Shared decision-making in pediatric physical therapy: A qualitative study among adolescents, parents, and physical therapists.

Shared decision making, the idea that patients and clinicians decide together on care, is widely encouraged in healthcare, but in pediatric physical therapy there has been no clear structure for how or when to involve children and parents. This study explored that gap through focus groups with adolescents, parents, and pediatric physical therapists, later checked against a wider survey of therapists, to understand how shared decision making actually happens, or could happen, in practice. Participants described that shared decision making could start as early as intake and goal setting, with children and parents staying involved as therapy continues, tailored to each family. Reported barriers included limited time and the difficulty of balancing different people's views, while a flexible, supportive practice culture helped.

The researchers used these insights to adapt an existing shared decision making model for pediatric physical therapy and to propose implementation strategies. As a qualitative study, it reflects participants' experiences and opinions rather than a tested measure of improved outcomes.

If you're a parent bringing a child to physical therapy, or a teenager attending sessions yourself, you may wonder how much say you actually get in decisions about treatment. This study looked at that question by talking with adolescents, parents, and pediatric physical therapists in focus groups, then checking the findings with a larger survey of therapists. People described that decisions could start being shared from the very first appointment, when goals for therapy are being set, and that this involvement could continue throughout treatment, adjusted to what works for each family.

Things that got in the way included therapists having limited time and the challenge of weighing multiple people's opinions together, while a supportive, flexible clinic environment made shared decisions easier. Because this is a qualitative study based on people's experiences and opinions rather than a trial measuring outcomes, it does not tell us whether shared decision making actually improves therapy results. Instead, it offers a starting framework describing how such conversations might be structured and supported in practice.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This paper addresses a practical uncertainty in pediatric physical therapy: there has been no structured guidance for how and when to involve children and parents in shared decision making during primary care treatment. The researchers conducted six focus groups, two each with adolescents aged 12 to 18, parents of children aged 4 to 18, and pediatric physical therapists, then validated themes through a survey of 46 pediatric therapists.

Barriers and facilitators were mapped using the Consolidated Framework for Implementation Research. Themes suggested shared decision making could reasonably begin at intake and goal setting, continuing throughout therapy with individualized involvement, and that discussions about treatment frequency, duration, homework, and expectations were areas where options could be compared. Reported barriers included time constraints and difficulty balancing multiple perspectives, while facilitators included adaptability per family and a supportive team culture.

The team then adapted a goal-based shared decision making model and proposed implementation strategies such as professional training, SDM tools, and team culture support. As qualitative research, these findings describe stakeholder perspectives and feasibility considerations rather than measured treatment effects, so they cannot establish that implementing shared decision making improves clinical outcomes, and applicability may vary across settings and family contexts.