Developing Consensus for an Upper and Lower Limb Athlete Pain Assessment Framework – A Real-time Delphi Study with International Sports Physiotherapists

Abstract

AbstractObjectivesThere is no current consensus on the key items sports physiotherapists should consider when completing a comprehensive biopsychosocial upper or lower limb pain assessment with athletes. We sought to develop recommendations to inform a framework for the assessment of upper and lower limb pain in athletes.DesignReal-time DelphiMethodsWe recruited sports physiotherapists currently working with athletes through the International Society of Sports Physical Therapists and Irish Society of Chartered Physiotherapists. Participants voted on 86 pain assessment items chosen using best available evidence. The real-time Delphi method facilitated independent anonymous voting, commenting and immediate review of consensus. Participants indicated level of agreement for inclusion in an upper and lower limb athlete pain assessment framework on a 6-point Likert scale from Strongly Disagree to Strongly Agree, and how often they are/will be required in practice on a 5-point scale fromNevertoAlways.Criteria for consensus agreement and inclusion were i) >70% sports physiotherapists voting agree/strongly agree AND ii) median vote selected by physiotherapists was Agree or Strongly Agree.Results41 sports physiotherapists (female n=20, male n=21), visited the survey an average of 5.3 times (±5), resulting in a completion rate of 98%. 64 assessment items (neurophysiological n=20, biomechanical n=15, affective n=8, cognitive n=3, socioenvironmental n=10, general assessment aspects of assessment n=8) met the criteria for consensus. Frequency of use in practice wasAlwaysfor 28 itemsOftenfor 32 items andSometimesfor 4 items.ConclusionWe have presented stakeholder-generated recommendations and priorities for athlete pain assessment.