The systematic and participatory development of a patient decision aid about terminal devices for people with upper limb absence: The PDA-TULA.
Nienke Kerver, Laura Boerema, Michael A H Brouwers and 2 others
PMID 36943778WHAT IT FOUND
A decision aid for upper limb terminal devices was built into prescribing software after stakeholder feedback.
It is designed to help patients compare preferences with device categories, but its effect on choices or acceptance is untested.
Key findings
01A digital patient decision aid for terminal devices was developed for adults with unilateral upper limb absence at the wrist or more proximal level and integrated into a national prosthesis prescribing protocol.
02The aid guides patients through terminal device information, personal values, and comparison with device category profiles, then generates a summary for consultation.
03The aid does not select a terminal device or use an algorithm; it creates a personal profile for discussion with clinicians.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The aid was not tested for effectiveness, so there is no evidence it improves patient choices, shared decision-making, or prosthesis acceptance. The authors could not examine whether it increases prosthesis acceptance because Dutch rejection rates before the aid was introduced were unknown. People who cannot read Dutch, speak Dutch, or use digital tools may need assistance to use the aid. The aid focuses on terminal devices and does not fully support decisions about wrist, harness, or socket options. Some subjective device ratings were based on expert opinion because scientific evidence was lacking. The paper reports alpha testing by stakeholders; beta testing and patient outcomes are not described here.
The easy way to misread this
Do not conclude that the decision aid improves prosthesis choices or acceptance. The paper reports development and alpha testing, and states that effectiveness was not tested yet.