision making in chronic pain patients. Evaluation and modification of treatment decisions. Zeitschrift für Arztliche Fortbildung und Qualitatssicherung 98(2): 95-100, 2004