Evidence map›Paper›PMID 41845305›Full record

ArticleBMC medical informatics and decision making2026

Exploring implementation of a shared decision-making intervention for patients following an Anterior Cruciate Ligament rupture: a qualitative investigation.

Hayley M Carter, David J Beard, Charlotte Dodsley, Paul Leighton, Joshua McCallion, Fiona Moffatt, Benjamin E Smith, Kate E Webster, Pip Logan

Abstract read
In one paragraph

Article in BMC medical informatics and decision making, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Hayley M CarterPhysiotherapy Outpatients, Level 3, Florence Nightingale Community Hospital, Derby, DE1 2QY, UK. hayley.carter1@nhs.net.ORCID 0000-0002-0837-0802
David J BeardSurgical Intervention Trials Unit, Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK.
Charlotte DodsleyPatient representative, The POP-ACLR Study, Derby, UK.
Paul LeightonSchool of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2UH, UK.
Joshua McCallionPatient representative, The POP-ACLR Study, Derby, UK.
Fiona MoffattSchool of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK.
Benjamin E SmithPhysiotherapy Outpatients, Level 3, Florence Nightingale Community Hospital, Derby, DE1 2QY, UK.
Kate E WebsterSchool of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia.
Pip LoganSchool of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2UH, UK.

Funding

NIHR NIHR302104
6 · The paper itself

Abstract

backgroundAnterior Cruciate Ligament (ACL) ruptures affect over 20,000 individuals in the UK each year. To date, three randomised controlled trials have compared the two main treatment options of surgical and non-surgical management following rupture and report conflicting findings. Recent qualitative research has also reported uncertainty and confusion among patients regarding decision-making about their choice of treatment. A theory- and evidence-based shared decision-making intervention was co-developed in a prior study to support patients to decide on treatment. The aim of this study was to understand implementation factors associated with implementing a shared decision-making intervention for patients following an anterior cruciate ligament (ACL) rupture.

methodsIndividual qualitative interviews, analysed using a framework approach underpinned by the Extended Normalisation Process Theory (ENPT). Data were mapped to the four ENPT constructs: potential, capacity, capability and contribution. Conducted as part of a non-randomised feasibility study in an orthopaedic and physiotherapy service at an acute National Health Service Teaching Hospital in the Midlands, UK. Five patients with a first time ACL rupture and five physiotherapists with experience of using the shared decision-making intervention.

resultsImplementation factors, including barriers and enablers to future implementation and normalisation, associated with implementing a shared decision-making intervention for patients following ACL rupture have been identified and mapped to ENPT. Both patients and physiotherapists demonstrated a clear understanding of the SDM intervention’s purpose (coherence) and individual intention to operationalise it within the pathway (potential, capacity). The intervention was further discussed to support interactional work between patients and clinicians during consultations and physiotherapists were positive about its workability and adaptability to meet patients’ needs (capability). Physiotherapists described the intervention’s role in altering the social roles of both themselves and of patients, which supported the set-up and action of SDM conversations (capacity). The communication of equipoise and context created for intervention delivery was identified to be critical to engagement (potential). The intervention was described as non-burdensome, patient participants reported they would recommend it to others following diagnosis of an ACL rupture and physiotherapist participants described utilising the intervention with patients outside the trial (contribution, capability).

conclusionImplementation factors, explored through the lens of ENPT, have supported understanding of future normalisation of the intervention in clinical practice. Areas of focus ahead of further research, for example understanding equipoise, have also been identified.

trial registrationISRCTN17801081. Registration date: 23.01.2024.

Indexed as

Anterior Cruciate Ligament InjuriesDecision Making, SharedPatient ParticipationAdultFemaleHumansMaleQualitative ResearchRuptureUnited KingdomAnterior cruciate ligamentExtended normalisation process theoryFeasibility studyImplementation factorsShared decision-making

Identifiers

PMID41845305
PMCPMC13107614

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.