International consensus on sports, exercise, and physical activity participation during post-operative interventions for Adolescent Idiopathic Scoliosis: An e-Delphi study.

The study recruited 53 participants from 18 countries, with 41 responding to round 1, 32 to round 2, and 29 to round 3.

• Final round 3 participants comprised 14 surgeons and 15 physiotherapists.
• One country of origin was unknown among the 53 recruited participants.
• Eligible participants were expert surgeons or physiotherapists with specific clinical or research experience in AIS.

Round 1 generated 85 statements under 19 themes surrounding graded return to sports, rehabilitation milestones, philosophical approaches, and treatment modalities.

• Round 1 consisted of open-ended questions from which statements were generated.
• Themes covered overarching considerations of care, MDT involvement, physiotherapy treatment modalities, pre-operative care, inpatient stay, and post-operative rehabilitation phases 1 through 4.
• Round 2 refined these to 56 statements, with those exceeding 75% agreement totaling 63 statements after seven were split into two due to multiple concepts.

Round 3 produced 66 statements with greater than 75% agreement across 9 themes, with all statements demonstrating statistical significance.

• All round 3 statements demonstrated significance at p < 0.001.
• Kendall's coefficient of concordance showed moderate agreement (W = 0.5).
• A Wilcoxon Sum-rank result (p < 0.05) showed stability between rounds 2 and 3.
• Consensus was defined as >75% agreement (strongly agree or agree) on the 5-point Likert scale.

Round 2 open comments generated an additional 22 statements, and round 3 open comments generated a further 5 recommendations.

• The 5 additional round 3 recommendations explored types of post-operative exercise, provision of rehabilitation, timeframes and milestones, and MDT involvement.
• Consensus from open comments was determined through content analysis of comments from more than 1 participant.
• The total final consensus output comprised 71 statements.

Subgroup analysis demonstrated consensus among surgeons but divergence among physiotherapists regarding the consensus statements.

• This divergence among physiotherapists was highlighted as a finding requiring further exploration.
• The subgroup analysis was conducted following the main round 3 consensus analysis.
• The authors noted this finding highlights the need for further exploration of these statements specifically within the physiotherapy subgroup.

There is a lack of evidence and worldwide variability in post-operative rehabilitation guidance following spinal fusion for adolescent idiopathic scoliosis.

• Physiotherapists and surgeons have a significant role in promoting participation and offering a graded return to sports, exercise, and physical activity following spinal fusion in AIS.
• The absence of evidence-based guidance motivated the development of this international consensus.
• This Delphi study is described as providing the first international consensus on return to sports, exercise, and physical activity following spinal fusion in AIS.

The final consensus comprised 71 statements organized across 9 themes covering the full continuum of care from pre-operative through four post-operative rehabilitation phases.

• The 9 themes included overarching considerations of care, the MDT, physiotherapy treatment modalities, pre-operative care, inpatient stay, and post-operative rehabilitation phases 1, 2, 3, and 4.
• 66 statements with >75% agreement came from round 3 ratings, with an additional 5 from round 3 open comments.
• A 3-round electronic Delphi methodology was used, with round 2 including a summary of existing literature for participants to review prior to rating statements.