Ashford, Stephen, Mohammed Meeran, Rasheed A., Clark, Teresa, Montesinos Ruiz, Macarena, Hoffman, Karen, Playford, Diane and Pandyan, Anand (2021) A consensus process to agree best practice for managing physical wellbeing in people with a prolonged disorder of consciousness. European journal of physical and rehabilitation medicine, 57 (5). pp. 701-709. doi:10.23736/S1973-9087.21.06624-7 ISSN 1973-9095.

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Abstract

Background: Current practice for physical wellbeing of people in a Prolonged Disorder of Consciousness (PDOC) is variable. A scoping literature review identified no agreed standard of care for physical management of those in a PDOC. This study addressed this deficit using a consensus process applied using nominal group technique.

Aim: The aims of this project were to promote best practice for physical management in PDOC, by identifying consensus for: 1) a pathway of care; and 2) current best practice recommendations.

Design: A consensus process using nominal group technique.

Setting: Representation from national, purposively selected, rehabilitation services assessing and managing people in a PDOC in the UK.

Population: The population to whom the consensus process relates are people in a PDOC, requiring physical management.

Methods: An initial meeting with selected clinical experts from national centres was conducted to set terms of reference. A consensus meeting using nominal group technique (N.=33) then followed. Experts were initially asked to review systematic review findings reproduced as statements. Following systematic refinement, they were then asked to vote on the importance and relevance of statements.

Results: Following the nominal group process, 25 initial recommendations were refined to 19, which expressed the principles of physical management for people with a Prolonged Disorder of Consciousness. Statements are grouped into "acute-care" (6-recommendations), "postacute care" (10-recommendations) and "long-term care" (3-recommendations). Across the participants, agreement with the final recommendation statements ranged from 100-61% (N.=33-20), 15 of the statements were supported by 85% or more experts (N.=29). In addition, a clinical pathway of care, incorporating the recommendation principles was produced (agreement from 28 experts, 83%).

Conclusions: The recommendations provide a basis for standardising current practice. They provide a standard against which care, and effectiveness can be evaluated. An accessible guideline document is planned for publication to enable implementation into practice, supported by online resources.

Clinical rehabilitation impact: Recommendations have been produced under the headings of "acute care," "postacute care" and "long-term care." In addition, a pathway for provision of care interventions has been identified for the physical management of people in a prolonged disorder of consciousness.

Item Type:	Journal Article
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Journal or Publication Title:	European journal of physical and rehabilitation medicine
Publisher:	Edizioni Minerva Medica
ISSN:	1973-9095
Official Date:	October 2021
Dates:	Date Event October 2021 Published
Volume:	57
Number:	5
Page Range:	pp. 701-709
DOI:	10.23736/S1973-9087.21.06624-7
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)

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