Shared Decision-Making and Patient Enablement in Outpatient Rehabilitation: An Observational Study

To examine the association between shared decision-making (SDM) and patient enablement in outpatient rehabilitation consultations.

In this observational cross-sectional study, 158 patients attending outpatient rehabilitation at four facilities in Japan were assessed, of whom 93 were included in the final analyses. Sociodemographic data, disease severity (modified Rankin Scale), treatment expectations, control preferences, and health literacy were collected via self-administered questionnaires. SDM was assessed using the SDM for Rehabilitation (SDM-Reha) scale, and patient enablement was assessed using the Patient Enablement Instrument (PEI). Linear mixed-effects models were used to examine the association between SDM-Reha and PEI, adjusting for age, sex, and disease severity (modified Rankin Scale [mRS]), with therapist ID included as a random effect to account for clustering.

The mean age was 68.3 years (SD = 12.5), and 50.5% were male. The mean SDM-Reha and PEI scores were 48.7 (SD = 7.0) and 5.3 (SD = 3.1), respectively. In the linear mixed-effects model adjusting for age, sex, and disease severity (modified Rankin Scale, mRS), SDM-Reha was significantly associated with PEI scores (β = 0.13, 95% CI 0.03-0.21, p = 0.012). Age, sex, and disease severity were not significantly associated with PEI.

Higher perceived SDM was associated with greater patient enablement in Japanese outpatient rehabilitation consultations. These findings suggest a potential relationship between rehabilitation decision-making experiences and patients' perceived ability to understand and manage their condition, but causal inferences are limited by the cross-sectional design.