Patient’s Perception of Autonomy Support and Shared Decision Making in Physical Therapy


Background: Shared Decision Making (SDM) is primarily intended to enhance patient autonomy. To date, the relationship between patients’ perceived levels of involvement and autonomy support has never been investigated in the field of physical therapy. Based on the recently reported extremely low level of observed SDM in physical therapy, similarly poor patient perceptions are expected. Objective: The main objectives of this study were to examine patients’ perceptions of SDM and autonomy support in physical therapy and to explore the relationship between both. Design: Patient survey after real consultations in physical therapy. Methods: Patients completed the Dyadic Observing Patient Involvement (Dyadic OPTION) instrument and the Health Care Climate Questionnaire (HCCQ) to examine patients’ perceived levels of SDM and autonomy support, respectively. Multilevel analyses were applied to determine the relationship between both perceptions. Results: Two hundred and twenty-nine patients, who were recruited by 13 physical therapists, agreed to participate. The median Dyadic OPTION score was 72.9 out of a total possible score of 100. The median HCCQ score was 94.3 out of a total possible score of 100. Patients’ experienced level of SDM (b = 0.14; p < 0.001) and patients’ age (b = 0.12; p = 0.001) contributed to patients’ perceived autonomy support. None of the physical therapist characteristics were related to patients’ perceived autonomy support. Limitations: Only 13 out of 125 therapists who were personally contacted agreed to participate. Conclusion: Using patients’ perceptions, we found that a relationship between SDM and autonomy support existed. In contrast to observational studies, our study also demonstrated that the participating physical therapists individually tailored patient support by adapting their implementation of SDM to each patient.

Share and Cite:

Devisch, I. , Dierckx, K. , Vandevelde, D. , Vriendt, P. and Deveugele, M. (2015) Patient’s Perception of Autonomy Support and Shared Decision Making in Physical Therapy. Open Journal of Preventive Medicine, 5, 387-399. doi: 10.4236/ojpm.2015.59043.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Moore, G.E. (2004) The Role of Exercise Prescription in Chronic Disease. British Journal of Sports Medicine, 38, 6-7.
[2] Dean, S.G., Smith, J.A., Payne, S. and Weinman, J. (2005) Managing Time: An Interpretative Phenomenological Analysis of Patients’ and Physiotherapists’ Perceptions of Adherence to Therapeutic Exercise for Low Back Pain. Disability and Rehabilitation, 27, 625-636.
[3] Hayden, J.A., van Tulder, M.W. and Tomlinson, G. (2005) Systematic Review: Strategies for Using Exercise Therapy to Improve Outcomes in Chronic Low Back Pain. Annals of Internal Medicine, 142, 776-785.
[4] Rhodes, R.E. and Fiala, B. (2009) Building Motivation and Sustainability into the Prescription and Recommendations for Physical Activity and Exercise Therapy: The Evidence. Physiotherapy Theory and Practice, 25, 424-441.
[5] Vermeire, E., Hearnshaw, H., Van, R.P. and Denekens, J. (2001) Patient Adherence to Treatment: Three Decades of Research. A Comprehensive Review. Journal of Clinical Pharmacy and Therapeutics, 26, 331-342.
[6] Williams, G.C. and Deci, E.L. (2001) Activating Patients for Smoking Cessation through Physician Autonomy Support. Med Care, 39, 813-823.
[7] Williams, G.C., Grow, V.M., Freedman, Z.R., Ryan, R.M. and Deci, E.L. (1996) Motivational Predictors of Weight Loss and Weight-Loss Maintenance. Journal of Personality and Social Psychology, 70, 115-126.
[8] Williams, G.C., McGregor, H.A., King, D., Nelson, C.C. and Glasgow, R.E. (2005) Variation in Perceived Competence, Glycemic Control, and Patient Satisfaction: Relationship to Autonomy Support from Physicians. Patient Education and Counseling, 57, 39-45.
[9] Hurkmans, E.J., Maes, S., de Gucht, V., Knittle, K., Peeters, A.J., Ronday, H.K., et al. (2010) Motivation as a Determinant of Physical Activity in Patients with Rheumatoid Arthritis. Arthritis Care & Research (Hoboken), 62, 371-377.
[10] Beauchamp, T.L. and Childress, J.F. (2001) Principles of Biomedical Ethics. 6th Edition, Oxford University Press, New York.
[11] Gauthier, C.C. (1993) Philosophical Foundations of Respect for Autonomy. Kennedy Institute of Ethics Journal, 3, 21-37.
[12] Charles, C., Gafni, A. and Whelan, T. (1997) Shared Decision-Making in the Medical Encounter: What Does It Mean? (Or It Takes at Least Two to Tango). Social Science & Medicine, 44, 681-692.
[13] Elwyn, G. and Miron-Shatz, T. (2010) Deliberation before Determination: The Definition and Evaluation of Good Decision Making. Health Expectations, 13, 139-147.
[14] Sandman, L. and Munthe, C. (2009) Shared Decision-Making and Patient Autonomy. Theoretical Medicine and Bioethics, 30, 289-310.
[15] Sandman, L., Granger, B.B., Ekman, I. and Munthe, C. (2011) Adherence, Shared Decision-Making and Patient Autonomy. Medicine, Health Care and Philosophy, 15, 115-127.
[16] Charles, C., Gafni, A. and Whelan, T. (1999) Decision-Making in the Physician-Patient Encounter: Revisiting the Shared Treatment Decision-Making Model. Social Science & Medicine, 49, 651-661.
[17] Madder, H. (1997) Existential Autonomy: Why Patients Should Make Their Own Choices. Journal of Medical Ethics, 23, 221-225.
[18] Swisher, L.L. (2002) A Retrospective Analysis of Ethics Knowledge in Physical Therapy (1970-2000). Physical Therapy, 82, 692-706.
[19] Ramsden, E.L. (1975) The Patient’s Right to Know. Implications for Interpersonal Communication Processes. Physical Therapy, 55, 133-138.
[20] Purtilo, R.B. (1988) Ethical Issues in Teamwork: The Context of Rehabilitation. Archives of Physical Medicine and Rehabilitation, 69, 318-322.
[21] Poulis, I. (2007) Bioethics and Physiotherapy. Journal of Medical Ethics, 33, 435-436.
[22] Delany, C.M., Edwards, I., Jensen, G.M. and Skinner, E. (2010) Closing the Gap between Ethics Knowledge and Practice through Active Engagement: An Applied Model of Physical Therapy Ethics. Physical Therapy, 90, 1068-1078.
[23] Dierckx, K., Deveugele, M., Roosen, P. and Devisch, I. (2013) Implementation of Shared Decision Making in Physical Therapy: Observed Level of Involvement and Patient Preference. Physical Therapy, 93, 1321-1330.
[24] Melbourne, E., Roberts, S., Durand, M.A., Newcombe, R., Legare, F. and Elwyn, G. (2011) Dyadic OPTION: Measuring Perceptions of Shared Decision-Making in Practice. Patient Education and Counseling, 83, 55-57.
[25] Saba, G.W., Wong, S.T., Schillinger, D., Fernandez, A., Somkin, C.P., Wilson, C.C., et al. (2006) Shared Decision Making and the Experience of Partnership in Primary Care. The Annals of Family Medicine, 4, 54-62.
[26] Elwyn, G., Edwards, A., Wensing, M., Hood, K., Atwell, C. and Grol, R. (2003) Shared Decision Making: Developing the OPTION Scale for Measuring Patient Involvement. Quality and Safety in Health Care, 12, 93-99.
[27] Elwyn, G., Edwards, A., Wensin, M. and Grol, R. (2005) Shared Decision Making. Measurement Using the OPTION Instrument. Cardiff University, Wales.
[28] Elwyn, G., Edwards, A., Hood, K., Robling, M., Wensing, M. and Grol, R. (2012) The OPTION-Instrument.
[29] Deci, E.L. and Ryan, R.M. (2013) Self-Determination Theory: An Approach to Human Motivation and Personality. University of Rochester.
[30] De Vries, A.M., de Roten, Y., Meystre, C., Passchier, J., Despland, J.N. and Stiefel, F. (2014) Clinician Characteristics, Communication, and Patient Outcome in Oncology: A Systematic Review. Psycho-Oncology, 23, 375-381.
[31] Bertakis, K.D. (2009) The Influence of Gender on the Doctor-Patient Interaction. Patient Education and Counseling, 76, 356-360.
[32] Barnsley, J., Williams, A.P., Cockerill, R. and Tanner, J. (1999) Physician Characteristics and the Physician-Patient Relationship. Impact of Sex, Year of Graduation, and Specialty. Canadian Family Physician, 45, 935-942.
[33] Cullati, S., Courvoisier, D.S., Charvet-Berard, A.I. and Perneger, T.V. (2011) Desire for Autonomy in Health Care Decisions: A General Population Survey. Patient Education and Counseling, 83, 134-138.
[34] Fiscella, K., Franks, P., Srinivasan, M., Kravitz, R.L. and Epstein, R. (2007) Ratings of Physician Communication by Real and Standardized Patients. The Annals of Family Medicine, 5, 151-158.
[35] Ludman, E.J., Simon, G.E., Rutter, C.M., Bauer, M.S. and Unutzer, J. (2002) A Measure for Assessing Patient Perception of Provider Support for Self-Management of Bipolar Disorder. Bipolar Disorders, 4, 249-253.
[36] Schmidt, K., Gensichen, J., Petersen, J.J., Szecsenyi, J., Walther, M., Williams, G., et al. (2012) Autonomy Support in Primary Care—Validation of the German Version of the Health Care Climate Questionnaire. Journal of Clinical Epidemiology, 65, 206-211.
[37] Carr-Hill, R.A. (1992) The Measurement of Patient Satisfaction. Journal of Public Health Medicine, 14, 236-249.
[38] Williams, G.C. and Deci, E.L. (1996) Internalization of Biopsychosocial Values by Medical Students: A Test of Self-Determination Theory. Journal of Personality and Social Psychology, 70, 767-779.
[39] van Vliet, L.M., van der Wall, E., Albada, A., Spreeuwenberg, P.M., Verheul, W. and Bensing, J.M. (2012) The Validity of Using Analogue Patients in Practitioner-Patient Communication Research: Systematic Review and Meta-Analysis. Journal of General Internal Medicine, 27, 1528-1543.
[40] Melbourne, E., Sinclair, K., Durand, M.A., Legare, F. and Elwyn, G. (2010) Developing a Dyadic OPTION Scale to Measure Perceptions of Shared Decision Making. Patient Education and Counseling, 78, 177-183.
[41] Street Jr., R.L., Gordon, H. and Haidet, P. (2007) Physicians’ Communication and Perceptions of Patients: Is It How They Look, How They Talk, or Is It Just the Doctor? Social Science & Medicine, 65, 586-598.
[42] Fullwood, C., Kennedy, A., Rogers, A., Eden, M., Gardner, C., Protheroe, J., et al. (2013) Patients’ Experiences of Shared Decision Making in Primary Care Practices in the United Kingdom. Medical Decision Making, 33, 26-36.
[43] Mead, N., Bower, P. and Roland, M. (2008) The General Practice Assessment Questionnaire (GPAQ)—Development and Psychometric Characteristics. BMC Family Practice, 9, 13.

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.