Background | Publications | Research group leaders
The purpose of the research project is to promote awareness of shared decision making and conduct clinical, comparative research on and around the topic.
The project provides reviews concerning shared decision making in general as well as its role in the treatment of certain injuries and diseases.
Furthermore, the project conducts clinical research on patient values, views and expectations as well as on the quality of shared decision making in orthopaedic disorders. The research will also assess the validity of different audiovisual aids in the decision making process.
Background
The myriad of randomized controlled trials published in orthopaedics and traumatology during the past decade have challenged the conventional decision making process followed in the specialty concerning the choice between surgical and non-surgical treatment.
Traditionally, orthopaedic decision making has leaned on the doctor’s view and previous experience of which treatment regimen is more reasonable. This has been mainly due to radiological and patient-related factors. In addition, the choice of treatment regimen has been heavily influenced by new implants on the market. Their adoption has been a most welcome development, although on occasion they have been used even too enthusiastically. The decision making has suffered from lack of research evidence informing the process.
In orthopaedic and traumatological research treatment outcome can be evaluated using a variety of different measures. These include, for instance, pain, bone nonunion, reoperation, complications, functional outcome, quality of life as well as return to work and overall satisfaction. Recent high-quality research evidence has shown that for quite many injuries or diseases there is no one best treatment regimen. This is due to the fact that very often succesful non-surgical treatment and surgical treatment both lead to almost equally good functional outcomes, but surgical treatment is associated with more complications. On the other hand, surgical treatment of for instance fractures provides higher probability of bone union along with possibly faster recovery in short-term follow-up. Furthermore, studies have employed numerous different outcome variables, so the heterogeneity of results makes consistent analysis between studies difficult.
Therefore, the superiority between treatment options is ultimately decided by patient-related considerations: what is valued most, and what is most important to the patient. This is fostered by shared decision making.
Publications
Review article (in Finnish with English summary): Treatment of Midshaft Clavicle Fractures in the 2020s – Towards Shared Decision Making
The treatment of midshaft clavicle fractures has been revolutionized during the 21st century. The contemporary view, which is based on numerous randomized clinical trials, is that there is no clear better option between surgical and non-surgical treatment of clavicle fractures. Each treatment has its own potential benefits and risks, and when making the treatment decision it is essential to take into consideration the patient’s views and wishes. In this article published in Suomen Lääkärilehti (Finnish Medical Journal) we review aspects relating to the treatment of midshaft clavicle fractures and factors relevant to the decision making process.
» https://www.laakarilehti.fi/tieteessa/katsausartikkeli/solisluun-keskiosan-murtumien-hoito-2020-luvulla-ndash-kohti-jaettua-paatoksentekoa/
A letter to the editor: Paradigm shift in orthopaedics: From objective superiority to shared decision making
It has been shown in randomized clinical trials that in the treatment of many orthopaedic injuries there is no clear objective superiority of one treatment option over another. In this commentary piece we provide a compact review of the changing landscape in orthopaedic decision making and discuss what kind of research is needed in future.
» https://www.injuryjournal.com/article/S0020-1383(21)00170-4/fulltext
Research project: Patient values, views and expectations in the choice of treatment regimen for musculoskeletal injuries (PANOs) – towards better tools for shared decision making
The purpose of the research is to examine patient values, expectations and wishes relating to the choice of treatment regimen and to treatment outcome in the most common fractures and injuries. In addition, the study seeks to investigate the patients’ experience of the role they have in the choice of treatment regimen.
Research group leaders
MD, PhD, Docent Aleksi Reito
Tampere University Hospital, TA3 (Operational Division 3), Musculoskeletal Centre
aleksi.reito@pshp.fi
twitter.com/AleksiReito
MD, PhD, Docent Antti Launonen
Tampere University Hospital, TA3 (Operational Division 3), Musculoskeletal Centre
antti.launonen@pshp.fi