Development of a patient decision aid for children and adolescents following anterior cruciate ligament rupture: an international mixed-methods study

Authors

Andrew R. Gamble, The University of Sydney School of Health Sciences
Marnee J. McKay, The University of Sydney School of Health Sciences
David B. Anderson, The University of Sydney School of Health Sciences
Evangelos Pappas, The University of Sydney School of Health Sciences
Ignatius Alvarez Cooper, Griffith University
Sophie Macpherson, The University of Sydney School of Health Sciences
Ian A. Harris, The University of Sydney
Stephanie R. Filbay, University of Melbourne
Kirsten McCaffery, The University of Sydney School of Public Health
Rachel Thompson, The University of Sydney School of Health Sciences
Tammy C. Hoffmann, Faculty of Health Sciences & Medicine
Christopher G. Maher, The University of Sydney
Joshua R. Zadro, The University of Sydney

Publication Name

BMJ Open

Abstract

Aim To develop and user test an evidence-based patient decision aid for children and adolescents who are considering anterior cruciate ligament (ACL) reconstruction. Design Mixed-methods study describing the development of a patient decision aid. Setting A draft decision aid was developed by a multidisciplinary steering group (including various types of health professionals and researchers, and consumers) informed by the best available evidence and existing patient decision aids. Participants People who ruptured their ACL when they were under 18 years old (ie, adolescents), their parents, and health professionals who manage these patients. Participants were recruited through social media and the network outreach of the steering group. Primary and secondary outcomes Semistructured interviews and questionnaires were used to gather feedback on the decision aid. The feedback was used to refine the decision aid and assess acceptability. An iterative cycle of interviews, refining the aid according to feedback and further interviews, was used. Interviews were analysed using reflexive thematic analysis. Results We conducted 32 interviews; 16 health professionals (12 physiotherapists, 4 orthopaedic surgeons) and 16 people who ruptured their ACL when they were under 18 years old (7 were adolescents and 9 were adults at the time of the interview). Parents participated in 8 interviews. Most health professionals, patients and parents rated the aid’s acceptability as good-to-excellent. Health professionals and patients agreed on most aspects of the decision aid, but some health professionals had differing views on non-surgical management, risk of harms, treatment protocols and evidence on benefits and harms. Conclusion Our patient decision aid is an acceptable tool to help children and adolescents choose an appropriate management option following ACL rupture with their parents and health professionals. A clinical trial evaluating the potential benefit of this tool for children and adolescents considering ACL reconstruction is warranted.

Open Access Status

This publication is not available as open access

Volume

14

Issue

4

Article Number

e081421