Using Consensus Techniques to Produce Clinical Guidelines for Patients Treated with the Ilizarov Fixator

Abstract

Summary This paper describes how the Delphi technique was used to produce clinical guidelines on the physiotherapy management of patients treated with an Ilizarov external fixator. The Ilizarov fixator is used for a variety of orthopaedic applications including fracture fixation, limb lengthening, deformity correction and treatment of bone loss ( Ilizarov, 1997 Ilizarov GA ‘The principles of the Ilizarov method’. Bulletin of the Hospital for Joint Diseases. 1997; 56: 49-53 PubMed Google Scholar ). The Delphi technique is a consensus method that may be applied where more traditional sources of information such as controlled trials and research papers are unavailable. Given the paucity of published research material in many areas of physiotherapy this may be a useful tool for producing guidelines in other areas of practice. The need for structured guidance in the management of this group of patients was established in earlier work ( Barker et al., 1999 Barker KL Burns M Littler S ‘Physiotherapy for patients with an Ilizarov external fixator’. Physiotherapy. 1999; 85: 426-432 Abstract Full Text Full Text PDF Scopus (5) Google Scholar ). An expert panel of 12 physiotherapists used the Delphi technique to produce draft guideline statements about practice. After three rounds these were formulated into clinical guidelines at a consensus meeting and rated for the strength of agreement among panel members. The guidelines were designed to be applicable to the range of uses of the Ilizarov fixator – trauma and elective, adult and paediatric. The final version of the guidelines was agreed by all the panel members and has been adopted by the British Limb Reconstruction Society, an affiliated society of the British Orthopaedic Association. This paper describes how the Delphi technique was used to produce clinical guidelines on the physiotherapy management of patients treated with an Ilizarov external fixator. The Ilizarov fixator is used for a variety of orthopaedic applications including fracture fixation, limb lengthening, deformity correction and treatment of bone loss ( Ilizarov, 1997 Ilizarov GA ‘The principles of the Ilizarov method’. Bulletin of the Hospital for Joint Diseases. 1997; 56: 49-53 PubMed Google Scholar ). The Delphi technique is a consensus method that may be applied where more traditional sources of information such as controlled trials and research papers are unavailable. Given the paucity of published research material in many areas of physiotherapy this may be a useful tool for producing guidelines in other areas of practice. The need for structured guidance in the management of this group of patients was established in earlier work ( Barker et al., 1999 Barker KL Burns M Littler S ‘Physiotherapy for patients with an Ilizarov external fixator’. Physiotherapy. 1999; 85: 426-432 Abstract Full Text Full Text PDF Scopus (5) Google Scholar ). An expert panel of 12 physiotherapists used the Delphi technique to produce draft guideline statements about practice. After three rounds these were formulated into clinical guidelines at a consensus meeting and rated for the strength of agreement among panel members. The guidelines were designed to be applicable to the range of uses of the Ilizarov fixator – trauma and elective, adult and paediatric. The final version of the guidelines was agreed by all the panel members and has been adopted by the British Limb Reconstruction Society, an affiliated society of the British Orthopaedic Association.