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European Journal of Physical and Rehabilitation Medicine 2021 October;57(5):701-9

DOI: 10.23736/S1973-9087.21.06624-7

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

A consensus process to agree best practice for managing physical wellbeing in people with a prolonged disorder of consciousness

Stephen ASHFORD 1, 2 , Rasheed A. MOHAMMED MEERAN 3, Teresa CLARK 4, Macarena MONTESINOS RUIZ 4, Karen HOFFMAN 5, Diane PLAYFORD 6, Anand PANDYAN 7

1 Regional Hyper-Acute Rehabilitation Unit, London North West University Healthcare NHS Trust and Department of Palliative Care, Policy and Rehabilitation, King’s College, London, UK; 2 Centre for Nursing, Midwifery and Allied Health Research, University College London Hospitals, and Institute for Neurology, University College, London, UK; 3 Holy Cross Hospital, Haslemere, UK; 4 Royal Hospital for Neurodisability, London, UK; 5 Royal London NHS Trust, London, UK; 6 University of Warwick, Warwick, UK; 7 School of Allied Health Professions, Keele University, Keele, UK



BACKGROUND: Current practice for physical wellbeing of people in a Prolonged Disorder of Consciousness (PDOC) is variable. A scoping literature review identified no agreed standard of care for physical management of those in a PDOC. This study addressed this deficit using a consensus process applied using nominal group technique.
AIM: The aims of this project were to promote best practice for physical management in PDOC, by identifying consensus for: 1) a pathway of care; and 2) current best practice recommendations.
DESIGN: A consensus process using nominal group technique.
SETTING: Representation from national, purposively selected, rehabilitation services assessing and managing people in a PDOC in the UK.
POPULATION: The population to whom the consensus process relates are people in a PDOC, requiring physical management.
METHODS: An initial meeting with selected clinical experts from national centres was conducted to set terms of reference. A consensus meeting using nominal group technique (N.=33) then followed. Experts were initially asked to review systematic review findings reproduced as statements. Following systematic refinement, they were then asked to vote on the importance and relevance of statements.
RESULTS: Following the nominal group process, 25 initial recommendations were refined to 19, which expressed the principles of physical management for people with a Prolonged Disorder of Consciousness. Statements are grouped into “acute-care” (6-recommendations), “postacute care” (10-recommendations) and “long-term care” (3-recommendations). Across the participants, agreement with the final recommendation statements ranged from 100-61% (N.=33-20), 15 of the statements were supported by 85% or more experts (N.=29). In addition, a clinical pathway of care, incorporating the recommendation principles was produced (agreement from 28 experts, 83%).
CONCLUSIONS: The recommendations provide a basis for standardising current practice. They provide a standard against which care, and effectiveness can be evaluated. An accessible guideline document is planned for publication to enable implementation into practice, supported by online resources.
CLINICAL REHABILITATION IMPACT: Recommendations have been produced under the headings of “acute care,” “postacute care” and “long-term care.” In addition, a pathway for provision of care interventions has been identified for the physical management of people in a prolonged disorder of consciousness.


KEY WORDS: Consciousness disorders; Consciousness; Consensus

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