The lack of a consensus for core health outcomes that should be reported in clinical research has hampered study design and evidence synthesis. We report a United Kingdom consensus for a core outcome set (COS) for clinical trials of patients with a hip fracture. We adopted a modified nominal group technique to derive consensus on 1) which outcome domains should be measured, and 2) methods of assessment. Participants reflected a diversity of perspectives and experience. They received an evidence synthesis and postal questionnaire in advance of the consensus meeting, and ranked the importance of candidate domains and the relevance and suitability of short-listed measures. During the meeting, pre-meeting source data and questionnaire responses were summarised, followed by facilitated discussion and a final plenary session. A COS was determined using a closed voting system: a 70% consensus was required. Consensus supported a five-domain COS: mortality, pain, activities of daily living, mobility, and health-related quality of life (HRQL). Single-item measures of mortality and mobility (indoor/outdoor walking status) and a generic multi-item measure of HRQL - the EuroQoL EQ-5D - were recommended. These measures should be included as a minimum in all hip fracture trials. Other outcome measures should be added depending on the particular interventions being studied.
ContributorsHaywood, K. L. Griffin, X. L. Achten, J. Costa, M. L.
Disease Category: Orthopaedics & trauma
Disease Name: Hip fracture
Age Range: 60
Sex: Either
Nature of Intervention: Complex intervention, Rehabilitation, Surgery
- Clinical experts
- Patient/ support group representatives
- Regulatory agency representatives
- Researchers
- Service commissioners
- Carer organisation/ support group representatives
- Recommendations for outcome measures (measurement/how)
- COS for clinical trials or clinical research
- Nominal group technique (NGT)
An agreed methodology for the best approach to achieve consensus on a core outcome set for use in clinical trials does not exist. However, evidence suggests that a more formal, explicit approach is preferable, for example, (modified) Nominal Group Techniques (NGT), Delphi methods, or a Consensus Development Conference.
We have integrated key aspects of the modified NGT with an approach towards achieving consensus in core outcome sets described by the OMERACT initiative. This approach aims at deriving consensus from a group of experts through highly structured, facilitator-led discussion.
We aim to achieve consensus on the following questions:
• What core outcome domains must be included in clinical trials of patients with hip fracture?
• What outcome measures are most relevant and acceptable for the proposed domains?