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
Bull, Anthony MJ
Beck, Belinda R
Brooke-Wavell, Katherine
Müller, Ralph
Vico, Laurence
Isaksson, Hanna
Harvey, Nicholas C
Buis, Arjan
Sherman, Kate
Jefferson, Gemma
Cleather, Daniel J
McGregor, Alison
Bennett, Alexander N
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2024
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Abstract

OBJECTIVE: To elicit expert opinion and gain consensus on specific exercise intervention parameters to minimise hip 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 six 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 resp onse. Round 3 statements reaching ≥70% agreement were defined as consensus. RESULTS: All 13 experts completed rounds 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 nine 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 three 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 nine items related to exercise prescription to minimise hip BMD loss following traumatic lower limb amputation. These recommendations should be tested in future interventional trials.

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British Journal of Sports Medicine

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© Author(s) (or their employer(s)) 2024. 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: https://creativecommons.org/licenses/by/4.0/.

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This publication has been entered in Griffith Research Online as an advance online version.

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Clinical sciences

Sports science and exercise

Applied and developmental psychology

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Behan, FP; Bull, AMJ; Beck, BR; Brooke-Wavell, K; Müller, R; Vico, L; Isaksson, H; Harvey, NC; Buis, A; Sherman, K; Jefferson, G; Cleather, DJ; McGregor, A; Bennett, AN, Developing an exercise intervention to minimise hip bone mineral density loss following traumatic lower limb amputation: a Delphi study, British Journal of Sports Medicine, 2024

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