Development of an intervention for patients following an anterior cruciate ligament rupture: an online nominal group technique consensus study

Hayley Carter; David Beard; Paul Leighton; Fiona Moffatt; Benjamin E Smith; Kate E Webster; Phillipa Logan

doi:10.1136/bmjopen-2023-082387

Development of an intervention for patients following an anterior cruciate ligament rupture: an online nominal group technique consensus study

BMJ Open. 2024 Jul 18;14(7):e082387. doi: 10.1136/bmjopen-2023-082387.

Authors

Hayley Carter^{1

2}, David Beard³, Paul Leighton², Fiona Moffatt⁴, Benjamin E Smith^{5

2}, Kate E Webster⁶, Phillipa Logan²

Affiliations

¹ Physiotherapy Outpatients, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK hayley.carter1@nhs.net.
² School of Medicine, University of Nottingham, Nottingham, UK.
³ Surgical Intervention Trials Unit, Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK.
⁴ School of Health Sciences, University of Nottingham, Nottingham, UK.
⁵ Physiotherapy Outpatients, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.
⁶ School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.

Abstract

Objectives: (1) To develop an intervention for to support patients diagnosed with an anterior cruciate ligament (ACL) rupture with decision-making regarding treatment. (2) To define evidence-based recommendations for the treatment of patients following an ACL rupture.

Design: Nominal group technique consensus study.

Setting: Online meetings with patients and key stakeholders working and receiving treatment in the National Health Service, UK.

Participants: Consensus meetings composed of eight voting participants and five non-voting facilitators. Voting participants included five clinicians, one outpatient therapy manager and two patients with experience in an ACL rupture and reconstructive surgery. Non-voting facilitators supported group discussions and/or observed study procedures. This included a clinical academic expert, two methodology experts and two patient representatives.

Method: Two online meetings were held. Pre-elicitation material was distributed ahead of the first meeting. Premeeting voting was conducted ahead of both meetings. A draft of the shared decision-making intervention and recommendations were shared ahead of the second meeting. Components were discussed and ranked for inclusion based on a 70% agreement threshold.

Results: The meetings led to the development of a shared decision-making intervention to support treatment decision-making following an ACL rupture. The intervention includes two components: (1) a patient information leaflet and key questions diagram and (2) option grid. The evidence-based recommendations encompass core components of treatment reaching the 70% threshold agreed by the group. The recommendations cover: (1) advice and education, (2) exercise guidance, (3) intervention delivery, (4) outcome measure use and (5) shared decision-making.

Conclusion: This study has successfully developed a shared decision-making intervention to support ACL treatment decision-making, ready for testing in a future feasibility study. Evidence-based recommendations for the treatment of patients following ACL injury, ready for testing in a National Health Service (UK) setting, are also presented.

Trial registration number: NCT05529511.

Keywords: Adult orthopaedics; Knee; Musculoskeletal disorders; Orthopaedic sports trauma.

MeSH terms

Anterior Cruciate Ligament Injuries* / surgery
Anterior Cruciate Ligament Injuries* / therapy
Anterior Cruciate Ligament Reconstruction / methods
Consensus*
Decision Making, Shared*
Female
Humans
Male
Patient Participation
United Kingdom

Associated data

ClinicalTrials.gov/NCT05529511