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

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

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.
1757-1146
Dando, Charlotte
d25a5d95-2f34-4fe6-af90-4a1569ca60fc
Cherry, Lindsey
95256156-ce8c-4e7c-b04d-b6e459232441
Jones, Lyndon
383ab7e3-3199-4f0e-bac4-25cc703c20f5
Bowen, Catherine
fd85c3c5-96d9-49b8-86c6-caa94e1a222b
Dando, Charlotte
d25a5d95-2f34-4fe6-af90-4a1569ca60fc
Cherry, Lindsey
95256156-ce8c-4e7c-b04d-b6e459232441
Jones, Lyndon
383ab7e3-3199-4f0e-bac4-25cc703c20f5
Bowen, Catherine
fd85c3c5-96d9-49b8-86c6-caa94e1a222b

Dando, Charlotte, Cherry, Lindsey, Jones, Lyndon and Bowen, Catherine (2017) The clinical diagnosis of symptomatic forefoot neuroma in the general population:: a Delphi consensus study. Journal of Foot and Ankle Research, 10 (59). (doi:10.1186/s13047-017-0241-2).

Record type: Article

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.

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More information

Accepted/In Press date: 11 December 2017
e-pub ahead of print date: 28 December 2017
Published date: 28 December 2017

Identifiers

Local EPrints ID: 417099
URI: http://eprints.soton.ac.uk/id/eprint/417099
ISSN: 1757-1146
PURE UUID: 75684ae6-e779-4ab1-89f6-0f34801f0591
ORCID for Lindsey Cherry: ORCID iD orcid.org/0000-0002-3165-1004
ORCID for Catherine Bowen: ORCID iD orcid.org/0000-0002-7252-9515

Catalogue record

Date deposited: 19 Jan 2018 17:30
Last modified: 22 Nov 2021 02:55

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Contributors

Author: Charlotte Dando
Author: Lindsey Cherry ORCID iD
Author: Lyndon Jones
Author: Catherine Bowen ORCID iD

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