Research priorities in children requiring elective surgery for conditions affecting the lower limbs: a James Lind Alliance Priority Setting Partnership

Authors: Martinique Vella-Baldacchino [1], Daniel C Perry [1]Andreas Roposch [2]Nicholas Nicolaou [3]Stephen Cooke [4]Patricia Ellis [5]Tim Theologis [6]


This paper was first published in BMJ Open journal on 30 December 2019.



Objective To identify and prioritise research questions concerning the elective surgical management of children with conditions affecting the lower limb by engaging patients, carers and healthcare professionals.
Design A modified nominal group technique.
Setting UK.
Participants 388 individuals (29 patients, 155 parents/carers, 204 healthcare professionals) were recruited through hospital clinics, patient charities and professional organisations and participated in the initial prioritisation survey; 234 individuals took part in the interim prioritisation survey. 33 individuals (3 patients, 9 parents/carers, 11 healthcare professionals, 7 individuals representing the project’s steering group and 3 James Lind Alliance (JLA) facilitators) attended the final face-to-face workshop to rank the top 10 research priorities.
Interventions Surveys were distributed using various media resources such as newsletters, internet messaging boards and the ‘Paediatric Lower Limb Surgery Priority Setting Partnership (PSP) website. Printed copies of the questionnaire were also made available to families in outpatient clinics.
Outcome measures Survey results, top 10 and top 26 priority rankings
Results The process took 18 months to complete (July 2017–January 2019); 388 people generated 1023 questions; a total of 801 research questions were classified as true uncertainties. Following the JLA methodology, 75 uncertainties were developed from the initial 801 questions. Twenty six of those were selected through a second survey and were taken to the final face-to-face workshop where the top 10 research priorities were selected. The top10 priorities included questions on cerebral palsy, common hip conditions (ie, Perthes’ disease and developmental dysplasia of the hip) as well as rehabilitation techniques and methods to improve shared decision-making between clinicians and patients/families.
Conclusions This is the first JLA PSP in children’s orthopaedic surgery, a particularly under-researched and underfunded area. We have identified important research topics which will guide researchers and funders and direct their efforts in future research.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:
Vella-Baldacchino MPerry DCRoposch A, et al
Research priorities in children requiring elective surgery for conditions affecting the lower limbs: a James Lind Alliance Priority Setting Partnership
See also a summary of the study in 'Useful Resources' on the right. 
Author affiliations:
1. Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal ScienceBotnar Research CentreOxfordOxfordshire, UK
2. University College London Great Ormond Street Institute of Child Health LibraryLondon, UK
3. Paediatric Orthopaedic SurgerySheffield Children's NHS Foundation TrustSheffield, UK
4. Paediatric Orthopaedic SurgeryUniversity Hospital CoventryCoventry, UK
5. James Lind AllianceSouthampton, UK
6. Paediatric Orthopaedic SurgeryOxford University Hospitals NHS Foundation TrustOxford, UK 



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