title: The use of a modified Delphi procedure for the determination of 26 prognostic factors in the sub-acute stage of stroke.
abstract: The aim of this study was to reach consensus about the prognostic factors when deciding the discharge destination from a hospital stroke unit, and to construct a prognostic conceptual framework. To realise an optimal integration of knowledge from research findings and from clinical experience by expert opinions we used a 'modified Delphi Technique', which is the most commonly used method for the production of clinical guidelines. The process yielded 26 prognostic factors, which were arranged in clinical and social sub-domains. The sub-domains and the factors within each sub-domain were prioritised according to their assumed predictive value for the decision process. The order of importance of the prognostic factors in the clinical domain was: (1) disabilities, (2) pre-morbid disabilities, (3) impairments and (4) disease/biology; and the order of importance of the factors in the social domain was: (1) home front, (2) social situation and (3) residence. The Delphi procedure is an excellent instrument to determine and prioritise prognostic factors. With this procedure research-based and consensus-based knowledge can be combined. For a valid procedure it is mandatory to state explicitly in advance how the scores will be judged, and to explain the scientific level of the evidence during the whole procedure.
authors.affiliation: Department of Rehabilitation Medicine, Academic Medical Center Amsterdam, The Netherlands. r.meijer@grootklimmendaal.nl
authors.forename: Ronald
authors.initials: R
authors.lastname: Meijer
authors.forename: Daniela
authors.initials: D
authors.lastname: Ihnenfeldt
authors.forename: Marinus
authors.initials: M
authors.lastname: Vermeulen
authors.forename: Rob
authors.initials: R
authors.lastname: De Haan
authors.forename: Jacques
authors.initials: J
authors.lastname: Van Limbeek
mesh_terms: D000203:Activities of Daily Living; D003697:Delphi Technique; D004185:Disability Evaluation; D006760:Hospitalization; D006801:Humans; D010351:Patient Discharge; D011379:Prognosis; D020127:Recovery of Function; D012107:Research Design; D012111:Residence Characteristics; D012944:Social Support; D000071939:Stroke Rehabilitation; D019467:Subacute Care / Q000458:organization & administration