The use of a modified Delphi procedure for the determination of 26 prognostic factors in the sub-acute stage of stroke.
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.
Meijer
Ronald
R
Department of Rehabilitation Medicine, Academic Medical Center Amsterdam, The Netherlands. r.meijer@grootklimmendaal.nl
Ihnenfeldt
Daniela
D
Vermeulen
Marinus
M
De Haan
Rob
R
Van Limbeek
Jacques
J
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