Shared decision-making: a physiotherapist’s perspective

Over the past year I’ve been working with a woman with diabetes in severe pain and with reduced mobility issues. By talking with her about issues beyond her biomedical needs and working with her setting clear goals and a plan, she has managed to loose over 10 stone and has come off all her pain and diabetes medication and now mostly walks unaided.

Recently I was presented with a 68 year old woman who was referred to me for physiotherapy to help alleviate her lower back pain and right lateral hip pain. The specific needs identified for this woman were to help her manage her pain, her reduced mobility, obesity and her low mood due to her situation. She had a diagnosis of Type 2 diabetes and her HbA1c level was 69mmol/mml.

As usual I completed my normal subjective assessment excluding any serious pathology. Through the assessment we highlighted the primary areas that the individual felt she needed support with. The primary goal set with the individual was to improve her mobility with the aim to not depend on a walking stick. We explored the issue regarding her weight, discussing how a change in this could help to improve her overall health including her mobility.

After seeing this person numerous times, it was apparent that she had many underlying psychosocial elements contributing to her pain and low mood. After attending my motivational interviewing training in August 2017 I was able to utilise these skills during assessments to discuss the issues and provide lots of positive affirmation and try to promote change.

I discussed this case with other colleagues, including senior physiotherapists, weight management physiotherapist , the persistent pain occupational therapist and a pain consultant. Through these discussions I was provided extra information on where I could direct the individual for further psychological support with the things we had discussed in her past.

By having a broader conversation and being asked about what mattered to her, beyond just her biomedical issues, she was able to share all her concerns and worries more openly. This then lead to a positive rapport. She felt that she was given support and the belief that she could manage a change in her lifestyle with a bit of hard work.

Together we set her some clear goals and with new motivation she managed to change her diet and increased her amount of daily exercise. I supported her by giving her a clear progressive exercise programme to facilitate her rehabilitation.

This approach has worked beyond our expectations. In less than one year she not only met all her initial goals, including losing 10 stone and significantly reducing her HbA1c level, but she has also come off all her pain and diabetes medication. But most importantly she is now walking around without her walking stick for most of the time.

The learning I took from this case is that it can be extremely beneficial, when indicated, to give the individual more time if your clinic list allows, to have a discussion beyond the biomedical. As can be seen with this example , having the time to discuss all her thoughts and concerns and taking a bio-psychosocial approach to her care really helped to build a positive rapport, which then helped her achieve her critical health gaols and importantly gave her back some control over her own health and care.

I feel that the skills learnt on my motivational interviewing training really enabled me to promote change in this individual’s care and lifestyle choices. I can’t recommend enough the benefits of shared decision-making.