The use of a modified Delphi procedure for the determination of 26 prognostic factors in the sub-acute stage of stroke

The use of a modified Delphi procedure for the determination of 26 prognostic factors in the sub-acute stage of stroke

Meijer R; Ihnenfeldt D; Vermeulen M; De Haan R; Van Limbeek J

International Journal Of Rehabilitation Research

2003

Hospitalization; Humans; Patient Discharge; Prognosis; Research Design; Activities of Daily Living; Residence Characteristics; Delphi Technique; Disability Evaluation; Non-U.S. Gov't; Research Support; social support; Recovery of Function; Cerebrovascular Accident/rehabilitation; Subacute Care/organization & administration

The aim of this study was to reach consensus about the prognostic factors when deciding the discharge destination from a hospital stroke unit, and to construct a prognostic conceptual framework. To realise an optimal integration of knowledge from research findings and from clinical experience by expert opinions we used a 'modified Delphi Technique', which is the most commonly used method for the production of clinical guidelines. The process yielded 26 prognostic factors, which were arranged in clinical and social sub-domains. The sub-domains and the factors within each sub-domain were prioritised according to their assumed predictive value for the decision process. The order of importance of the prognostic factors in the clinical domain was: (1) disabilities, (2) pre-morbid disabilities, (3) impairments and (4) disease/biology; and the order of importance of the factors in the social domain was: (1) home front, (2) social situation and (3) residence. The Delphi procedure is an excellent instrument to determine and prioritise prognostic factors. With this procedure research-based and consensus-based knowledge can be combined. For a valid procedure it is mandatory to state explicitly in advance how the scores will be judged, and to explain the scientific level of the evidence during the whole procedure.

2003

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