Using a modified nominal group technique to develop complex interventions for a randomised controlled trial in children with symptomatic pes planus

Abstract

Background Children with symptomatic flat feet (pes planus) frequently present for care but there remains uncertainty about how best to manage their condition. There is considerable variation in practice between and within professions. We intend to conduct a three-arm trial to evaluate three frequently used interventions for pes planus (exercise and advice, exercise and advice plus prefabricated orthoses, and exercise and advice plus custom made orthoses). Each of these interventions are complex and required developing prior to starting the trial. This paper focusses on the development process undertaken to develop the interventions. Methods We used a modified Nominal Group Technique combining an electronic survey with two face-to-face meetings to achieve consensus on the final logic model and menu of options for each intervention. Using the Nominal Group Technique across consecutive meetings in combination with a questionnaire is novel, and enabled us to develop complex interventions that reflect contemporary clinical practice. Results In total 16 healthcare professionals took part in the consensus. These consisted of 11 podiatrists, two orthotists, two physiotherapists, and one orthopaedic surgeon. Both meetings endorsed the logic model with amendments to reflect the wider psychosocial impact of pes planus and its treatment, as well as the increasing use of shared decision making in practice. Short lists of options were agreed for prefabricated and custom made orthoses, structures to target in stretching and strengthening exercises, and elements of health education and advice. Conclusions Our novel modification of the nominal group technique produced a coherent logic model and shortlist of options for each of the interventions that explicitly enable adaptability. We formed a consensus on the range of what is permissible within each intervention so that their integrity is kept intact and they can be adapted and pragmatically applied. The process of combining survey data with face-to-face meetings has ensured the interventions mirror contemporary practice and may provide a template for other trials.

The impact of Risser exercises on plantar arch formation in kindergarten children with flat feet

“…Short lists of treatment options such as prefabricated and custom-made orthoses, stretching and strengthening exercises, and health promotion and counseling were agreed upon. They concluded that the process of combining data with face-to-face meetings ensured that the interventions are reflected in contemporary practice (Backhouse et al, 2022). Rosero, et al (2021), in the article "Addressing the Data Acquisition Paradigm in the Early Detection of Pediatric Foot Deformities", mention that analysis of plantar pressure through podometry has made it possible to analyze and detect various types of feet in pediatric patients.…”

Correction: Using a modified nominal group technique to develop complex interventions for a randomised controlled trial in children with symptomatic pes planus

“…Following the publication of the original article [ 1 ], we were notified that the third author name was spelled incorrectly as Stewart Morison instead of Stewart Morrison (double “r”).…”