Clinical consensus recommendations for the non-surgical treatment of children with Perthes’ disease in the UK

Author:

Galloway Adam M.12ORCID,Keene David J.34ORCID,Anderson Anna1,Holton Colin2,Redmond Anthony C.5,Siddle Heidi J.6,Richards Suzanne7,Perry Daniel C.89ORCID

Affiliation:

1. University of Leeds, Leeds, UK

2. Leeds Teaching Hospitals NHS Trust, Leeds, UK

3. University of Exeter, Exeter, UK

4. Royal United Hospitals Bath NHS Foundation Trust, Bath, UK

5. Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK

6. Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and Consultant Podiatrist, Leeds Teaching Hospitals NHS Trust, Leeds, UK

7. Leeds Institute of Health Science, University of Leeds, Leeds, UK

8. University of Liverpool, Liverpool, UK

9. Alder Hey Children’s Hospital, Liverpool, UK

Abstract

AimsThe aim of this study was to produce clinical consensus recommendations about the non-surgical treatment of children with Perthes’ disease. The recommendations are intended to support clinical practice in a condition for which there is no robust evidence to guide optimal care.MethodsA two-round, modified Delphi study was conducted online. An advisory group of children’s orthopaedic specialists consisting of physiotherapists, surgeons, and clinical nurse specialists designed a survey. In the first round, participants also had the opportunity to suggest new statements. The survey included statements related to ‘Exercises’, ‘Physical activity’, ‘Education/information sharing’, ‘Input from other services’, and ‘Monitoring assessments’. The survey was shared with clinicians who regularly treat children with Perthes’ disease in the UK using clinically relevant specialist groups and social media. A predetermined threshold of ≥ 75% for consensus was used for recommendation, with a threshold of between 70% and 75% being considered as ‘points to consider’.ResultsA total of 40 participants took part in the first round, of whom 31 completed the second round. A total of 87 statements were generated by the advisory group and included in the first round, at the end of which 31 achieved consensus and were removed from the survey, and an additional four statements were generated. A total of 60 statements were included in the second round and 45 achieved the threshold for consensus from both rounds, with three achieving the threshold for ‘points to consider’. The recommendations predominantly included self-management, particularly relating to advice about exercise and education for children with Perthes’ disease and their families.ConclusionChildren’s orthopaedic specialists have reached consensus on recommendations for non-surgical treatment in Perthes’ disease. These statements will support decisions made in clinical practice and act as a foundation to support clinicians in the absence of robust evidence. The dissemination of these findings and the best way of delivering this care needs careful consideration, which we will continue to explore.Cite this article: Bone Joint J 2024;106-B(5):501–507.

Publisher

British Editorial Society of Bone & Joint Surgery

Cited by 2 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Children’s orthopaedics;Bone & Joint 360;2024-08-02

2. Diagnosis and Management of Legg-Calvé-Perthes Disease in the Obese Pediatric Population;JBJS Journal of Orthopaedics for Physician Assistants;2024-07

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