Use of the nominal group technique to identify UK stakeholder views of the measures and domains used in the assessment of therapeutic exercise adherence for patients with musculoskeletal disorders

Abstract

ObjectivesThe objective was to the undertake nominal group technique (NGT) to evaluate current exercise adherence measures and isolated domains to develop stakeholder consensus on the domains to include in the measurement of therapeutic exercise adherence for patients with musculoskeletal disorders.DesignA 1-day NGT workshop was convened. Six exercise adherence measures were presented to the group that were identified in our recent systematic review. Discussions considered these measures and isolated domains of exercise adherence. Following discussions, consensus voting identified stakeholder agreement on the suitability of the six offered adherence measures and the inclusion of isolated domains of exercise adherence in future measurement.SettingOne stakeholder NGT workshop held in Sheffield, UK.ParticipantsKey stakeholders from the UK were invited to participate from four identified populations. 14 participants represented patients, clinicians, researchers and service managers.ResultsAll six exercise adherence measures were deemed not appropriate for use in clinical research or routine practice with no measure reaching 70% group agreement for suitability, relevance, acceptability or appropriateness. Three measures were deemed feasible to use in clinical practice. 25 constructs of exercise adherence did reach consensus threshold and were supported to be included as domains in the future measurement of exercise adherence.ConclusionA mixed UK-based stakeholder group felt these six measures of exercise adherence were unacceptable. Differences in opinion within the stakeholder group highlighted the lack of consensus as to what should be measured, the type of assessment that is required and whose perspective should be sought when assessing exercise adherence. Previously unused domains may be needed alongside current ones, from both a clinician's and patient’s perspective, to gain understanding and to inform future measurement development. Further conceptualisation of exercise adherence is required from similar mixed stakeholder groups in various socioeconomic and cultural populations.

Identification and Prioritization of Attributes for a Discrete Choice Experiment Using the Nominal Group Technique: Patients’ Choice of Public Health Facilities in Cape Town, South Africa

“…Accordingly, we conducted group discussions up to data saturation, with no new information being attained by the fourth focus group. The sample size is within the same magnitude as other NGT studies such as Evans et al 55 (n = 14), Mallet et al 56 (n = 14), Hifinger et al 57 (n = 14), Somers et al 58 (n = 24), Pena et al (n = 27), and Hiligsmann et al 36 (n = 26). These studies have shown NGT with relatively small sample groups to be a successful methodology in eliciting preferences.…”

Identifying priorities for the collection and use of data related to community first response and out-of-hospital cardiac arrest: protocol for a nominal group technique study

“…We are very conscious of the need for the patient and family perspective to be represented in the study and will ensure that they are present in the stakeholder group. The NGT is a small group technique that can include sample sizes from 2 -14 participants 14,16 , however larger sample sizes have been employed in some studies 19 . This study involves multiple stakeholder groups and as such, to facilitate adequate representation from each cohort while maintaining a manageable size for the conduct of group discussions during the NGT process, the maximum sample size in total for the panel will be 20 participants 19 .…”

“…The maximum sample size is 20 individuals in total for the panel. Previous nominal group technique (NGT) research has a range of sample sizes from 2 -14 participants 14,16 , with some research including larger sample sizes (24 participants) 19 . To ensure adequate representation for each of our stakeholder groups we have opted for a larger sample size of 20 participants.…”

Identifying priorities for the collection and use of data related to community first response and out-of-hospital cardiac arrest: protocol for a nominal group technique study

“…Stage four involves private voting to prioritise and rank responses according to which responses the participants think are most important. The NGT is frequently used in health service research to identify and agree on priorities, for example identifying quality markers in general practice 15 , evaluating exercise adherence measures in patients with musculoskeletal disorders 16 , and determining important treatment outcomes for patients with aphasia 17 . The process facilitates a balanced selection of ideas/topics that are important to the participant group as a whole 18 .…”