Introduction The implementations of a structured consensus process can facilitate agreement among experts on varied and inconsistent clinical and educational practices. Recommendations exist for use of the Delphi consensus process in health care research. Most Delphi studies in orthotics and prosthetics research occurred after these recommendations were published, and it is unclear how closely these recommendations have been followed when applying this method. The aim of this review is to summarize the characteristics of Delphi processes in orthotics and prosthetics in order to guide future research. Materials and Methods A review was undertaken of published reports of Delphi processes used to research some aspect of the orthotics and prosthetics profession. Research methods were evaluated to identify and characterize features of the application of the Delphi process. These features were compared with the recommendations for Delphi processes in health care research. Results The application of the Delphi method in the 19 reviewed studies varied significantly in regards to topic, qualifications and number of experts, survey item creation, number of rounds, consensus requirements, outcomes, inclusion of a final conference, dropout rate, and final output. Although some studies closely followed the recommendations for the use of the Delphi method in health care, others deviated greatly. Conclusions Although the Delphi method is a common consensus process used in orthotics and prosthetics research, study methods vary and do not always follow recommended guidelines. Guidelines for future Delphi processes in orthotics and prosthetics research can be developed based on the data collected in this review. It is likely that there will be an increase in the number of Delphi studies conducted in this field in the future. Understanding the way this method has been implemented in previous studies can inform the design of future studies and may result in a more consistent application of this valuable research method.

Background: Phantom limb pain (PLP) commonly occurs post-amputation and can negatively affect the daily functioning of persons with amputation. Best practices for medication and non-drug management remain unclear. Objective: To better understand the PLP experience and patients' familiarity with treatments, phone interviews were conducted at the Minneapolis Veterans Affairs Regional Amputation Center in Veterans with amputations. Methods: Fifty Veteran participants (average age 66, 96% male) with lower limb amputation were recruited for phone-based data collection of patient-reported outcomes (ie, demographics using the Trinity Amputation and Prosthesis Experience Scales-Revised (TAPES-R) and pain experience using the Phantom Phenomena Questionnaire) to characterize the population and a semi-structured interview. Notes taken during interviews were analyzed using the Krueger and Casey constant comparison analysis method. Results: Participants had an average of 15 years since amputation, and 80% reported PLP as identified with the Phantom Phenomena Questionnaire. Investigators identified several core themes from the qualitative interviews including 1) high variability in the experience of PLP, 2) acceptance and resilience, and 3) PLP treatment perceptions. The majority of participants reported trying common non-drug treatments with none endorsed consistently as highly effective. Conclusion: More research is needed to inform identification and implementation of clinical best practices for non-drug interventions for PLP and understand the factors that influence engagement in non-drug interventions. The participants in this study were largely male, so these results may not be generalizable to females.

Background:Validated criteria to guide assessment of student performance in clinical tasks in prosthetics and orthotics education have not been established. Lack of established criteria and assessment methods presents challenges in evaluating student performance on clinical tasks, such as taking impressions for patellar-tendon-bearing (PTB) sockets.Objectives:To establish assessment criteria for the PTB impression process for use in educational settings.Study design:Delphi consensus process.Methods:Initial Delphi survey items were based on interviews with prosthetic instructors and focus groups with prosthetic students. Expert prosthetic educators were then identified by purposive sampling to complete multiple-round Internet-based Delphi surveys. The Delphi surveys asked experts to indicate their level of agreement on various assessment methods and criteria in PTB education. Consensus for survey items was reviewed after each survey round and used to determine the content of and need for subsequent rounds.Results:Fourteen experts completed two Delphi survey rounds. Items were categorized into educational materials/strategies, impression stages/materials, measurement tools, measurements taken, assessment during impression, assessment after impression, feedback, student self-assessment, and grading. In two survey rounds, 40 items guiding assessment methods and criteria for PTB impressions achieved 80% consensus.Conclusions:A high level of consensus was achieved in two survey rounds. Lower levels of consensus were reached on specific objective criteria, such as use of measurement thresholds when evaluating student impressions. Standardized assessment of student performance on PTB impression-taking instead relies primarily on qualitative assessments based on instructor expertise.