Miller Leanne K, Jerosch-Herold Christina, Shepstone Lee
Hand Therapy, Therapies Department, Norfolk and Norwich University Hospital, Norwich, NR, UK.
School of Health Sciences, University of East Anglia, Norwich, NR, UK.
Hand Ther. 2022 Jun;27(2):58-66. doi: 10.1177/17589983221090280. Epub 2022 Apr 14.
INTRODUCTION: Hand oedema (swelling) is a common consequence of hand trauma or surgery, but there is little agreement on how interventions to treat hand oedema should be delivered in practice. The purpose of this study was to engage a group of self-identified hand therapy experts to develop consensus on how four commonly used oedema management treatments should be implemented, which could be used in clinical practice or future clinical trials. METHOD: A web-based Delphi study was conducted with eight volunteer hand therapists who met the pre-defined eligibility criteria for an 'expert' and were members of the British Association of Hand Therapists (BAHT). An a priori level of agreement was set at 75%. Interventions requiring consensus were decided on as a result of a previous national survey of practice and consisted of compression, elevation, massage and kinesiology tape. RESULTS: A total of 25 items were discussed across 3 rounds. This ranged from 23 items in round 1, to three items in round 3. In round 1, consensus was reached on 7/23 (30%) items. The required 75% consensus was reached on 14 items in round 2 and 1/3 items achieved consensus in round 3. Massage was the only treatment that required a third round. DISCUSSION: Consensus was reached on intervention description for three of the four modalities including the materials used (what), method of application including duration and frequency (when and how much) and tailoring or modifications. Two questions relating to massage did not reach the required consensus threshold and a majority agreement was accepted. The small panel size is a limitation and may affect the credibility of the consensus reached.
引言:手部水肿(肿胀)是手部创伤或手术后的常见后果,但对于如何在实践中实施治疗手部水肿的干预措施,目前尚无定论。本研究的目的是邀请一组自我认定的手部治疗专家,就四种常用的水肿管理治疗方法应如何实施达成共识,这些方法可用于临床实践或未来的临床试验。 方法:对八名符合“专家”预定义资格标准且为英国手部治疗师协会(BAHT)成员的志愿者手部治疗师进行了基于网络的德尔菲研究。事先设定的一致同意水平为75%。根据之前的全国实践调查确定了需要达成共识的干预措施,包括压迫、抬高、按摩和肌内效贴布。 结果:在三轮讨论中总共讨论了25项内容。第一轮讨论了23项,第三轮讨论了3项。在第一轮中,23项中有7项(30%)达成了共识。在第二轮中,14项达成了所需的75%的共识,第三轮中3项中有1项达成了共识。按摩是唯一需要进行第三轮讨论的治疗方法。 讨论:就四种治疗方式中的三种,包括所使用的材料(是什么)、应用方法(包括持续时间和频率,何时以及多少)以及定制或调整,达成了关于干预描述的共识。与按摩相关的两个问题未达到所需的共识阈值,因此接受了多数意见。小组规模较小是一个局限性,可能会影响所达成共识的可信度。
Phys Ther. 2016-10
Clin Trials. 2020-3-10
J Adv Nurs. 2003-2
Scand J Plast Reconstr Surg Hand Surg. 2000-12
J Adv Nurs. 2000-10
J Health Serv Res Policy. 1999-10