Attaining a British consensus statement on managing idiopathic congenital talipes equinovarus (CTEV) through a Delphi process: a study protocol

Gelfer, Yael; Blanco, J. A. Parra; Trees, Amanda H; Davis, Naomi; Buckingham, Rachel; Peek, A.; Wright, E. M.; Rajan, Roy; Atherton, W. G.; Watson, Douglas; Easton, Victoria; Garg, Neeraj; Mavrotas, Jason; Tennant, S; Theologis, Tim

doi:10.1136/bmjopen-2021-049212

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…Following the same approach employed by BSCOS to create best practice guidelines for the management of children with clubfoot, 18,19 we set up an online anonymized Delphi survey with invitations sent to all members of the society. We gathered not only their responses to the proposed statements, but also data on their place of work (regional centre or non-specialist unit) and the number of children they tend to treat for musculoskeletal infection in a typical year.…”

Section: Methodsmentioning

confidence: 99%

Consensus guidelines on the management of musculoskeletal infection affecting children in the UK

et al. 2023

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AimsThe aim of this study was to determine the consensus best practice approach for the investigation and management of children (aged 0 to 15 years) in the UK with musculoskeletal infection (including septic arthritis, osteomyelitis, pyomyositis, tenosynovitis, fasciitis, and discitis). This consensus can then be used to ensure consistent, safe care for children in UK hospitals and those elsewhere with similar healthcare systems.MethodsA Delphi approach was used to determine consensus in three core aspects of care: 1) assessment, investigation, and diagnosis; 2) treatment; and 3) service, pathways, and networks. A steering group of paediatric orthopaedic surgeons created statements which were then evaluated through a two-round Delphi survey sent to all members of the British Society for Children’s Orthopaedic Surgery (BSCOS). Statements were only included (‘consensus in’) in the final agreed consensus if at least 75% of respondents scored the statement as critical for inclusion. Statements were discarded (‘consensus out’) if at least 75% of respondents scored them as not important for inclusion. Reporting these results followed the Appraisal Guidelines for Research and Evaluation.ResultsA total of 133 children’s orthopaedic surgeons completed the first survey, and 109 the second. Out of 43 proposed statements included in the initial Delphi, 32 reached ‘consensus in’, 0 ‘consensus out’, and 11 ‘no consensus’. These 11 statements were then reworded, amalgamated, or deleted before the second Delphi round of eight statements. All eight were accepted as ‘consensus in’, resulting in a total of 40 approved statements.ConclusionIn the many aspects of medicine where relevant evidence is not available for clinicians to base their practice, a Delphi consensus can provide a strong body of opinion that acts as a benchmark for good quality clinical care. We would recommend clinicians managing children with musculoskeletal infection follow the guidance in the consensus statements in this article, to ensure care in all medical settings is consistent and safe.Cite this article: Bone Joint J 2023;105-B(7):815–820.

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Section: Methodsmentioning

confidence: 99%

Consensus guidelines on the management of musculoskeletal infection affecting children in the UK

et al. 2023

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“…The list of the internal and external members and their affiliations is published in the protocol paper and has not changed. 17 The Delphi survey was open to all BSCOS members. The number and clinical roles of the BSCOS members and associates who participated in the Delphi survey are presented in Table II.…”

Section: Methodsmentioning

confidence: 99%

“…The study protocol, including methods and timeline, was previously published at the start of the study to ensure that the predefined protocol would be followed. 17 A summary of these stages is reported below. The Appraisal of Guidelines for Research & Evaluation checklist was used as the principle for result reporting.…”

Section: Methodsmentioning

confidence: 99%

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Attaining a British consensus on managing idiopathic congenital talipes equinovarus up to walking age

Gelfer

Davis

Blanco

et al. 2022

The Bone & Joint Journal

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Aims The aim of this study was to gain an agreement on the management of idiopathic congenital talipes equinovarus (CTEV) up to walking age in order to provide a benchmark for practitioners and guide consistent, high-quality care for children with CTEV. Methods The consensus process followed an established Delphi approach with a predetermined degree of agreement. The process included the following steps: establishing a steering group; steering group meetings, generating statements, and checking them against the literature; a two-round Delphi survey; and final consensus meeting. The steering group members and Delphi survey participants were all British Society of Children’s Orthopaedic Surgery (BSCOS) members. Descriptive statistics were used for analysis of the Delphi survey results. The Appraisal of Guidelines for Research & Evaluation checklist was followed for reporting of the results. Results The BSCOS-selected steering group, the steering group meetings, the Delphi survey, and the final consensus meeting all followed the pre-agreed protocol. A total of 153/243 members voted in round 1 Delphi (63%) and 132 voted in round 2 (86%). Out of 61 statements presented to round 1 Delphi, 43 reached ‘consensus in’, no statements reached ‘consensus out’, and 18 reached ‘no consensus’. Four statements were deleted and one new statement added following suggestions from round 1. Out of 15 statements presented to round 2, 12 reached ‘consensus in’, no statements reached ‘consensus out’, and three reached ‘no consensus’ and were discussed and included following the final consensus meeting. Two statements were combined for simplicity. The final consensus document includes 57 statements allocated into six successive stages. Conclusion We have produced a consensus document for the treatment of idiopathic CTEV up to walking age. This will provide a benchmark for standard of care in the UK and will help to reduce geographical variability in treatment and outcomes. Appropriate dissemination and implementation will be key to its success. Cite this article: Bone Joint J 2022;104-B(6):758–764.

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“…4 Based on the British Society for Children’s Orthopaedic Surgery (BSCOS) consensus statement for CTEV management, 5 delivery within an established Ponseti clinic is the desirable standard of care in the UK. 5,6 This clinic design carries a substantial caseload and thus requires expertise to both identify and treat various pathologies, and to provide accurate decision-making and continuity of care.…”

Section: Introductionmentioning

confidence: 99%

A ‘Hub and Spoke’ Shared Care initiative for CTEV Ponseti service

Hussain,

Russell,

Cavanagh

et al. 2023

Bone Jt Open

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AimsThe Ponseti method is the gold standard treatment for congenital talipes equinovarus (CTEV), with the British Consensus Statement providing a benchmark for standard of care. Meeting these standards and providing expert care while maintaining geographical accessibility can pose a service delivery challenge. A novel ‘Hub and Spoke’ Shared Care model was initiated to deliver Ponseti treatment for CTEV, while addressing standard of care and resource allocation. The aim of this study was to assess feasibility and outcomes of the corrective phase of Ponseti service delivery using this model.MethodsPatients with idiopathic CTEV were seen in their local hospitals (‘Spokes’) for initial diagnosis and casting, followed by referral to the tertiary hospital (‘Hub’) for tenotomy. Non-idiopathic CTEV was managed solely by the Hub. Primary and secondary outcomes were achieving primary correction, and complication rates resulting in early transfer to the Hub, respectively. Consecutive data were prospectively collected and compared between patients allocated to Hub or Spokes. Mann-Whitney U test, Wilcoxon signed-rank test, or chi-squared tests were used for analysis (alpha-priori = 0.05, two-tailed significance).ResultsBetween 1 March 2020 and 31 March 2023, 92 patients (139 feet) were treated at the service (Hub 50%, n = 46; Spokes 50%, n = 46), of whom nine were non-idiopathic. All patients (n = 92), regardless of allocation, ultimately achieved primary correction, with idiopathic patients at the Hub requiring fewer casts than the Spokes (mean 4.0 (SD 1.4) vs 6.9 (SD 4.4); p < 0.001). Overall, 60.9% of Spokes’ patients (n = 28/46) required transfer to the Hub due to complications (cast slips Hub n = 2; Spokes n = 17; p < 0.001). These patients ultimately achieved full correction at the Hub.ConclusionThe Shared Care model was found to be feasible in terms of providing primary correction to all patients, with results comparable to other published services. Complication rates were higher at the Spokes, although these were correctable. Future research is needed to assess long-term outcomes, parents’ satisfaction, and cost-effectiveness.Cite this article: Bone Jt Open 2023;4(11):865–872.

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Attaining a British consensus statement on managing idiopathic congenital talipes equinovarus (CTEV) through a Delphi process: a study protocol

Cited by 4 publications

References 22 publications

Consensus guidelines on the management of musculoskeletal infection affecting children in the UK

Consensus guidelines on the management of musculoskeletal infection affecting children in the UK

Attaining a British consensus on managing idiopathic congenital talipes equinovarus up to walking age

A ‘Hub and Spoke’ Shared Care initiative for CTEV Ponseti service

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