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A UK Priority Setting Partnership with the James Lind Alliance

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A UK Priority Setting Partnership with the James Lind Alliance Open access Original research BMJ Open: first published as 10.1136/bmjopen-2019-030028 on 15 December 2019. Downloaded from Research priorities for the management of broken bones of the upper limb in people over 50: a UK priority setting partnership with the James Lind Alliance Warren J Sheehan ,1 Mark A Williams ,2 Zoe Paskins,3,4 Matthew L Costa,5 Miguel Antonio Fernandez ,1,6 Jenny Gould,7 Philip Bell,8 Liz Baird,9 Richard Grant,10 Patricia Ellis,11 Catherine White,12 Laura Arnel,1 Lauren Exell,1 Stephen Gwilym1 To cite: Sheehan WJ, ABSTRACT Strengths and limitations of this study Williams MA, Paskins Z, et al. Objective To determine research priorities for the Research priorities for the management of broken bones of the upper limb in ► This is the first time healthcare professionals have management of broken bones people over 50, which represent the shared priorities of the upper limb in people worked alongside patients and carers to set prior- of patients, their families, carers and healthcare over 50: a UK priority setting ities for upper limb fracture research using the es- professionals. partnership with the James tablished James Lind Alliance methodology. Design/setting A national (UK) research priority setting Lind Alliance. BMJ Open ► Survey responses were received from all over the partnership. 2019;9:e030028. doi:10.1136/ UK, with an even split of healthcare professionals Participants People aged 50 and over who have bmjopen-2019-030028 and members of the public (patients, carers, family experienced a fracture of the upper limb, carers involved Prepublication history and and friends). ► in their care, family and friends of patients, healthcare additional material for this ► Although substantial effort went into recruitment, professionals involved in the treatment of these patients. paper are available online. To ethnic minority groups were still under- represented. Methods Using a multiphase methodology in partnership view these files, please visit ► While the research priorities are now reported, it is the journal online (http:// dx. doi. with the James Lind Alliance over 15 months (September up to the research community and research funding http://bmjopen.bmj.com/ 2017 to December 2018), a national scoping survey asked org/ 10. 1136/ bmjopen- 2019- organisations to refine and deliver the answers to 030028). respondents to submit their research uncertainties. These these questions. were amalgamated into a smaller number of research Received 27 February 2019 questions. The existing evidence was searched to ensure Revised 06 June 2019 that the questions had not already been answered. A Accepted 26 July 2019 second national survey asked respondents to prioritise the INTRODUCTION research questions. A final shortlist of 25 questions was Upper limb fractures are very common inju- taken to a multi- stakeholder workshop where a consensus ries1 with distal radius and proximal humerus 2 3 was reached on the top 10 priorities. fractures being the most prevalent. Of these on September 30, 2021 by guest. Protected copyright. Results There were 1898 original uncertainties submitted injuries, over 60% of all distal radius and 75% by 328 respondents to the first survey. These original of all proximal humerus fractures occur in uncertainties were refined into 51 research questions people over 50.3 These fractures can arise of which 50 were judged to be true uncertainties from both high energy trauma, such as a road following a review of the research evidence. There were traffic accident, and low energy trauma, such 209 respondents to the second (interim prioritisation) survey. The top 10 priorities encompass a broad range of as falling from a standing height—sometimes uncertainties in management and rehabilitation of upper called fragility fractures. As the population © Author(s) (or their limb fractures. ages, the incidence of these types of upper employer(s)) 2019. Re- use limb fractures is increasing.4 permitted under CC BY-NC. No Conclusions The top 10 UK research priorities commercial re- use. See rights highlight uncertainties in how we assess outcomes, Fractures of the upper limb have significant and permissions. Published by provide information, achieve pain control, rationalise cost implications to the health and social care BMJ. surgical intervention, optimise rehabilitation and provide services.1 5 They often require both outpa- For numbered affiliations see psychological support. The breadth of these research areas tient and inpatient care, and treatment may end of article. highlights the value of this methodology. This work should involve surgery. They also have financial and help to steer research in this area for the next 5–10 years social implications for the people affected Correspondence to and the challenge for researchers now is to refine and and their families.1 5 Many people over 50 do Warren J Sheehan; deliver answers to these research priorities. warren. sheehan@ ouh. nhs. uk not return to their pre-injur y level of function Sheehan WJ, et al. BMJ Open 2019;9:e030028. doi:10.1136/bmjopen-2019-030028 1 Open access BMJ Open: first published as 10.1136/bmjopen-2019-030028 on 15 December 2019. Downloaded from following a fracture and often report long- term impaired research into the best management of broken bones of function, fear of falling and associated disability.1 5–8 the upper limb in people over 50. Research is integral in shaping the future of healthcare provision. However, the research being undertaken does not always match the research priorities of patient s and METHODS 9–11 healthcare professionals. This can lead to a waste of The ‘Broken Bones of the Upper Limb in People over 50’ 12 time, money and other resources. There has been a PSP was conducted in accordance with the JLA process18 19 strong drive to rectify this issue in recent years, and there and was undertaken over a 15-month period (September is good evidence that patient and public involvement 2017 to December 2018). See figure 1 ‘Time Frame of (PPI) in research has enhanced the quality and appropri- Priority Setting Partnership’. ateness of research.13–15 It has also helped to ensure that study findings are disseminated in a user-friendly way.13–15 Steering group and partner organisations PPI is now a key part of the design, conduct and delivery Steering group members were recruited to ensure that of research in health and social care.16 17 there was a good representation of PPI members and The James Lind Alliance (JLA) is a non- profit organisa- healthcare professionals including medics and allied health tion hosted by the National Institute for Health Research professionals. Each member had an interest in upper limb (NIHR). It provides a valuable means by which both patients fractures and links to relevant partner organisations (see and clinicians can shape the health research agenda. The supplementary appendix 1—partner organisations). This aim of the JLA is to enable patients, carers and healthcare ensured that a range of stakeholder groups was represented. professionals to work together on an equal footing and to The steering group was supported by a JLA adviser with identify, prioritise and agree which research uncertainties local administrative support. The JLA adviser was assigned are most important to them.18 19 To date, there have been as an independent neutral facilitator to ensure that each over 50 priority setting partnerships (PSPs) across a range member had an equal opportunity to contribute to discus- of disciplines, with over 100 research topics addressed as a sions and decisions and to ensure that the PSP followed direct result of the JLA PSPs.19–21 the JLA process in a fair and transparent way. The infor- Although there are existing research recommendations mation specialist designed the surveys, managed the data in guidelines from the National Institute of Health and and performed the analysis, with each task being over- Care Excellence (NICE) and the British Society of Surgery seen and advised on by the steering group. for the Hand (BSSH),22 23 there has not, until now, been a national priority setting exercise for the management of Definition of scope broken bones of the upper limb in people over 50. The The scope of this PSP covered any uncertainty relating to aim of this project was to use the JLA process to obtain the upper limb fractures, including those of the scapula, clav- views of patients, carers and healthcare professionals in icle, humerus, radius and ulna bones, in people over 50. http://bmjopen.bmj.com/ order to establish, and then disseminate, their agreed top Although fractures of the hand and carpal bones would 10 research priorities. These priorities will drive future also fall under the definition of upper limb fractures, it was on September 30, 2021 by guest. Protected copyright. Figure 1 Time frame of priority setting partnership (PSP). 2 Sheehan WJ, et al. BMJ Open 2019;9:e030028. doi:10.1136/bmjopen-2019-030028 Open access BMJ Open: first published as 10.1136/bmjopen-2019-030028 on 15 December 2019. Downloaded from agreed that they would not be a part of this PSP as they had response. These alterations were agreed by the steering already been covered by the JLA PSP on ‘Common Condi- group who had access to the unedited uncertainty. tions Affecting the Hand and Wrist’.24 We excluded uncer- Once the responses were collated, general comments tainties about chronic regional pain syndrome, too, as they and out- of- scope uncertainties were removed and uncer- were also included in the hand and wrist PSP.24 tainties with similar meaning were grouped together Prevention of primary and secondary fractures under an initial question. These questions were then (including uncertainties about osteoporosis) was placed under overarching themes. excluded from this PSP as it was felt that this is a very extensive and important area that should have its own Creation of indicative questions priority setting project.
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