Patient Preferences for Musculoskeletal Disorders

Overseen By Emily H Jaarsma, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Texas at Austin

Disqualifiers: Cognitive impairment, Severe psychiatric illness

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to understand how people choose imaging tests for musculoskeletal issues, such as arthritis or tendon problems. It will examine whether a structured discussion about the pros and cons of a test, known as a Diagnostic Advance Care Planning Discussion, increases confidence and reduces conflict in decision-making. Participants will either engage in a detailed conversation with a researcher or read brief information about the test, then provide feedback through a survey. Ideal participants are adults with non-traumatic musculoskeletal conditions, like carpal tunnel syndrome or osteoarthritis, who are seeking specialized care. This study is solely for research purposes and will not impact any medical treatment. As an unphased trial, it offers participants the chance to contribute to valuable research that could enhance decision-making processes for future patients.

Do I need to stop my current medications for this trial?

The trial does not require you to stop taking your current medications, as it focuses on decision-making about imaging tests and does not involve actual medical testing or treatment changes.

What prior data suggests that this protocol is safe?

A previous study showed that structured conversations about healthcare choices make patients feel more confident and less uncertain. These discussions focus on understanding what is important to each person and do not involve any medical procedures or tests.

There is no physical risk because participants only discuss hypothetical situations. These conversations are safe and help people think more clearly about their options. Participants will not undergo any medical tests, so there are no direct health risks. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores how structured conversations can impact decision-making for musculoskeletal disorders. Unlike traditional approaches, which often involve straightforward information delivery, the intervention here uses an Advance Care Planning-style conversation. This method helps participants understand their own values and goals regarding diagnostic tests. By focusing on personalized discussions, this trial aims to uncover whether such conversations can lead to more informed and value-consistent decisions for patients.

What evidence suggests that this trial's methods could be effective for decision-making in musculoskeletal imaging tests?

This trial will compare two approaches to discussing medical decisions. Participants in the intervention group will engage in a structured, scenario-based conversation simulating a diagnostic decision-making discussion. Research has shown that structured discussions can help patients feel more confident and less uncertain. For example, advanced practice physiotherapists use these discussions to diagnose and treat muscle and joint problems. These conversations focus on patients' values and preferences, leading to better choices. Studies have found that such discussions help patients understand the pros and cons of medical tests or treatments. Although this trial doesn't involve medical testing, past evidence supports the effectiveness of these value-focused talks in making healthcare decisions. ^{1 5 6 7 8}

Who Is on the Research Team?

David Ring, MD

Principal Investigator

Dell Medical School, University of Texas at Austin, TX, United States

Are You a Good Fit for This Trial?

This trial is for adults with musculoskeletal issues like arthritis, tendonitis, or nerve compression who are visiting a specialty clinic. It's not for actual medical testing but to understand decision-making preferences regarding diagnostic imaging tests.

Inclusion Criteria

English literacy

Seeking musculoskeletal specialty care

I am 18 years old or older.

Exclusion Criteria

Severe psychiatric illness that would interfere with participation in the scenario-based discussion or completion of the survey instruments

I do not have any mental or physical conditions that would prevent me from discussing scenarios or completing surveys.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

Intervention

Participants engage in a structured conversation or receive brief written information about a proposed diagnostic imaging test

1 session

1 visit (in-person)

Survey

Participants complete a survey to measure enthusiasm and decisional conflict regarding the diagnostic test

Immediately following intervention

Follow-up

Participants are monitored for any changes in decision-making confidence and preferences

Not specified

What Are the Treatments Tested in This Trial?

Interventions

• Diagnostic Advance Care Planning Discussion

Trial Overview The study compares the effects of a structured conversation about the pros and cons of imaging tests versus just reading written information on patients' willingness and confidence in deciding whether to undergo such tests.

How Is the Trial Designed?

Group I: Intervention (Group 1) Experimental Treatment 1 Intervention

Participants randomized to the intervention group will engage in a structured, scenario-based conversation simulating a diagnostic decision-making discussion. This conversation will be guided by a trained researcher using branching scripted prompts designed to reflect an Advance Care Planning (ACP)-style approach. The discussion will explore the participant's values, goals, and understanding of potential benefits and harms of the proposed hypothetical imaging test. No actual diagnostic tests will be ordered.

Group II: Control (Group 2) Active Control 1 Intervention

Participants randomized to the control group will receive the same hypothetical clinical scenario, including mention of a proposed diagnostic imaging test. Instead of a structured discussion, they will be presented with a brief, standardized informational statement describing what the test involves, what it may show, and general risks or limitations. No values-based discussion or simulated conversation will occur.

Who Is Running the Clinical Trial?

University of Texas at Austin

Lead Sponsor

Trials

387

Recruited

86,100+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12541268/

Clinical and Economic Outcomes Associated With ... Timely assessment and early use of physical therapy (PT) can improve musculoskeletal functional status and health outcomes and avoid unnecessary ...

2. implementationscience.biomedcentral.com implementationscience.biomedcentral.com/articles/10.1186/s13012-019-0931-1

Implementation interventions for musculoskeletal programs of ... Implementing programs of care to manage musculoskeletal disorders can be challenging in complex healthcare systems such as in the military.

3. jmir.org jmir.org/2024/1/e52964/

Investigating the Use of Telemedicine by Health Care ... This study aims to appraise the evidence on diagnostic and treatment plan concordance between remote assessment using synchronous or asynchronous forms of ...

4. sciencedirect.com sciencedirect.com/science/article/pii/S1836955323000814

Advanced practice physiotherapists can diagnose and ... Advanced practice physiotherapists can diagnose and triage patients with musculoskeletal disorders while providing effective care: a systematic review.

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11748281/

Evaluation of musculoskeletal complaints, treatment ... This study evaluates MSK management, gender differences, and patient perceptions in Jordanian family medicine clinics, aiming to improve care strategies and ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12126469/

Advancing Musculoskeletal Care Using AI and Digital Health ... AI and digital health (DH) solutions are reshaping musculoskeletal (MSK) care across diagnostics, treatment planning, workflow optimization, and administrative ...

7. sciencedirect.com sciencedirect.com/science/article/pii/S2666756825000261

Addressing the growing burden of musculoskeletal ... The prevalence of musculoskeletal diseases such as osteoarthritis, osteoporosis, sarcopenia, and rheumatoid arthritis is rising sharply with global ageing.

8. link.springer.com link.springer.com/article/10.1007/s10926-024-10175-1

Electronic Health Records for Predicting Outcomes to Work ... Predicting outcomes of all MSK disorders using EHRs has been researched in 6 studies, with only 3 focusing on MSK therapists and 4 addressing WMSDs.