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Finding consensus for hamstring surgery in ambulatory children with cerebral palsy using the Delphi method
Robert M Kay1, James McCarthy2, Unni Narayanan3
1Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Insights
An expert panel established consensus on hamstring surgery indications for children with cerebral palsy. This aims to reduce practice variation and improve outcomes for ambulatory children undergoing these procedures.
Area of Science:
- Pediatric Orthopedics
- Cerebral Palsy Research
- Surgical Consensus
Background:
- Significant variation exists in hamstring surgery indications and techniques for pediatric cerebral palsy patients.
- Uncertainty prevails regarding hamstring transfer versus traditional hamstring lengthening procedures.
Purpose of the Study:
- To establish consensus on indications for hamstring surgery in ambulatory children with cerebral palsy using the Delphi method.
- To provide expert guidance for optimizing surgical decision-making.
Main Methods:
- An international expert panel utilized a five-level Likert scale to assess agreement on hamstring surgery aspects.
- Consensus was defined as ≥80% agreement; general agreement as 60%-79%.
Main Results:
- Consensus or general agreement was reached on 84% of statements regarding hamstring surgery.
- Key findings include the importance of assessing pelvic tilt and that lateral hamstring lengthening is rarely indicated.
- Repeat hamstring lengthening often yields poor outcomes, and the panel showed division on hamstring transfer indications.
Conclusions:
- The study provides crucial insights for pediatric orthopedic surgeons to optimize hamstring surgery decisions in ambulatory cerebral palsy patients.
- Implementing these consensus guidelines can reduce practice variation and enhance patient outcomes.
Purpose:
There is marked variation in indications and techniques for hamstring surgery in children with cerebral palsy. There is particular uncertainty regarding the indications for hamstring transfer compared to traditional hamstring lengthening. The purpose of this study was for an international panel of experts to use the Delphi method to establish consensus indications for hamstring surgery in ambulatory children with cerebral palsy.
Methods:
The panel used a five-level Likert-type scale to record agreement or disagreement with statements regarding hamstring surgery, including surgical indications and techniques, post-operative care, and outcome measures. Consensus was defined as at least 80% of responses being in the highest or lowest two of the five Likert-type ratings. General agreement was defined as 60%-79% falling into the highest or lowest two ratings. There was no agreement if neither of these thresholds was reached.
Results:
The panel reached consensus or general agreement for 38 (84%) of 45 statements regarding hamstring surgery. The panel noted the importance of assessing pelvic tilt during gait when considering hamstring surgery, and also that lateral hamstring lengthening is rarely needed, particularly at the index surgery. They noted that repeat hamstring lengthening often has poor outcomes. The panel was divided regarding hamstring transfer surgery, with only half performing such surgery.
Conclusion:
The results of this study can help pediatric orthopedic surgeons optimize decision-making in their choice and practice of hamstring surgery for ambulatory children with cerebral palsy. This has the potential to reduce practice variation and significantly improve outcomes for ambulatory children with cerebral palsy.
Level Of Evidence:
level V.
