Community-based rehabilitation implementation framework to address patellofemoral pain amongst runners in under-resourced communities: Delphi consensus

Consensus methods in patellofemoral pain: how rigorous are they? A scoping review

OBJECTIVE

Clinicians treating patients with patellofemoral pain (PFP) rely on consensus statements to make the best practice recommendations in the absence of definitive evidence on how to manage PFP. However, the methods used to generate and assess agreement for these recommendations have not been examined. Our objective was to map the methods used to generate consensus-based recommendations for PFP and apply four novel questions to assess the rigour of consensus development.

DESIGN

Scoping review.

DATA SOURCES

We searched Medline, SPORTDiscus, CINAHL and Embase from inception to May 2022 to identify consensus-derived statements or practice guidelines on PFP. The Joanna Briggs Institute Manual for Evidence Synthesis was followed to map the existing evidence. We measured the consensus methods based on four sets of questions addressing the panel composition, application of the consensus method chosen, agreement process and the use of evidence mapping.

ELIGIBILITY CRITERIA

All consensus statements or clinical guidelines on PFP were considered.

RESULTS

Twenty-two PFP consensus statements were identified. Panel composition: 3 of the 22 (14%) consensus groups reported the panellists' experience, 2 (9%) defined a desired level of expertise, 10 (45%) reported panellist sex and only 2 (9%) included a patient. Consensus method: 7 of 22 (32%) reported using an established method of consensus measurement/development. Agreement process: 10 of 22 (45%) reported their consensus threshold and 2 (9%) acknowledged dissenting opinions among the panel. Evidence mapping: 6 of 22 (27%) reported using systematic methods to identify relevant evidence gaps.

CONCLUSIONS

PFP consensus panels have lacked diversity and excluded key partners including patients. Consensus statements on PFP frequently fail to use recognised consensus methods, rarely describe how 'agreement' was defined or measured and often neglect to use systematic methods to identify evidence gaps.

Lessons learned about development and assessment of feasibility of tools for health and rehabilitation services

BACKGROUND

Given the dire need for health and rehabilitation services internationally, exacerbated during the COVID-19 pandemic, there is a critical need to develop tools to support service delivery. This need is palpable in the Global South where tools developed in Eurocentric contexts are not always adaptable, applicable, or relevant. It is for this reason that the researchers present three case studies of tool development using pilot and feasibility studies in South Africa and share the lessons learned from these studies.

OBJECTIVES

To describe three case studies that developed new tools for health and rehabilitation services using pilot and feasibility studies. To synthesize lessons learned from these case studies on the development of tools.

METHOD

The researchers describe three case studies that were developed. The case studies are summarized as follows: aims and objectives, context, problem, study design, findings, and what happened after the study. Thereafter, a qualitative cross-case analysis was conducted by the researchers to generate themes.

FINDINGS

The case studies are described individually and followed by themes identified through cross-case analysis.

DISCUSSION

The lessons learned are discussed. It is essential to develop new tools and protocols, motivated by the need for equitable and contextually relevant practices. Partnerships and collaboration with end-users are critical for success. A critical, scientific process is essential in developing new tools. Pilot and feasibility studies are invaluable in developing tools and assessing the feasibility of tools and implementation. The goal is to develop practical, usable tools and protocols.

CONCLUSION

Through the lessons learned, the researchers are hopeful that the international health and rehabilitation professions will continue to strengthen the scientific development of contextually relevant tools and resources.

Developing and implementing a model of care for athletes living with disabilities: A protocol

Background

Athletes living with disabilities (ALWDs) face various challenges including stigma, discrimination, poor access to quality services and lack of funding. Their needs are also numerous. Despite the transformative promise of 'Leave No One Behind' of the United Nations' 2030 agenda, people living with disabilities are still left behind.

Objectives

To investigate the challenges and needs of ALWDs and to develop and implement a model of care (MoC), using South Africa as an example.

Method

Our study will use a mixed-method design. The conceptual framework to manage this project is guided by a 'process redesign framework'. Phase 1 will analyse the problems and needs of ALWDs. Phase 2 will include a review study to map the range of care strategies for athletes. Phase 3 will include a Delphi study to develop a suitable MoC. Phase 4 will involve the implementation of the MoC. Participants for phase 1 will include ALWDs. Phases 3 and 4 will include disability sports experts.

Results

Our study will present the challenges and needs of ALWDs and propose a MoC.

Conclusion

There is a need to think beyond disability and have robust discussions to challenge the way services are provided for ALWDs. Everyone has a role to play to help bring about changes that will improve the quality of life of these athletes.

Clinical implications

A new MoC will assist in improving the quality of service for ALWDs.