I continue discussing an excellent editorial published in the BJJ. Alex Trompeter writes:
We are now seeing the pendulum swing in terms of treatments we select, as our understanding of the science of fracture fixation improves. More
A. Trompeter 2020
important, however, is the recognition that the patient’s own experience is the most vital outcome when measuring the success of a treatment. No
longer is the radiograph showing a superb fixation, or the number of degrees of movement of a joint what really matters. Whether we have restored the patient’s quality of life, as defined by them, is what counts more than any other measure.
Basically Mr Trompeter writes about shared decision making. I couldn’t agree more. I am a huge fan of SDM and I´m sure SDM is the future in orthopaedics also. I have written about this many times earlier, here and here.
SDM and patient involvement is just as Mr Trumpeter says. Patient does not value superb fixation seen in postoperative radiograph. Nor they value certain joint ROM. Each patient has his/her personal values and preferences. Only way to assess them is by talking with the patient. The aim of SDM is to align patient values and preferences with possible outcomes included in certain treatment option. Operative treatment may sometimes results to faster return to work and sports but along comes possible surgical related risks. Patient may not value time to work at all but favor safer and less risky treatment options. The role of SDM is to acknowledge this thereby hopefully increasing patient satisfaction and adherence. This should be a focus in future studies.
SDM remains seriously under-investigated concept in orthopaedics and traumatology although some authors have done excellent work. I´ll keep blogging about SDM in orthopaedics and maybe I´ll reveal also some serious research efforts related to this topic.