Research priorities in fragility fractures of the lower limb and pelvis: a UK priority setting partnership with the James Lind Alliance

Abstract

ObjectiveTo determine research priorities in fragility fractures of the lower limb and pelvis which represent the shared priorities of patients, their friends and families, carers and healthcare professionals.Design/settingA national (UK) research priority setting partnership.ParticipantsPatients over 60 years of age who have experienced a fragility fracture of the lower limb or pelvis; carers involved in their care (both in and out of hospital); family and friends of patients; healthcare professionals involved in the treatment of these patients including but not limited to surgeons, anaesthetists, paramedics, nurses, general practitioners, physicians, physiotherapists and occupational therapists.MethodsUsing a multiphase methodology in partnership with the James Lind Alliance over 18 months (August 2016–January 2018), a national scoping survey asked respondents to submit their research uncertainties. These were amalgamated into a smaller number of research questions. The existing evidence was searched to ensure that the questions had not been answered. A second national survey asked respondents to prioritise the research questions. A final shortlist of 25 questions was taken to a multistakeholder workshop where a consensus was reached on the top 10 priorities.ResultsThere were 963 original uncertainties submitted by 365 respondents to the first survey. These original uncertainties were refined into 88 research questions of which 76 were judged to be true uncertainties following a review of the research evidence. Healthcare professionals and other stakeholders (patients, carers, friends and families) were represented equally in the responses. The top 10 represent uncertainties in rehabilitation, pain management, anaesthesia and surgery.ConclusionsWe report the top 10 UK research priorities in patients with fragility fractures of the lower limb and pelvis. The priorities highlight uncertainties in rehabilitation, postoperative physiotherapy, pain, weight-bearing, infection and thromboprophylaxis. The challenge now is to refine and deliver answers to these research priorities.

Research priorities for the management of broken bones of the upper limb in people over 50: a UK priority setting partnership with the James Lind Alliance

“…Although the original uncertainties and initial questions were more specific, the 246 initial questions would have been too difficult to prioritise, and so, as per JLA guidelines,18 the broader indicative questions needed to be developed. This issue has also been raised in other PSPs,20 21 however, Fernandez et al 21 found that the ‘more specific’ questions often ranked lower than the broader, ‘less specific’ questions, and so using broader questions was in fact seen as a strength in this particular study.…”

“…Much effort was made to publicise the surveys as widely as possible, and although we received responses from many different counties, both surveys had a larger number of responses from the counties where steering group members were based. Although the number of responses for both surveys was not high in comparison to those of some PSPs,20 this project did compare well to many others 21 26. Considerable effort was made by all steering group members to engage patients and healthcare professionals via their partner organisations, general practitioner surgeries, hospital outpatient clinics, and families and friends; however, there was significant difficulty in recruiting from ethnic minority groups.…”

“…The aim of the JLA is to enable patients, carers and healthcare professionals to work together on an equal footing and to identify, prioritise and agree which research uncertainties are most important to them 18 19. To date, there have been over 50 priority setting partnerships (PSPs) across a range of disciplines, with over 100 research topics addressed as a direct result of the JLA PSPs 19–21…”

Patient experiences of an ankle fracture and the most important factors in their recovery: a qualitative interview study

“…While several clinical effectiveness trials have recently been published to ascertain the optimal management strategies for individuals with fractures of the lower limbs,6–8 there is comparably less research into the patient experiences of recovering from these injuries. In 2018 a James Lind Alliance priority setting partnership on the subject of lower limb fractures in older people was completed and the sixth priority listed in this research area was ‘what is most important to adults in their recovery from a fragility fracture of the lower limb?’ 9. This highlights the demand from academics and clinicians, and patients and members of the public for further research in this area.…”

Research priorities in advanced heart failure: James Lind alliance priority setting partnership

“…Comparison with existing literature Previous PSPs have covered a variety of healthcare topics, including diabetes mellitus, inflammatory bowel disease, renal transplantation, fragility fractures and congenital heart disease. [15][16][17][18][19] Each PSP has used existing networks to engage relevant groups of patients, carers and healthcare professionals. Some diseases, such as diabetes mellitus, have large, often well-engaged patient groups, so the number of respondents was higher.…”