Development of a patient decision aid for children and adolescents following anterior cruciate ligament rupture: an international mixed-methods study
Andrew Gamble1, Marnee McKay1, Evangelos Pappas3, Ignatius Cooper4, David Anderson1, Ian Harris2,5, Rachel Thompson7, Kirsten McCaffery6, Tammy Hoffmann8, Chris Maher2, Josh Zadro2 1The University of Sydney, Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, Sydney, NSW, Australia2Sydney Institute for Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia3The University of Wollongong, School of Medicine and Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia4Queensland University of Technology, Discipline of Physiothearpy, School of Health Sciences, Faculty of Medicine and Health, Brisbane City, QLD, Australia5Ingham Institute for Applied Medical Research, Southwestern Sydney Clinical School, UNSW Sydney, Sydney, NSW, Australia6The University of Sydney, Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, Sydney, NSW, Australia7The University of Sydney, Discipline of Behavioural and Social Sciences in Health, School of Health Sciences, Faculty of Medicine and Health, Sydney, NSW, Australia8Bond University, Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Robina, QLD, Australia
Abstract
Aim: To develop and test the usability of an evidence-based patient decision aid comparing management options for children and adolescents following anterior cruciate ligament (ACL) rupture.
Design: Mixed-methods study describing the development of a patient decision aid.
Methods: A draft decision aid was developed using guidance from a multidisciplinary steering group and existing patient decision aids. Children and adolescents who previously ruptured their ACL when <18 years-old, but are now >18 years of age, parents and health professionals managing ACL ruptures were recruited through social media for a semi-structured interview. The decision aid was updated following interviews and feedback was analysed using reflexive thematic analysis. Questionnaire data were analysed descriptively.
Results: A total of 32 interviews were completed; 16 people who had ruptured their ACL (7 children, 9 adults), 8 parents and 16 health professionals (12 physiotherapists, 4 orthopaedic surgeons). Most participants agreed on the content and rated the aid’s acceptability as good or excellent. There was some disagreement from health professionals on the evidence for non-surgical management.
Conclusion: Our patient decision aid is an acceptable tool and mostly aligns with the views of key stakeholders.
Key Practice Points:
•The patient decision aid is an acceptable resource to facilitate shared decision making between children and adolescents, their parents and health professionals following ACL rupture.
•Equitable access to simple evidence-based information is valued by children, adults, and their parents.
•Psychological and social support, and positive language despite uncertainty was identified as important by children, adults, and their parents.
Biography
Andrew has worked as a musculoskeletal physiotherapist in private practice and with sporting teams for over 9 years. He is now teaching into the Physiotherapy program at Sydney University; recently receiving a Sydney School of Health Sciences Teaching Award in 2022. Andrew began his PhD in 2021 on improving outcomes following ACL rupture and promoting evidence-based care. Andrew’s recent publications include a systematic review comparing the amount of supervision needed in ACL rehabilitation, and a content analysis of online information on ACL management, which he presented at the 4th World congress of Sports Physical Therapy in Denmark in 2022.