A modified Delphi study to identify which items should be evaluated in shoulder instability research: a first step in developing a core outcome set

Lukas P E Verweij; Inger N Sierevelt; David N Baden; Robert Jan Derksen; Henk-Jan van der Woude; Karin M C Hekman; Michel P J van den Bekerom; SINC study group

doi:10.1016/j.jseint.2023.06.012

A modified Delphi study to identify which items should be evaluated in shoulder instability research: a first step in developing a core outcome set

JSES Int. 2023 Jul 14;7(6):2304-2310. doi: 10.1016/j.jseint.2023.06.012. eCollection 2023 Nov.

Authors

Lukas P E Verweij^{1

2

3}, Inger N Sierevelt^{4

5}, David N Baden⁶, Robert Jan Derksen⁷, Henk-Jan van der Woude^{3

8}, Karin M C Hekman^{3

9

10}, Michel P J van den Bekerom^{3

10

11

12}; SINC study group

Collaborators

Affiliations

¹ Amsterdam UMC, Location AMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands.
² Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands.
³ Amsterdam Shoulder and Elbow Center of Expertise (ASECE), Amsterdam, The Netherlands.
⁴ Xpert Clinics, Department of Orthopedic Surgery, Amsterdam, The Netherlands.
⁵ Spaarnegasthuis Academy, Orthopedic Department, Hoofddorp, The Netherlands.
⁶ Emergency Department, Diakonessenhuis, Utrecht, The Netherlands.
⁷ Department of Trauma Surgery, Zaandam Medical Center, Zaandam, The Netherlands.
⁸ Department of Radiology, OLVG, Amsterdam, The Netherlands.
⁹ Shoulder Center IBC Amstelland, Amstelveen, The Netherlands.
¹⁰ Department of Orthopedic Surgery, Medical Center Jan van Goyen, Amsterdam, The Netherlands.
¹¹ Shoulder and Elbow Unit, Joint Research, Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands.
¹² Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

Abstract

Background: The aim of this study was to identify items that healthcare providers and/or patients consider important to include in a questionnaire for clinical trials and cohort studies in shoulder instability research. This could serve as a basis to develop a core outcome set for shoulder instability research.

Methods: Healthcare providers and patients were included in a panel for a modified Delphi consensus study. The study consisted of three rounds, comprising (1) identifying items, (2) rating the importance of the items, and (3) rating the importance again after seeing a summary of the results of round two. Importance was rated on a 9-point Likert scale. Consensus was defined as ≥ 80% of the panel giving a score of 7 or higher.

Results: In total, 44 healthcare providers and 30 patients completed all three rounds. Round one identified 54 items. After round three, the panel reached a consensus on 11 items that should be included in a questionnaire, comprising re-dislocation (99%), instable feeling of the shoulder (96%), limitations during sport (93%), patient satisfaction with the shoulder (93%), fear/anxiety for re-dislocation (91%), range of motion (88%), return to old level of functioning (85%), performing daily activities (85%), return to sport (82%), return to work (82%), and trusting the shoulder (81%).

Conclusion: Healthcare providers and patients reached a consensus on 11 items that should be included in a questionnaire for shoulder instability research. These items can facilitate design and development of future clinical trials and form the basis for the development of a core outcome set.

Keywords: Consensus; Core outcome set; Delphi; Dislocation; Instability; Outcome; Shoulder.