Research Article| Volume 35, ISSUE 2, P299-307, April 2022

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A modified-delphi study establishing consensus in the therapeutic management of posttrauamtic elbow stiffness

Published:January 12, 2022DOI:


      • Web based modified Delphi study identifying expert consensus during 3 rounds.
      • Consensus was found in the following categories: examination procedures, therapeutic interventions, orthotic intervention considerations, contributing patient factors, and clinical decisions and rehabilitation challenges.
      • Findings of this study support the need for future high-level studies looking at effectiveness of recommended therapeutic interventions.


      Study Design

      : Web-based modified Delphi study.


      : Therapy is widely considered the first choice of treatment for posttraumatic stiffness of the elbow since loss of motion is a common sequela following traumatic elbow injuries. There is high variability in practice patterns for the management of the posttraumtic elbow.


      : The aim of this study is to identify the current therapeutic management of posttraumatic elbow stiffness using expert consensus.


      : This study surveyed experts using a web-based 3 round modified Delphi method. Quantitative data and comments were collected during the first round. Questions with Likert scaling were used to identify consensus (defined as 75% agreement) with each statement and comment boxes enabled open-ended responses to gather expert opinion. Lack of consensus and data from comments guided the second-round of the survey. This process was repeated after Round 2 to develop the Round 3 survey. Consensus was achieved at Round 3 and no further rounds were needed.


      : Round 1 included 34 experts (response rate 20%), not all experts were able to continue through all rounds. Round 2 included 18 experts and Round 3 included 15 experts. Survey items were categorized as follows: examination procedures, therapeutic interventions, orthotic intervention considerations, contributing patient factors, and clinical decisions and rehabilitation challenges. Twenty-five percent of items achieved consensus after Round 1, 30% after Round 2 and 52% after Round 3. Although most participants agreed that orthotic intervention is critical to patient outcomes, there were conflicting thoughts about the orthotic design and wearing schedule.


      : The findings of this web-based modified Delphi study helped to establish a current body of knowledge using expert consensus to guide practice and identify specific questions that can be studied in future clinical studies on posttraumatic elbow stiffness.


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      JHT Read for Credit

      Quiz: # 846

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • # 1.
        How many rounds were needed to reach consensus?
        • a.
        • b.
        • c.
        • d.
      • # 2.
        To be included as a so-called expert, a therapist had to treat a minimum of ______ traumatic elbow patients in a year
        • a.
        • b.
        • c.
        • d.
      • # 3.
        Commonly encountered clinical issues included
        • a.
          reactive flares to interventions
        • b.
          reluctance to wearing splints
        • c.
          altered esthetics secondary to limited ROM
        • d.
          insurance company's declining reimbursement for therapy
      • # 4.
        The experts agreed that the chief intervention was
        • a.
          manual therapy
        • b.
          orthotic wearing
        • c.
          physical agent modalities
        • d.
          therapeutic exercise
      • # 5.
        The Modified Weeks Test was the most commonly identified tool for assessing orthotic intervention
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.