调查。
支撑是青少年特发性脊柱侧凸(AIS)保守治疗的主要手段。这项研究的目的是在包括外科医生在内的多学科国际支撑专家小组中建立最佳实践指南(BPG)。理疗师,物理治疗师,和矫形器使用正式的共识建立技术。目前,AIS的支具治疗实践存在显著差异,因此,有一个强大的需要开发BPG支持AIS。
我们利用Delphi过程和名义组技术在多学科的支撑专家小组之间建立共识。我们之前的工作确定了我们达成共识的支撑治疗中的变异性区域。在对文献进行回顾之后,进行了三项迭代调查.主题包括支撑目标,开始和停止支撑的迹象,大括号类型,支撑处方,射线照片,身体活动,和物理治疗脊柱侧弯特定的练习。然后举行了面对面会议,允许与会者投票赞成或反对列入每个项目。在整个调查和面对面会议中,80%的协议被认为是共识。对未达成共识的项目进行了讨论和修订,并重复进行了协商一致表决。
在受邀参加的38位专家中,我们收到了来自32、35和34的每次调查的答复,分别。11位外科医生,4名理疗师,8位理疗师,3名矫形器,和一名研究科学家参加了最后的面对面会议。专家们就10个支撑领域的67个项目达成了共识,这些项目被合并为最终的最佳做法建议。
我们认为,通过减少AIS支撑实践的变异性,坚持这些BPG将导致AIS患者的次优结局减少。并提供了未来研究的框架。
四级。
Survey.
Bracing is the mainstay of conservative treatment in Adolescent Idiopathic Scoliosis (AIS). The purpose of this study was to establish best practice
guidelines (BPG) among a multidisciplinary group of international bracing experts including surgeons, physiatrists, physical therapists, and orthotists utilizing formal
consensus building techniques. Currently, there is significant variability in the practice of brace treatment for AIS and, therefore, there is a strong need to develop BPG for bracing in AIS.
We utilized the Delphi process and the nominal group technique to establish consensus among a multidisciplinary group of
bracing experts. Our previous work identified areas of variability in brace treatment that we targeted for consensus. Following a review of the literature, three iterative surveys were administered. Topics included bracing goals, indications for starting and discontinuing bracing, brace types, brace prescription, radiographs, physical activities, and physiotherapeutic scoliosis-specific exercises. A face-to-face meeting was then conducted that allowed participants to vote for or against inclusion of each item. Agreement of 80% throughout the surveys and face-to-face meeting was considered consensus. Items that did not reach
consensus were discussed and revised and repeat voting for
consensus was performed.
Of the 38 experts invited to participate, we received responses from 32, 35, and 34 for each survey, respectively. 11 surgeons, 4 physiatrists, 8 physical therapists, 3 orthotists, and 1 research scientist participated in the final face-to-face meeting. Experts reached
consensus on 67 items across 10 domains of
bracing which were consolidated into the final best practice recommendations.
We believe that adherence to these BPG will lead to fewer sub-optimal outcomes in patients with AIS by reducing the variability in AIS bracing practices, and provide a framework future research.
Level IV.