Allied health professionals’ views on important outcomes of children’s elective lower limb orthopaedic surgery: a qualitative interview study to inform a core outcome set

Abstract

Purpose

A common methodological limitation of research that guides surgical procedure selection for children’s elective lower limb orthopaedic surgeries is inconsistent outcome selection. Improving outcome consistency can be achieved through the development of a core outcome set (COS). The aim of this study is to identify which outcomes are considered important for children’s elective lower limb orthopaedic surgeries by allied health professionals (AHPs) and explore why they select these outcomes, to inform a COS development project.

Methods

Online semi-structured interviews were conducted with relevant AHPs. Participants were selected using maximum variation purposive sampling; selection was based on profession and inpatient/outpatient role. The data set was analysed using an inductive and deductive approach to thematic analysis.

Results

Four physiotherapists, three orthotists, three prosthetists, and two occupational therapists were interviewed. Most identified outcomes of importance related to “activities and participation”. From the data, we conceptualised that AHPs with effective multidisciplinary communication focused on child-centred outcomes, while clinicians with limited multidisciplinary teamwork focused on role-based outcomes.

Conclusions

There is concurrence between outcomes identified as important in this study, and other qualitative studies in similar populations. These important outcomes were seldom measured in previous studies or in routine clinical practice.

Implications for rehabilitation

• Allied health professionals (AHPs) prioritise activity and participation outcomes after children’s elective lower limb orthopaedic surgery.

• It is important to the rehabilitation of children after elective lower limb orthopaedic surgery that all involved AHPs collaborate with the wider multidisciplinary team.

• Multidisciplinary team communication encourages collaborative outcome identification, and discourages role defined outcome focus.

Keywords:

• Paediatrics
• children
• orthopaedics
• surgery
• outcomes
• interviews

Acknowledgements

We thank each of the participants who generously contributed their time to this study. We are grateful to the professional bodies who distributed the research advert to their members, including the British Association of Prosthetists and Orthotists (BAPO), the Association of Paediatric Chartered Physiotherapists (APCP), and the Royal College of Podiatry (RCPod). We thank the members of the Great Ormond Street Hospital Young Persons Advisory Group (GOSH YPAG) and the Oxford Patient Engagement Network for Arthritis and Musculoskeletal Conditions (OPEN ARMS) patient and public involvement groups for their invaluable contributions to this study and the wider project. Finally, we thank the National Institute of Health Research (NIHR) for their grant support of this project.

Author contributions

Eileen Mairi Morrow – provided a substantial contribution to the design, analysis and interpretation of the work, drafting the manuscript, and approving the final version. Christopher Morris – provided a substantial contribution to the design and interpretation of the work, revising the manuscript, and approving the final version. Tim Theologis – provided a substantial contribution to the conceptualisation of the work, revising the manuscript, and approving the final version. Julia Frost – provided a substantial contribution to the conceptualisation, design, analysis and interpretation of the work, revising the manuscript, and approving the final version.

Disclosure statement

The authors report there are no further competing interests to declare.

Data availability statement

Due to the nature of the interviews conducted for this study, transcripts are not available as supplementary data to maintain pseudo-anonymity of participants. All other available data including demographic details are included within the manuscript.

Additional information

Funding

Eileen Morrow’s contributions were supported by NIHR. This report is independent research supported by the National Institute for Health Research HEE/NIHR ICA Programme Pre-doctoral Clinical Academic Fellowship, Miss Eileen Morrow, NIHR301104. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Departmentof Health and Social Care.