Table 7 Summary and interpretation of the feedback on general issues from the consultation process

i

Were the overall aims of the initiative acceptable?

No direct question: answer deduced from actions taken by responders and the lack of contrary statements.

Yes: no contrary evidence.

ii

Was the consultation group representative?

This depends on the reference population and the validity of the criteria used to define the key characteristics of such a group. Our non-validated inclusion criteria were met in that the group included, with the exception of a special-interest general practitioner (GP), all relevant clinical specialities, confirmed active researchers, opinion leaders and a consumer representative.

Probably, no. However, the absence of a GP aside, the group members provided clinical coverage of the whole care programme and would be influential in setting and enacting the future research agenda.

iii

Was the care pathways scheme acceptable?

No direct question though general comments invited. No criticisms on overall scheme including basic structure. However, some suggestions for a) specific inclusion of risk assessment for future fractures and subsequent medical management, b) management of chronic regional pain syndrome type 1 (RSD), and c) specialist centres for secondary treatment.

Yes, overall. Suggestions for explicit development of secondary prevention pathway, management of RSD and specialist intervention for secondary treatment.

iv

Was the presentation of the decision points in terms of treatment questions acceptable?

No direct question. Answer deduced from lack of contrary statements. One respondent suggested a move to a decision-tree format. Another suggested better definition of care provider questions in terms of action and decision making.

Yes, overall.

v

Was restricting the project evidence base to that presented in the five Cochrane reviews a reasonable compromise?

There was no direct overall criticism of our decision to confine our remit to RCTs within our five reviews, and from their responses, people clearly were not constrained to RCT evidence. However, some respondents stressed that RCTs are not always appropriate. There was also some call for evidence from other clinical areas. In addition, some respondents indicated that consideration of outcome measurement and the association of fracture classification/position with clinical outcome was missing.

Yes, generally. However, other study designs are more appropriate for some issues, and some other issues could be informed by evidence from other subjects (e.g. wound care). Also considered missing was evidence from studies on prognosis and outcome measurement.

vi

Were the interpretation and presentation of the evidence considered valid?

No explicit comment received on structure and contents of the evidence document, including choice of effectiveness categories scheme. Many took the interpretation of evidence 'as a given'. There were instances where respondent's judgement of the available evidence differed from ours; usually where we considered there was insufficient evidence to draw a conclusion of effectiveness or lack of effectiveness.

Yes, probably given the absence of direct comments and since the summary statements were often used as a basis for feedback. However, there were some differences – our interpretation of the evidence was usually more cautious.

vii

Was the questionnaire design acceptable and did it facilitate feedback?

Some respondents, who indicated that the full questionnaire was too much, were encouraged to at least comment on research priorities. Others felt more comfortable completing only the questions within their professional domain. Equivalent questions on parallel pathways were probably irksome to some respondents but an alternative approach would have lost the consistent presentation of questions in the project documentation. The wording for some questions was sub-optimal.

Yes in that some quality feedback was obtained but with some serious reservations.

viii

Was the single consultation exercise a reasonable substitute for the originally envisaged two stage Delphi consultation?

Given the excessive demands on consultation group members, it is unlikely that multi-staged consensus process would have worked or achieved equivalent or superior results to the actual methods applied.

Yes, the pragmatic alternative appeared more viable.