How should interventions to treat hand oedema be delivered? An online Delphi Consensus Method

Introduction: Hand oedema (swelling) is a common consequence of hand trauma or surgery, but there is little agreement on how interventions to treat hand oedema should be delivered in practice. The purpose of this study was to engage a group of self-identified hand therapy experts to develop consensus on how four commonly used oedema management treatments should be implemented, which could be used in clinical practice or future clinical trials.

Method: A web-based Delphi study was conducted with eight volunteer hand therapists who met the pre-defined eligibility criteria for an ‘expert’ and were members of the British Association of Hand Therapists (BAHT). An a priori level of agreement was set at 75%. Interventions requiring consensus were decided on as a result of a previous national survey of practice and consisted of compression, elevation, massage and kinesiology tape.

Results: A total of 25 items were discussed across 3 rounds. This ranged from 23 items in round 1, to three items in round 3. In round 1, consensus was reached on 7/23 (30%) items. The required 75% consensus was reached on 14 items in round 2 and 1/3 items achieved consensus in round 3. Massage was the only treatment that required a third round.

Discussion: Consensus was reached on intervention description for three of the four modalities including the materials used (what), method of application including duration and frequency (when and how much) and tailoring or modifications. Two questions relating to massage did not reach the required consensus threshold and a majority agreement was accepted. The small panel size is a limitation and may affect the credibility of the consensus reached.