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. 2016 May 20:16:56.
doi: 10.1186/s12874-016-0165-8.

Using the modified Delphi method to establish clinical consensus for the diagnosis and treatment of patients with rotator cuff pathology

Breda H Eubank  1 , Nicholas G Mohtadi  2   3 , Mark R Lafave  4 , J Preston Wiley  2 , Aaron J Bois  3 , Richard S Boorman  3 , David M Sheps  5
Affiliations

Using the modified Delphi method to establish clinical consensus for the diagnosis and treatment of patients with rotator cuff pathology

Breda H Eubank et al. BMC Med Res Methodol. .

Abstract

Background: Patients presenting to the healthcare system with rotator cuff pathology do not always receive high quality care. High quality care occurs when a patient receives care that is accessible, appropriate, acceptable, effective, efficient, and safe. The aim of this study was twofold: 1) to develop a clinical pathway algorithm that sets forth a stepwise process for making decisions about the diagnosis and treatment of rotator cuff pathology presenting to primary, secondary, and tertiary healthcare settings; and 2) to establish clinical practice guidelines for the diagnosis and treatment of rotator cuff pathology to inform decision-making processes within the algorithm.

Methods: A three-step modified Delphi method was used to establish consensus. Fourteen experts representing athletic therapy, physiotherapy, sport medicine, and orthopaedic surgery were invited to participate as the expert panel. In round 1, 123 best practice statements were distributed to the panel. Panel members were asked to mark "agree" or "disagree" beside each statement, and provide comments. The same voting method was again used for round 2. Round 3 consisted of a final face-to-face meeting.

Results: In round 1, statements were grouped and reduced to 44 statements that met consensus. In round 2, five statements reached consensus. In round 3, ten statements reached consensus. Consensus was reached for 59 statements representing five domains: screening, diagnosis, physical examination, investigations, and treatment. The final face-to-face meeting was also used to develop clinical pathway algorithms (i.e., clinical care pathways) for three types of rotator cuff pathology: acute, chronic, and acute-on-chronic.

Conclusion: This consensus guideline will help to standardize care, provide guidance on the diagnosis and treatment of rotator cuff pathology, and assist in clinical decision-making for all healthcare professionals.

Keywords: Delphi technique; algorithm; clinical practice guideline; consensus guideline; experts; rotator cuff.

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Figures

Fig. 1
Fig. 1
Modified Delphi methodology and results
Fig. 2
Fig. 2
Clinical management algorithm for acute rotator cuff pathology. Legend: *A trained shoulder expert is any primary, secondary, or allied healthcare practitioner who has the expertise and knowledge in musculoskeletal medicine to appropriately and accurately assess shoulder pathology
Fig. 3
Fig. 3
Clinical management algorithm for chronic and acute-on-chronic rotator cuff pathology. Legend: *A trained shoulder expert is any primary, secondary, or allied healthcare practitioner who has the expertise and knowledge in musculoskeletal medicine to appropriately and accurately assess shoulder pathology
See this image and copyright information in PMC

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