Informed Decisions and Patient Outcomes
Patients with non-arthritic hip pain (NAHP) may not be appropriately prepared to make informed treatment decisions. Patients with NAHP who present to a hip preservation clinic have already seen a handful of providers and experienced prolonged pain lasting an average of three years. Common treatments include physical therapy and surgery, with only three published comparative trials. Evaluation and decisional support from each discipline for these treatments may improve the decision-making process for patients by reducing decisional conflict and increasing patient satisfaction. Ultimately, more informed treatment planning may assist patients to achieve optimal outcomes. The overall objective of this project was to assess the feasibility of an interdisciplinary shared decision-making process for patients, physicians, and physical therapists to select treatment for NAHP. Aim 1 identified barriers and facilitators to implement an interdisciplinary shared decision-making model in a hip preservation clinic. The results of this aim indicated that patients were interested in participation to support research efforts, but were also interested in multiple-provider care, specifically including a physical therapist. Patients reported time as a participation barrier, but time was not a barrier for clinicians to conduct the interdisciplinary evaluation. All participants assigned to the interdisciplinary group completed their evaluations, despite increased time. Interdisciplinary evaluation by physical therapists and orthopaedic surgeons may not always be feasible in-person as part of a hip preservation clinic. Remote, coordinated collaboration may be of interest (and benefit) to patients with NAHP. Aim 2 evaluated the extent to which an interdisciplinary evaluation between a physical therapist and surgeon influenced treatment decisions of persons presenting to a hip preservation clinic for NAHP. The decision to include physical therapy in the final treatment plan did not differ between participants who received an interdisciplinary evaluation compared to those who received a standard evaluation. Interdisciplinary evaluation appeared to have the largest effect on physical therapy treatment decisions for patients who were not initially interested in physical therapy. Consultation with a physical therapist may increase knowledge and understanding of potential physical therapy benefits for patients with NAHP. The addition of a physical therapist to the evaluation did not further reduce or increase decisional conflict of patients, which significantly reduced for both groups. Providers should consider if, and why, a patient may be conflicted and consider his or her treatment preferences in the joint decision-making process. Aim 3 investigated factors that contributed to treatment pathway for persons with NAHP after evaluation in a hip preservation clinic. Participant experience with physical therapy was the only category that significantly predicted inclusion of physical therapy in the final treatment plan. Significant predictors included interest in physical therapy prior to evaluation, interdisciplinary evaluation that included a physical therapist, and lack of previous physical therapy. Physical therapists clearly impact treatment plans of patients with NAHP presenting to a surgical clinic and should be included in treatment planning for patients who may benefit from physical therapy treatment. Overall, interdisciplinary evaluation with a physical therapist and orthopaedic surgeon is feasible, and impactful for patients with NAHP considering physical therapy treatment.