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Logo of bmcmidmBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Medical Informatics and Decision Making
 
BMC Med Inform Decis Mak. 2012; 12: 5.
Published online Feb 6, 2012. doi:  10.1186/1472-6947-12-5
PMCID: PMC3395830
Reaching consensus on the physiotherapeutic management of patients following upper abdominal surgery: a pragmatic approach to interpret equivocal evidence
Susan D Hanekom,corresponding author1 Dina Brooks,2 Linda Denehy,3 Monika Fagevik-Olsén,4 Timothy C Hardcastle,5 Shamila Manie,6 and Quinette Louw1
1Department of Interdisciplinary Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Stellenbosch University, Francie van Zyl Drive, Tygerberg 7505 South Africa
2Department of Physical Therapy 160-500 University Avenue, Toronto, Ontario M5G 1V7 Canada
3Department of Physiotherapy, The University of Melbourne, Parkville Melbourne, 3010 Australia
4Department of Physical Therapy, Sahlgrenska University Hospital, Gothenburg, 413 45, Sweden
5Trauma Surgery and Trauma ICU, Inkosi Albert Luthuli central Hospital & University of KwaZulu-Natal 800 Bellair Rd Mayville Durban 4058 South Africa
6Department of Health and Rehabilitation Sciences, Division of Physiotherapy, University of Cape Town, Old Main Building, Groote Schuur Hospital, Observatory Cape Town 7925 South Africa
corresponding authorCorresponding author.
Susan D Hanekom: sdh/at/sun.ac.za; Dina Brooks: dina.brooks/at/utoronto.ca; Linda Denehy: l.denehy/at/unimelb.edu.au; Monika Fagevik-Olsén: monika.fagevik-olsen/at/vgregion.se; Timothy C Hardcastle: timothyhar/at/ialch.co.za; Shamila Manie: shamila.manie/at/uct.ac.za; Quinette Louw: qalouw/at/sun.ac.za
Received June 29, 2010; Accepted February 6, 2012.
Abstract
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.
Conclusion
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.
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