Research priorities in lower leg soft-tissue injuries in older adults: A modified Delphi study (PRIME)

Lower leg soft-tissue injuries in older adults are common. These injuries can be complicated by frailty, comorbidities, and impaired healing; however, there is limited high-quality evidence to guide optimal management. This study aimed to establish a consensus-driven research agenda for lower leg soft-tissue injuries in older adults using a modified Delphi approach.

An international three-round modified Delphi study was conducted, with clinicians involved in the management of lower leg soft-tissue invited to participate. In Round 1, participants submitted open-text responses identifying challenges in assessment and management. These were thematically grouped and converted into research questions. In Rounds 2 and 3, these were rated by participants and ranked using predefined consensus criteria.

In Round 1137 participants generated 498 research items, which were refined into 30 research questions across 6 domains. In Round 2142 respondents rated the importance of each question using a Likert scale, with a predefined consensus threshold, resulting in 8 questions meeting the criteria. In Round 3168 respondents ranked these questions to establish research priorities. The final consensus highlighted research priorities relating to decision making between operative and non-operative management, comparative effects on wound healing and mortality, influence of comorbidities, prevention of operative complications, the role of standardised assessment and care pathways, impact of mobility and nutrition and optimal dressing selection.

The priorities identified highlight critical evidence gaps and provide a framework to inform future studies and the development of care pathways for this vulnerable patient population.