背景:化疗诱导的周围神经病变(CIPN)是化疗最常见的副作用。作为一种基于感觉的神经病,停止化疗后,这种情况会持续很长时间,并影响癌症幸存者的生活质量。澳大利亚的足病医生一直在管理与CIPN相关的下肢并发症的患者,然而,关于CIPN的管理指南不存在。这项研究的目的是就最佳管理出现CIPN症状的患者的策略达成澳大利亚足病医生的共识和协议。
方法:根据开展和报告Delphi研究(CREDES)的建议,对具有CIPN专业知识的澳大利亚足病医生进行了三轮在线改良Delphi调查。小组成员在第一轮中回答了不限成员名额的问题,随后将他们的回答定为主题,并进行了分析,以达成现有共识。在第2轮中返回了未达成共识的声明,以使用五点李克特量表寻求响应者的同意,并允许响应者发表进一步评论。为了达成共识或协议,70%或更多的小组成员需要发表相同的评论或同意或强烈同意相同的主题声明。在第3轮中,达成50%至69%共识或同意的陈述返回给小组成员,让他们根据小组结果考虑他们的回应。
结果:第一轮获得了来自同意参加的26名足病医生中的21名的229条评论。这些评论以53项声明为主题,接受了11项协商一致声明。第二轮导致22项声明达成协议,17名受访者的18条评论中产生了15条新声明。第3轮导致11项声明达成协议。结果被发展成为一组临床建议,用于诊断和管理患有CIPN的人。这些建议提供了以下方面的指导:1)识别CIPN的常见体征和症状,包括感觉,运动和自主神经症状;2)CIPN的诊断和评估,包括神经系统,运动和皮肤病学评估方式;3)足病医生确定的CIPN的最佳临床实践和管理策略,包括足病和非足病特异性护理。
结论:这是足病学文献中的第一项研究,旨在为临床表现提供专家知情的共识建议,CIPN患者的诊断、评估和管理。这些建议旨在帮助指导足病医生对CIPN患者的持续护理。
BACKGROUND: Chemotherapy Induced Peripheral Neuropathy (CIPN) is the most common presenting side effect of chemotherapy. As a sensory based neuropathy, this condition can persist for a long time after cessation of chemotherapy and impact the quality of life of cancer survivors. Podiatrists in Australia have been managing people with CIPN related lower limb complications, however
guidelines on management of CIPN do not exist. The aim of this study was to achieve
consensus and agreement of Australian podiatrists on strategies to best manage people presenting with symptoms of CIPN.
METHODS: An online three-round modified Delphi survey of Australian podiatrists with expertise in CIPN was conducted in line with recommendations for conducting and reporting of Delphi studies (CREDES). Panellists responded to open-ended questions in Round 1, whereupon their responses were themed into statements and analysed for existing consensus. Statements not reaching
consensus were returned during Round 2 to seek agreement from responders using a five-point Likert scale and to allow responders to make further comments. For a statement to reach consensus or agreement, 70% or more of panellists needed to make the same comment or agree or strongly agree with the same themed statement. Statements reaching 50 to 69%
consensus or agreement were returned to panellists in Round 3 for them to consider their responses in the light of group outcomes.
RESULTS: Round one resulted in 229 comments from 21 of 26 podiatrists who agreed to participate. These comments were themed into 53 statements with 11
consensus statements accepted. Round 2 resulted in 22 statements reaching agreement, and 15 new statements being generated from 18 comments made by 17 respondents. Round 3 resulted in 11 statements reaching agreement. Outcomes were developed into a set of clinical recommendations for diagnosis and management of people presenting with CIPN. These recommendations provide guidance on 1) identifying common signs and symptoms of CIPN including sensory, motor and autonomic symptoms; 2) diagnosis and assessment of CIPN including neurological, motor and dermatological assessment modalities; and 3) best clinical practice and management strategies for CIPN identified by podiatrists including both podiatry and non-podiatry specific care.
CONCLUSIONS: This is the first study in podiatry literature to develop expert-informed consensus-based recommendations for clinical presentation, diagnosis and assessment and management of people with CIPN. These recommendations aim to help guide podiatrists in the consistent care of people with CIPN.