Developing an exercise intervention to minimise hip bone mineral density loss following traumatic lower limb amputation : a Delphi study

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Behan, Fearghal P. and Bull, Anthony M.J. and Beck, Belinda and Brooke-Wavell, Katherine and Müller, Ralph and Vico, Laurence and Isaksson, Hanna and Harvey, Nicholas and Buis, Arjan and Sherman, Kate and Jefferson, Gemma and Cleather, Daniel J. and McGregor, Alison H. and Bennett, Alexander N. (2024) Developing an exercise intervention to minimise hip bone mineral density loss following traumatic lower limb amputation : a Delphi study. British Journal of Sports Medicine. e108721. ISSN 1473-0480 (https://doi.org/10.1136/bjsports-2024-108721)

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Abstract

Objective: To elicit expert opinion and gain consensus on specific exercise intervention parameters to minimise bone mineral density (BMD) loss following traumatic lower limb amputation. Methods: In three Delphi rounds, statements were presented to a panel of 13 experts from 6 countries. Experts were identified through publications or clinical expertise. Round 1 involved participants rating their agreement with 22 exercise prescription statements regarding BMD loss post amputation using a 5-point Likert scale. Agreement was deemed as 3-4 on the scale (agree/strongly agree). Statements of <50% agreement were excluded. Round 2 repeated remaining statements alongside round 1 feedback. Round 3 allowed reflection on round 2 responses considering group findings and the chance to change or maintain the response. Round 3 statements reaching ≥70% were deemed to reach consensus. Results: All 13 experts completed round 1, 2 and 3 (100% completion). Round 1 excluded 12 statements and added 1 statement (11 statements for rounds 2-3). Round 3 reached consensus on 9 statements to guide future exercise interventions. Experts agreed that exercise interventions should be performed at least 2 days per week for a minimum of 6 months, including at least 3 different resistance exercises at an intensity of 8-12 repetitions. Interventions should include weight-bearing and multiplanar exercises, involve high-impact activities and be supervised initially. Conclusion: This expert Delphi process achieved consensus on 9 items related to exercise prescription to minimise BMD loss following lower limb amputation. These will be implemented in a future interventional trial.

ORCID iDs

Behan, Fearghal P., Bull, Anthony M.J., Beck, Belinda, Brooke-Wavell, Katherine, Müller, Ralph, Vico, Laurence, Isaksson, Hanna, Harvey, Nicholas, Buis, Arjan ORCID logoORCID: https://orcid.org/0000-0003-3947-293X, Sherman, Kate, Jefferson, Gemma, Cleather, Daniel J., McGregor, Alison H. and Bennett, Alexander N.;
CORE (COnnecting REpositories)