The clinical diagnosis of symptomatic forefoot neuroma in the general population: a Delphi consensus study

Abstract Background There is limited evidence for defining what specific method or methods should be used to clinically influence clinical decision making for forefoot neuroma. The aim of this study was to develop a clinical assessment protocol that has agreed expert consensus for the clinical diagn...

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Main Authors: Charlotte Dando, Lindsey Cherry, Lyndon Jones, Catherine Bowen
Format: Article
Language:English
Published: BMC 2017-12-01
Series:Journal of Foot and Ankle Research
Subjects:
Online Access:http://link.springer.com/article/10.1186/s13047-017-0241-2
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spelling doaj-666a669f5da645f5a27f9e0f5882da532020-11-24T21:59:54ZengBMCJournal of Foot and Ankle Research1757-11462017-12-011011710.1186/s13047-017-0241-2The clinical diagnosis of symptomatic forefoot neuroma in the general population: a Delphi consensus studyCharlotte Dando0Lindsey Cherry1Lyndon Jones2Catherine Bowen3University of Southampton and Solent NHS TrustNIHR Clinical Lecturer in Podiatric Rheumatology, University of Southampton, Southampton and Solent NHS TrustTotal Foot HealthUniversity of SouthamptonAbstract Background There is limited evidence for defining what specific method or methods should be used to clinically influence clinical decision making for forefoot neuroma. The aim of this study was to develop a clinical assessment protocol that has agreed expert consensus for the clinical diagnosis of forefoot neuroma. Methods A four-round Delphi consensus study was completed with 16 expert health professionals from either a clinical or clinical academic background, following completion of a structured literature review. Clinical experience ranged from 5 to 34 years (mean: 19.5 years). Consensus was sought on the optimal methods to achieve the clinical diagnosis of forefoot neuroma. Round 1 sought individual input with an open ended question. This developed a list of recommendations. Round 2 and 3 asked the participants to accept or reject each of the recommendations in the list in relation to the question: “What is the best way to clinically diagnose neuroma in the forefoot?” Votes that were equal to or greater than 60% were accepted into the next round; participant’s votes equal to or less then 20% were excluded. The remaining participant’s votes between 20 to 60% were accepted and placed into the following round for voting. Round 4 asked the participants to rank the list of recommendations according to the strength of recommendation they would give in relation to the question: “What is the best way to clinically diagnose neuroma in the forefoot?” The recruitment and Delphi rounds were conducted through email. Results In round 1, the 16 participants identified 68 recommendations for the clinical diagnosis of forefoot neuroma. In round 2, 27 recommendations were accepted, 11 recommendations were rejected and 30 recommendations were assigned to be re-voted on. In round 3, 36 recommendations were accepted, 22 recommendations were rejected and 11 recommendations were assigned to be re-voted on. In round 4, 21 recommendations were selected by the participants to form the expert derived clinical assessment protocol for the clinical diagnosis of forefoot neuroma. From these 21 recommendations, a set of themes were established: location of pain, non weight bearing sensation, weight bearing sensation, observations, tests and imaging. Conclusion Following the identification of 21 method recommendations, a core set of clinical diagnostic methods have been prepared as a clinical assessment protocol for the diagnosis of forefoot neuroma. Based on expert opinion, the core set will assist clinicians in forming a clearer diagnosis of forefoot neuroma.http://link.springer.com/article/10.1186/s13047-017-0241-2ConsensusDelphiForefoot neuromaProtocolDiagnosisTests
collection DOAJ
language English
format Article
sources DOAJ
author Charlotte Dando
Lindsey Cherry
Lyndon Jones
Catherine Bowen
spellingShingle Charlotte Dando
Lindsey Cherry
Lyndon Jones
Catherine Bowen
The clinical diagnosis of symptomatic forefoot neuroma in the general population: a Delphi consensus study
Journal of Foot and Ankle Research
Consensus
Delphi
Forefoot neuroma
Protocol
Diagnosis
Tests
author_facet Charlotte Dando
Lindsey Cherry
Lyndon Jones
Catherine Bowen
author_sort Charlotte Dando
title The clinical diagnosis of symptomatic forefoot neuroma in the general population: a Delphi consensus study
title_short The clinical diagnosis of symptomatic forefoot neuroma in the general population: a Delphi consensus study
title_full The clinical diagnosis of symptomatic forefoot neuroma in the general population: a Delphi consensus study
title_fullStr The clinical diagnosis of symptomatic forefoot neuroma in the general population: a Delphi consensus study
title_full_unstemmed The clinical diagnosis of symptomatic forefoot neuroma in the general population: a Delphi consensus study
title_sort clinical diagnosis of symptomatic forefoot neuroma in the general population: a delphi consensus study
publisher BMC
series Journal of Foot and Ankle Research
issn 1757-1146
publishDate 2017-12-01
description Abstract Background There is limited evidence for defining what specific method or methods should be used to clinically influence clinical decision making for forefoot neuroma. The aim of this study was to develop a clinical assessment protocol that has agreed expert consensus for the clinical diagnosis of forefoot neuroma. Methods A four-round Delphi consensus study was completed with 16 expert health professionals from either a clinical or clinical academic background, following completion of a structured literature review. Clinical experience ranged from 5 to 34 years (mean: 19.5 years). Consensus was sought on the optimal methods to achieve the clinical diagnosis of forefoot neuroma. Round 1 sought individual input with an open ended question. This developed a list of recommendations. Round 2 and 3 asked the participants to accept or reject each of the recommendations in the list in relation to the question: “What is the best way to clinically diagnose neuroma in the forefoot?” Votes that were equal to or greater than 60% were accepted into the next round; participant’s votes equal to or less then 20% were excluded. The remaining participant’s votes between 20 to 60% were accepted and placed into the following round for voting. Round 4 asked the participants to rank the list of recommendations according to the strength of recommendation they would give in relation to the question: “What is the best way to clinically diagnose neuroma in the forefoot?” The recruitment and Delphi rounds were conducted through email. Results In round 1, the 16 participants identified 68 recommendations for the clinical diagnosis of forefoot neuroma. In round 2, 27 recommendations were accepted, 11 recommendations were rejected and 30 recommendations were assigned to be re-voted on. In round 3, 36 recommendations were accepted, 22 recommendations were rejected and 11 recommendations were assigned to be re-voted on. In round 4, 21 recommendations were selected by the participants to form the expert derived clinical assessment protocol for the clinical diagnosis of forefoot neuroma. From these 21 recommendations, a set of themes were established: location of pain, non weight bearing sensation, weight bearing sensation, observations, tests and imaging. Conclusion Following the identification of 21 method recommendations, a core set of clinical diagnostic methods have been prepared as a clinical assessment protocol for the diagnosis of forefoot neuroma. Based on expert opinion, the core set will assist clinicians in forming a clearer diagnosis of forefoot neuroma.
topic Consensus
Delphi
Forefoot neuroma
Protocol
Diagnosis
Tests
url http://link.springer.com/article/10.1186/s13047-017-0241-2
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