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Research priorities in children requiring elective surgery for conditions affecting the lower limbs: a James Lind
Martinique Vella-Baldacchino1, Daniel C Perry1, Andreas Roposch2
1Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Science, Botnar Research Centre, Oxford, Oxfordshire, UK.
Insights
This study identified key research priorities for pediatric lower limb surgery by engaging patients, families, and healthcare professionals. The findings will guide future research and funding in this under-researched area.
Area of Science:
- Pediatric Orthopedic Surgery
- Health Services Research
- Patient Engagement
Background:
- Elective surgical management of pediatric lower limb conditions is an under-researched area.
- There is a need to prioritize research questions to effectively address these conditions.
- Engaging diverse stakeholders is crucial for relevant research prioritization.
Purpose of the Study:
- To identify and prioritize research questions for the elective surgical management of pediatric lower limb conditions.
- To involve patients, carers, and healthcare professionals in setting research priorities.
- To guide future research and funding in pediatric orthopedic surgery.
Main Methods:
- A modified nominal group technique was employed.
- Surveys were distributed via newsletters, online platforms, and in clinics.
- A multi-stage process involved initial prioritization surveys, an interim survey, and a final workshop.
Main Results:
- 388 individuals participated, generating 1023 questions, with 801 classified as uncertainties.
- The process identified 75 uncertainties, narrowed to 26, and finally to the top 10 research priorities.
- Top priorities included cerebral palsy, hip conditions (Perthes' disease, DDH), rehabilitation, and shared decision-making.
Conclusions:
- This is the first James Lind Alliance Priority Setting Partnership (PSP) in pediatric orthopedic surgery.
- The identified research priorities will direct future research and funding efforts.
- This study highlights the importance of patient and public involvement in shaping research agendas.
Objective:
To identify and prioritise research questions concerning the elective surgical management of children with conditions affecting the lower limb by engaging patients, carers and healthcare professionals.
Design:
A modified nominal group technique.
Setting:
UK.
Participants:
388 individuals (29 patients, 155 parents/carers, 204 healthcare professionals) were recruited through hospital clinics, patient charities and professional organisations and participated in the initial prioritisation survey; 234 individuals took part in the interim prioritisation survey. 33 individuals (3 patients, 9 parents/carers, 11 healthcare professionals, 7 individuals representing the project's steering group and 3 James Lind Alliance (JLA) facilitators) attended the final face-to-face workshop to rank the top 10 research priorities.
Interventions:
Surveys were distributed using various media resources such as newsletters, internet messaging boards and the 'Paediatric Lower Limb Surgery Priority Setting Partnership (PSP) website. Printed copies of the questionnaire were also made available to families in outpatient clinics.
Outcome Measures:
Survey results, top 10 and top 26 priority rankings RESULTS: The process took 18 months to complete (July 2017-January 2019); 388 people generated 1023 questions; a total of 801 research questions were classified as true uncertainties. Following the JLA methodology, 75 uncertainties were developed from the initial 801 questions. Twenty six of those were selected through a second survey and were taken to the final face-to-face workshop where the top 10 research priorities were selected. The top10 priorities included questions on cerebral palsy, common hip conditions (ie, Perthes' disease and developmental dysplasia of the hip) as well as rehabilitation techniques and methods to improve shared decision-making between clinicians and patients/families.
Conclusions:
This is the first JLA PSP in children's orthopaedic surgery, a particularly under-researched and underfunded area. We have identified important research topics which will guide researchers and funders and direct their efforts in future research.
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