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Logo for the Journal of Rehab R&D
Volume 42 Number 5, September/October 2005
Pages 693 — 704


Abstract - Use of the Delphi Technique for developing national clinical guidelines for prescription of lower-limb prostheses

Harmen van der Linde, MD, PhD;1* Cheriel J. Hofstad, MSc;1 Jacques van Limbeek, MD, PhD;1
Klaas Postema, MD, PhD;2 Jan H. B. Geertzen, MD, PhD2

1Rehabilitation Centre Sint Maartenskliniek, Nijmegen, the Netherlands; 2Department of Rehabilitation, University Hospital Groningen, Groningen, the Netherlands
Abstract — The aim of this project was the development of evidence- and consensus-based clinical practice guidelines for lower-limb prosthesis prescription for achieving transparency and consensus among clinicians, manufacturers, and insurance companies. This article describes a modified Delphi Technique, which is based on different methods of collecting evidence, and its role in the development of national clinical guidelines for prosthesis prescription. We used a multimethod approach to develop guidelines for the clinical practice of prosthesis prescription for lower-limb amputees. The Delphi Technique was central in the process, and the panel was made up of experts from three key disciplines on a national level. Our approach involved various methods: a systematic review, a survey of national clinical practice on prosthesis prescription, and interviews with experts. These activities resulted in 45 postulates about prosthesis prescription. The views of the national expert panel were then presented at a consensus development conference. The participants in the Delphi Technique sessions reached a consensus on 37 of the postulates on prosthesis prescription for lower-limb amputees. The postulates were categorized according to amputation level and partitioned into different domains. The total process resulted in the development of draft clinical guidelines comprising guidance for prescribing prostheses for the lower limb. The scope and applicability of these guidelines will have to be measured and evaluated in future work.
Key words: artificial limbs, consensus-based guideline development, consensus development conference, Delphi Technique, lower-limb amputation, lower-limb prosthesis prescription, practice guidelines, prosthesis prescription format.

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