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      Using the modified Delphi method to establish clinical consensus for the diagnosis and treatment of patients with rotator cuff pathology

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          Abstract

          Background

          Patients presenting to the healthcare system with rotator cuff pathology do not always receive high quality care. High quality care occurs when a patient receives care that is accessible, appropriate, acceptable, effective, efficient, and safe. The aim of this study was twofold: 1) to develop a clinical pathway algorithm that sets forth a stepwise process for making decisions about the diagnosis and treatment of rotator cuff pathology presenting to primary, secondary, and tertiary healthcare settings; and 2) to establish clinical practice guidelines for the diagnosis and treatment of rotator cuff pathology to inform decision-making processes within the algorithm.

          Methods

          A three-step modified Delphi method was used to establish consensus. Fourteen experts representing athletic therapy, physiotherapy, sport medicine, and orthopaedic surgery were invited to participate as the expert panel. In round 1, 123 best practice statements were distributed to the panel. Panel members were asked to mark “agree” or “disagree” beside each statement, and provide comments. The same voting method was again used for round 2. Round 3 consisted of a final face-to-face meeting.

          Results

          In round 1, statements were grouped and reduced to 44 statements that met consensus. In round 2, five statements reached consensus. In round 3, ten statements reached consensus. Consensus was reached for 59 statements representing five domains: screening, diagnosis, physical examination, investigations, and treatment. The final face-to-face meeting was also used to develop clinical pathway algorithms (i.e., clinical care pathways) for three types of rotator cuff pathology: acute, chronic, and acute-on-chronic.

          Conclusion

          This consensus guideline will help to standardize care, provide guidance on the diagnosis and treatment of rotator cuff pathology, and assist in clinical decision-making for all healthcare professionals.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12874-016-0165-8) contains supplementary material, which is available to authorized users.

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          Most cited references82

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          The levels of evidence and their role in evidence-based medicine.

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                Author and article information

                Contributors
                beubank@mtroyal.ca
                Journal
                BMC Med Res Methodol
                BMC Med Res Methodol
                BMC Medical Research Methodology
                BioMed Central (London )
                1471-2288
                20 May 2016
                20 May 2016
                2016
                : 16
                : 56
                Affiliations
                [ ]Department of Health and Physical Education, Faculty of Health, Community, and Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB T3E 6K6 Canada
                [ ]Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada
                [ ]Orthopaedic Surgeon, Sport Medicine Centre, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada
                [ ]Division of Orthopaedics, Department of Surgery, University of Alberta, 116 St & 85 Ave., Edmonton, AB T6G 2R3 Canada
                Article
                165
                10.1186/s12874-016-0165-8
                4875724
                27206853
                5daf6fe1-64be-44b3-b40f-69d0ee53806e
                © Eubank et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 21 November 2015
                : 14 May 2016
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Medicine
                consensus guideline,delphi technique,experts,rotator cuff,algorithm,clinical practice guideline

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