Reaching consensus on the physiotherapeutic management of patients following upper abdominal surgery: a pragmatic approach to interpret equivocal evidence.
BACKGROUND
Postoperative pulmonary complications remain the most significant cause of morbidity following open upper abdominal surgery despite advances in perioperative care. However, due to the poor quality primary research uncertainty surrounding the value of prophylactic physiotherapy intervention in the management of patients following abdominal surgery persists. The Delphi process has been proposed as a pragmatic methodology to guide clinical practice when evidence is equivocal.


METHODS
The objective was to develop a clinical management algorithm for the post operative management of abdominal surgery patients. Eleven draft algorithm statements extracted from the extant literature by the primary research team were verified and rated by scientist clinicians (n=5) in an electronic three round Delphi process. Algorithm statements which reached a priori defined consensus-semi-interquartile range (SIQR)<0.5-were collated into the algorithm.


RESULTS
The five panelists allocated to the abdominal surgery Delphi panel were from Australia, Canada, Sweden, and South Africa. The 11 draft algorithm statements were edited and 5 additional statements were formulated. The panel reached consensus on the rating of all statements. Four statements were rated essential.


CONCLUSIONS
An expert Delphi panel interpreted the equivocal evidence for the physiotherapeutic management of patients following upper abdominal surgery. Through a process of consensus a clinical management algorithm was formulated. This algorithm can now be used by clinicians to guide clinical practice in this population.
Department of Interdisciplinary Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Stellenbosch University, Francie van Zyl Drive, Tygerberg 7505, South Africa. sdh@sun.ac.za
Susan D
SD
Hanekom
Dina
D
Brooks
Linda
L
Denehy
Monika
M
Fagevik-Olsén
Timothy C
TC
Hardcastle
Shamila
S
Manie
Quinette
Q
Louw
D034841:Abdominal Cavity / Q000601:surgery*; D000465:Algorithms; D016638:Critical Illness; D003697:Delphi Technique; D019317:Evidence-Based Medicine; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans