A modified Delphi consensus study to identify UK osteopathic profession research priorities

Operating Department Practitioner's research priorities: A Delphi study

With the 2022 Allied Health Professions' Research and Innovation Strategy and the College of Operating Department Practitioners joining the Council for Allied Health Professions Research, understanding the Operating Department Practitioner profession's vision for research and innovation and identifying its research priorities has become important. This Delphi study aimed to establish research priorities for the Operating Department Practitioner profession. Questionnaires were distributed to Operating Department Practitioners using College of Operating Department Practitioners and social media networks. Round 1 saw 49 eligible responses; this reduced to 21 in Round 2 and 17 in Round 3. Thirty-one research priorities were identified by consensus. Priority rank was determined by mean score, percentage agreement, and coefficient of variance. By reaching a consensus, Operating Department Practitioners co-created research priorities and identified several themes that will contribute to professional development and patient care and support funding opportunities. The five key themes were Workforce Transformation, Education, Patient Safety and Experience, Innovation and Technology, and Theatre Culture.

Promotion of sports, exercise and physical activity participation during postoperative interventions for adolescent idiopathic scoliosis: protocol for an international e-Delphi study

INTRODUCTION

Adolescent idiopathic scoliosis (AIS) is present in 2%-3% of those under 18 years old and has a significant impact on pain, function and quality of life. Up to 10% of adolescents with AIS progress to spinal fusion surgery, and of those individuals many experience reduced musculoskeletal function and do not return to sports postoperatively. Physiotherapists have a significant role in promoting participation and offering a graded return to sports, exercise and physical activity. However, there is a lack of evidence and variability between surgeons and physiotherapists worldwide regarding rehabilitation milestones and return to exercise, sports and physical activity. This study aims to reach a consensus on when it is safe and how an individual might begin a graded return to sports, exercise and physical activity.

METHODS AND ANALYSIS

This protocol was written in accordance with the Guidance on Conducting and REporting DElphi Studies (CREDES) guidelines. An international expert sample of surgeons and physiotherapists in AIS will be recruited. This electronic Delphi is anticipated to consist of three iterative rounds. Round 1 will be a series of open-ended questions examining rehabilitation milestones and return to sports, exercise and physical activity postoperatively. Round 2 will commence with a summary of the existing literature for participants to review. Rounds 2 and 3 will involve a collated summary of results from the previous round, including any dissonance. During rounds 2 and 3, participants will be asked to privately rate responses on a 5-point Likert scale. The study steering group and patient and public involvement representative have been involved from conceptualisation and will continue to be involved until final dissemination.

ETHICS AND DISSEMINATION

Full ethical approval has been provided by the University of Birmingham, reference number: ERN_1617-Nov2023. Dissemination will take place through conference presentation and peer-reviewed publications.

Conservative management for lumbar radiculopathy based on the stage of the disorder: a Delphi study

PURPOSE

Conservative management of lumbar radiculopathy (LR) is the first treatment option. To date, systematic reviews and clinical practice guidelines have not considered the most appropriate timing of management. This study aimed to establish consensus on effective conservative treatment modalities across different stages (i.e., acute, sub-acute, or chronic) of LR.

MATERIALS AND METHODS

Through an iterative multistage Delphi process, experts rated agreement with proposed treatment modalities across stages of LR and could suggest additional treatment modalities. The agreement was measured using a 5-point Likert scale. Descriptive statistics were used to measure agreement (median, interquartile ranges, and percentage of agreement). Consensus criteria were defined a priori for each round.

RESULTS

Fourteen panelists produced a consensus list of effective treatment modalities across stages of LR. Acute stage management should focus on providing patients with information about the condition including pain education, individualized physical activity, and directional preference exercises, supported with NSAIDs. In the sub-acute stage, strength training and neurodynamic mobilization could be added and transforaminal/epidural injections considered. In the chronic stage, spinal manipulative therapy, specific exercise, and function-specific physical training should be combined with individualized vocational, ergonomic and postural advice.

CONCLUSIONS

Experts agree effectiveness of interventions differs through the evolution of LR.IMPLICATIONS FOR REHABILITATIONTo date clinical guideline for conservative management of lumbar radiculopathy do not consider the evolution of the condition.Acute stage management of lumbar radiculopathy should focus on providing information about the condition and support individualized physical activity with pain medication.Sub-acute management should add neurodynamic mobilization to strength training, while transforaminal and/or epidural injections could be considered.Chronic stage management should consider spinal manipulative therapy and focus on restoring personalized functional capacity.

Possible solutions to enhance evidence-based practice proposed by rehabilitation professionals in Japan: a Delphi study

[Purpose] We aimed to identify possible solutions to enhance evidence-based practice (EBP) in rehabilitation professionals in Japan. [Participants and Methods] A three-round Delphi method was undertaken among a cohort of clinical therapists (328 physical therapists, 55 occupational therapists, and 6 speech therapists). In the first round, the participants listed possible solutions for promoting EBP, other than 12 solutions presented in a previous study; subsequently, a new list was created. In the second round, a newly-created list of solutions was presented, and the participants responded on a 5-point Likert scale on how much they agreed with the solutions promoting EBP in Japanese rehabilitation professionals. In the third round, the distribution of responses obtained in the second round was presented, and participant's agreement was again assessed on a 5-point Likert scale. [Results] Across the three rounds, data were collected from 33.7% to 47.0% of all eligible participants. After the first round, 17 possible solutions were developed, and a list of 29 solutions was used in the second round. After the third round, 10 solutions reached the predetermined criteria for consensus. [Conclusion] In this study, ten possible solutions to promote EBP were proposed by the Japanese rehabilitation professionals.

Classification criteria for cervical radiculopathy: An international e-Delphi study

BACKGROUND

Establishing a set of uniform classification criteria (CC) for cervical radiculopathy (CR) is required to aid future recruitment of homogenous populations to clinical trials.

OBJECTIVES

To establish expert informed consensus on CC for CR.

DESIGN

A pre-defined four round e-Delphi study in accordance with the guidance on Conducting and Reporting Delphi Studies.

METHODS

Individuals with a background in physiotherapy who had authored two or more peer-reviewed publications on CR were invited to participate. The initial round asked opinions on CC for CR. Content analysis was performed on round one output and a list of discrete items were generated forming the round two survey. In rounds two to four, participants were asked to rate the level of importance of each item on a six-point Likert scale. Data were analysed descriptively using median, interquartile range and percentage agreement. Items reaching pre-defined consensus criteria were carried forward to the next round. Items remaining after the fourth round constituted expert consensus on CC for CR.

RESULTS

Twelve participants participated with one drop out. The final round identified one inclusion CC and 12 exclusion CC. The inclusion CC that remained achieved 82% agreement and was a cluster criterion consisting of radicular pain with arm pain worse than neck pain; paraesthesia or numbness and/or weakness and/or altered reflex; MRI confirmed nerve root compression compatible with clinical findings.

CONCLUSIONS

The CC identified can be used to inform eligibility criteria for future CR trials although caution should be practiced as consensus on measurement tools requires further investigation.

Timing of Evidence-Based Nonsurgical Interventions as Part of Multimodal Treatment Guidelines for the Management of Cervical Radiculopathy: A Delphi Study

OBJECTIVE

Conservative management of cervical radiculopathy (CR) is a first treatment option because the risk-benefit ratio for surgery is less favorable. Systematic reviews and clinical practice guidelines reporting on the effectiveness of nonsurgical management have not considered the timing of management. The aim of this study was to establish consensus on effective nonsurgical treatment modalities at different stages (ie, acute, subacute, or chronic) of CR using the Delphi method approach.

METHODS

Through an iterative multistage process, experts within the field rated their agreement with a list of proposed treatment modalities according to the stage of CR and could suggest missing treatment modalities. Agreement was measured using a 5-point Likert scale. Descriptive statistics were used to measure agreement (median, interquartile ranges, and percentage of agreement). Consensus criteria were defined a priori for each round. Consensus for Round 3 was based on ≥2 of the following: a median Likert scale value of ≥4, interquartile range value of ≤1, and/or a percentage of agreement ≥70%.

RESULTS

Data analysis produced a consensus list of effective treatment modalities in different stages of recovery.

CONCLUSION

According to experts, the focus of multimodal management in the acute stage should consist of patient education and spinal manipulative therapy, specific (foraminal opening) exercises, and sustained pain-relieving positions. In the subacute stage, increasing individualized physical activity including supervised motor control, specific exercises, and/or neurodynamic mobilization could be added. In the chronic stage, focus should shift to include general aerobic exercise as well as focused strength training. Postural education and vocational ergonomic assessment should also be considered.

IMPACT

Multimodal conservative management of individuals with CR should take the stage of the condition into consideration. The focus of therapeutic interventions should shift from passive pain-relieving intervention in the acute stage to increasingly more individualized physical activity and self-management in the chronic stage.

Identifying priorities for sport and physical activity research in Canada: an iterative priority-setting study

BACKGROUND

There is a need for better alignment between research on sport and physical activity and the needs of those who are in a position to implement the findings. To facilitate advancement and alignment, we identified the top research priorities of sport and physical activity knowledge users from various sectors.

METHODS

For this priority-setting study, we used an iterative process of data collection and analysis. Sport and physical activity knowledge users from multiple sectors participated in a workshop (September 2019), which included small working group exercises followed by large-group syntheses leading to the identification of issues that required better understanding. We then sent an online questionnaire to participants for content validation and interim prioritization, to reduce the number of priorities (December 2019 to January 2020). A new questionnaire containing a shortened list of research priorities was sent to an expanded group of respondents to further streamline the list of priorities (January-March 2020).

RESULTS

The 24 workshop participants identified 68 issues, of which 21 were retained by the 18 participants in the interim priority-setting questionnaire. The final prioritization questionnaire was completed by 33 stakeholder groups; this step produced a final list of 8 top research priorities. The final priorities identified for sport and physical activity research related to financial support, suboptimal promotion, dropout, best interventions, participation among Indigenous populations, volunteer engagement, safe and inclusive experiences, and knowledge exchange.

INTERPRETATION

The 8 priorities identified in this study provide guidance to Canadian sport and physical activity researchers. Research efforts on these priorities will reflect pressing issues as identified by representatives of all sport and physical activity sectors.

Timing of evidence-based non-surgical interventions as part of multimodal treatment guidelines for the management of cervical radiculopathy: a Delphi study protocol

INTRODUCTION

Cervical radiculopathy (CR) is a clinical condition whereby motor, reflex and/or sensory changes such as radicular pain, paraesthaesia or numbness can exist. Conservative management is a preferred first treatment option as the risk-benefit ratio for surgery is less favourable. Systematic reviews and treatment guidelines gather evidence on the effectiveness of non-surgical management of patients with CR from randomised controlled trials, which do not consider the natural course of recovery to modify the management strategy accordingly. The aim of this study is to establish consensus on effective non-surgical treatment modalities for patients in different stages (acute, subacute and chronic) of CR, using the Delphi method approach.

METHODS AND ANALYSIS

Through an iterative multistage process, experts within the field will rate their agreement with a list of proposed treatment modalities and suggest any missing treatment modalities during each round. Agreement will be measured using a five-point Likert scale. Descriptive statistics will be used to measure agreement (median, IQR and percentage of agreement). Consensus criteria will be defined a priori for each round. Data analysis at the end of round three will produce a consensus list of effective treatment modalities for the management of patients with CR in different stages of recovery.

ETHICS AND DISSEMINATION

Ethical approval has been granted from the University of Birmingham ethics committee under ERN_20-1121. The study findings will be submitted to a peer-reviewed journal and to relevant conferences for dissemination of the study results.

A Delphi study to explore and gain consensus regarding the most important barriers and facilitators affecting physiotherapist and pharmacist non-medical prescribing

Non-medical prescribing was introduced into the United Kingdom to improve patient care, but early research indicated a third of Allied Health Professionals may not use their prescribing qualification. A previous literature review, highlighting factors influencing prescribing, identified only papers with nursing and pharmacy participants. This investigation explored consensus on factors affecting physiotherapist and pharmacist non-medical prescribers. A three round Delphi study was conducted with pharmacist and physiotherapist prescribers. Round One comprised information gathering on facilitators and barriers to prescribing participants had experienced, and underwent content analysis. This was followed by two sequential consensus seeking rounds with participants asked to rate the importance of statements to themselves. Consensus criteria were determined a priori, including median, interquartile range, percentage agreement and Kendall’s Coefficient of Concordance (W). Statements reaching consensus were ranked for importance in Round Three and analysed to produce top ten ranks for all participants and for each professional group. Participants, recruited October 2018, comprised 24 pharmacists and 18 physiotherapists. In Round One, content analysis of 172 statements regarding prescribing influences revealed 24 themes. 127 statements were included in Round Two for importance rating (barriers = 68, facilitators = 59). After Round Two, 29 statements reached consensus (barriers = 1, facilitators = 28), with no further statements reaching consensus following Round Three. The highest ranked statement in Round Three overall was: “Being able to prescribe to patients is more effective and really useful working [in my area]”. Medical support and improved patient care factors appeared the most important. Differences were noted between physiotherapist and pharmacist prescribers regarding the top ten ranked statements, for example team working which pharmacists ranked higher than physiotherapists. Differences may be explained by the variety of practice areas and relative newness of physiotherapy prescribing. Barriers appear to be post or person specific, whereas facilitators appear universal.

A Delphi study to establish consensus on an educational package of musculoskeletal clinical prediction rules for physiotherapy clinical educators

BACKGROUND

Clinical prediction rules (CPRs) are evidence-based tools to aid clinical decision-making, and there are many that are relevant for physiotherapists, especially in the musculoskeletal field. However, a lack of awareness and understanding by physiotherapy clinical educators could limit students' exposure to these potentially valuable tools. An educational package tailored for clinical educators could help them recognise the value of CPRs and implement them in clinical practice with students.

OBJECTIVES

To determine consensus on the essential content and optimal delivery of an educational package on musculoskeletal CPRs for physiotherapy clinical educators.

DESIGN

An online survey of physiotherapy experts who have published on CPRs, using a Delphi approach.

METHOD

Sixteen experts were recruited for a two-round reactive Delphi study in which they rated previously identified elements, as well as suggesting new items for an educational package.

FINDINGS

A pre-defined consensus of ≥70% identified that the content of an educational package should cover fundamental aspects of CPRs including why, when and how to use them clinically, and their limitations. Information on the evidence-base of different types of CPRs, with specific examples, was also identified as important. Online delivery was recommended via self-directed learning and webinars, along with electronic versions of actual CPRs. A self-assessment component was also supported.

CONCLUSIONS

An educational package on musculoskeletal CPRs for clinical educators was supported with key elements outlined by an international panel of experts.

IMPLICATIONS

Improving clinical educators' knowledge of CPRs may lead to physiotherapy students having a greater understanding and ability to use CPRs.

Research priorities to inform "Treat All" policy implementation for people living with HIV in sub-Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA)

INTRODUCTION

"Treat All" - the treatment of all people with HIV, irrespective of disease stage or CD4 cell count - represents a paradigm shift in HIV care that has the potential to end AIDS as a public health threat. With accelerating implementation of Treat All in sub-Saharan Africa (SSA), there is a need for a focused agenda and research to identify and inform strategies for promoting timely uptake of HIV treatment, retention in care, and sustained viral suppression and addressing bottlenecks impeding implementation.

METHODS

The Delphi approach was used to develop consensus around research priorities for Treat All implementation in SSA. Through an iterative process (June 2017 to March 2018), a set of research priorities was collectively formulated and refined by a technical working group and shared for review, deliberation and prioritization by more than 200 researchers, implementation experts, policy/decision-makers, and HIV community representatives in East, Central, Southern and West Africa.

RESULTS AND DISCUSSION

The process resulted in a list of nine research priorities for generating evidence to guide Treat All policies, implementation strategies and monitoring efforts. These priorities highlight the need for increased focus on adolescents, men, and those with mental health and substance use disorders - groups that remain underserved in SSA and for whom more effective testing, linkage and care strategies need to be identified. The priorities also reflect consensus on the need to: (1) generate accurate national and sub-national estimates of the size of key populations and describe those who remain underserved along the HIV-care continuum; (2) characterize the timeliness of HIV care and short- and long-term HIV care continuum outcomes, as well as factors influencing timely achievement of these outcomes; (3) estimate the incidence and prevalence of HIV-drug resistance and regimen switching; and (4) identify cost-effective and affordable service delivery models and strategies to optimize uptake and minimize gaps, disparities, and losses along the HIV-care continuum, particularly among underserved populations.

CONCLUSIONS

Reflecting consensus among a broad group of experts, researchers, policy- and decision-makers, PLWH, and other stakeholders, the resulting research priorities highlight important evidence gaps that are relevant for ministries of health, funders, normative bodies and research networks.

Scoping review of priority setting of research topics for musculoskeletal conditions

OBJECTIVE

Describe research methods used in priority-setting exercises for musculoskeletal conditions and synthesise the priorities identified.

DESIGN

Scoping review.

SETTING AND POPULATION

Studies that elicited the research priorities of patients/consumers, clinicians, researchers, policy-makers and/or funders for any musculoskeletal condition were included.

METHODS AND ANALYSIS

We searched MEDLINE and EMBASE from inception to November 2017 and the James Lind Alliance top 10 priorities, Cochrane Priority Setting Methods Group, and Cochrane Musculoskeletal and Back Groups review priority lists. The reported methods and research topics/questions identified were extracted, and a descriptive synthesis conducted.

RESULTS

Forty-nine articles fulfilled our inclusion criteria. Methodologies and stakeholders varied widely (26 included a mix of clinicians, consumers and others, 16 included only clinicians, 6 included only consumers or patients and in 1 participants were unclear). Only two (4%) reported any explicit inclusion criteria for priorities. We identified 294 broad research priorities from 37 articles and 246 specific research questions from 17 articles, although only four (24%) of the latter listed questions in an actionable format. Research priorities for osteoarthritis were identified most often (n=7), followed by rheumatoid arthritis (n=4), osteoporosis (n=4) and back pain (n=4). Nearly half of both broad and specific research priorities were focused on treatment interventions (n=116 and 111, respectively), while few were economic (n=8, 2.7% broad and n=1, 0.4% specific), implementation (n=6, 2% broad and n=4, 1.6% specific) or health services and systems research (n=15, 5.1% broad and n=9, 3.7% specific) priorities.

CONCLUSIONS

While many research priority-setting studies in the musculoskeletal field have been performed, methodological limitations and lack of actionable research questions limit their usefulness. Future studies should ensure they conform to good priority-setting practice to ensure that the generated priorities are of maximum value.

PROSPERO REGISTRATION NUMBER

CRD42017059250.

Research priorities of the Canadian chiropractic profession: a consensus study using a modified Delphi technique

Background

Research funds are limited and a healthcare profession that supports research activity should establish research priority areas. The study objective was to identify research priority areas for the Canadian chiropractic profession, and for stakeholders in the chiropractic profession to rank these in order of importance.

Methods

We conducted a modified Delphi consensus study between August 2015 and May 2017 to determine the views of Canadian chiropractic organisations (e.g. Canadian Chiropractic Association; provincial associations) and stakeholder groups (e.g. chiropractic educational institutions; researchers). Participants completed three online Delphi survey rounds. In Round 1, participants suggested research areas within four broad research themes: 1) Basic science; 2) Clinical; 3) Health services; and 4) Population health. In Round 2, researchers created sub-themes by categorising the areas suggested in Round 1, and participants judged the importance of the research sub-themes. We defined consensus as at least 70% of participants agreeing that a research area was "essential" or "very important". In Round 3, results from Round 2 were presented to the participants to re-evaluate the importance of sub-themes. Finally, participants completed an online pairwise ranking activity to determine the rank order of the list of important research sub-themes.

Results

Fifty-seven participants, of 85 people invited, completed Round 1 (response rate 67%). Fifty-six participants completed Round 2, 55 completed Round 3, and 53 completed the ranking activity. After three Delphi rounds and the pairwise ranking activity was completed, the ranked list of research sub-themes considered important were: 1) Integration of chiropractic care into multidisciplinary settings; 2) Costs and cost-effectiveness of chiropractic care; 3) Effect of chiropractic care on reducing medical services; 4) Effects of chiropractic care; 5) Safety/side effects of chiropractic care; 6) Chiropractic care for older adults; 7) Neurophysiological mechanisms and effects of spinal manipulative therapy; 8) General mechanisms and effects of spinal manipulative therapy.

Conclusions

This project identified research priority areas for the Canadian chiropractic profession. The top three priority areas were all in the area of health services research: 1) Integration of chiropractic care into multidisciplinary settings; 2) Costs and cost-effectiveness of chiropractic care; 3) Effect of chiropractic care on reducing medical services.

Development of an active behavioural physiotherapy intervention (ABPI) for acute whiplash-associated disorder (WAD) II management: a modified Delphi study

OBJECTIVE

To develop an active behavioural physiotherapy intervention (ABPI) for managing acute whiplash-associated disorder (WAD) II using a modified Delphi method to develop consensus for the basic features of the ABPI.

DESIGN

Modified Delphi study. Our systematic review and meta-analysis evaluating conservative management for acute WADII found that a combined ABPI may be a useful intervention to prevent patients progressing to chronicity. No previous research has considered a combined behavioural approach and active physiotherapy in the management of acute WADII patients. The ABPI was therefore developed using a rigorous consensus method using international research and local clinical whiplash experts. Descriptive statistics were used to assess consensus in each round.

SETTING

Online international survey.

PARTICIPANTS

A purposive sample of 97 potential participants (aiming to recruit n=30) consisting of international research whiplash experts, UK private physiotherapists and UK postgraduate musculoskeletal physiotherapy students were invited to participate via electronic mail with an attached participant information sheet and consent form.

RESULTS

36 individuals signed and returned the consent form. In round 1, 32/36 participants (response rate=89%, mean age±SD=36.03±13.22 years) across 8 countries (Australia, Finland, Greece, India, Netherlands, Norway, Sweden and UK) contributed to round 1 questionnaire. Response rates were 78% and 75% for rounds 2 and 3, respectively. Following round 3, 12 underlying principles (eg, return to normal function as soon as possible, pain management, encouragement of self-management, reduce fear avoidance and anxiety) achieved consensus. The treatment components reaching consensus included behavioural (eg, education, reassurance, self-management) and physiotherapy components (eg, exercises for stability and mobility). No passive intervention achieved consensus.

CONCLUSIONS

Experts suggested and agreed the underlying principles and treatment components of the ABPI for the management of acute WADII. The ABPI was underpinned by social cognitive theory focusing on self-efficacy enhancement prior to conducting a phase II trial.