Level V Evidence
Research Pearls: Expert Consensus Based Evidence Using the Delphi Method

https://doi.org/10.1016/j.arthro.2018.10.004Get rights and content

Abstract

The evolution of a systematic approach to assessing pertinent investigations is known as evidence-based medicine (EBM). EBM is defined as the conscientious and judicious use of current best evidence from clinical care research and integration of clinical expertise in the management of individual patients. There is no doubt that EBM is important but may not give clinically meaningful guidance on topics with clinical equipoise for individual patient care. When EBM has been insufficiently developed for a specific topic, a consensus opinion of experts can be valuable. In principle, there are 2 consensus methods for expert opinion available: the nominal group technique and the Delphi method. The nominal group technique is a structured face-to-face meeting facilitating discussion and allows participants to voice their opinions. The key characteristics of the Delphi method are the use of panel experts to obtain data, no face-to-face discussions, the use of sequential questionnaires, the systematic emergence of a concurrent opinion, use of frequency distributions to identify patterns, and the use of at least 2 rounds with feedback between rounds. We should not dismiss the collective experience of our leading experts, and expert consensus-based evidence should be explored as another tool to improve the quality of treatment for our patients.

Section snippets

The Delphi Method

Another consensus-based evidence technique is the Delphi method. One of the advantages of Delphi is that responses remain anonymous.21, 24 Delphi is a structured process to collect knowledge by a series of open-ended questionnaires with controlled feedback to reach consensus.25 One of the main advantages of Delphi is that consensus can be achieved if evidence is lacking or uncertainty exists in a given field.26, 27 An example of using the Delphi method to establish clinical consensus has been

How Does Delphi Work?

The Delphi method should have 3 distinct and important features: anonymity, controlled feedback, and statistical group response.29, 30 Anonymity is a crucial feature because it reduces the effect or influence of dominant individuals and key opinion leaders. Controlled feedback between rounds communicating the results of the previous round reduces noise and allows participants to reflect on their response and compare it with the overall direction of the collective group. Finally, statistical

Limitations of the Delphi Method

The Delphi method has been criticized to represent only the lowest common denominator46 and may lead to a watered-down approach of the best opinion.26 The main concerns are that the number of rounds may result is some convergence of individual statements, having an unclear effect on the accuracy of the group's decision making, that anonymity may lead to a lack of accountability and hasty decisions and provide bland general statements, giving the illusion of precision26, 46; however, execution

Conclusions

We should not dismiss the collective experience of our leading experts, and expert consensus-based evidence should be explored as another tool to improve the quality of treatment for our patients.9 Expert consensus may represent an underused research tool. EBM and Delphi can be combined if there is insufficient or low-quality evidence.48 The best of both worlds? We do not know. At the end of the day, it is not the evidence, it is the way you use it.49 Or as Sackett et al.5 said in 1996, “good

References (49)

  • D.L. Sackett et al.

    Evidence-based medicine: What is it and what it isn’t

    BMJ

    (1996)
  • K. O’Rourke

    An historical perspective on meta-analysis: Dealing quantitatively with varying study results

    J R Soc Med

    (2007)
  • W. Rosenberg et al.

    Evidence-based medicine: An approach to clinical problem-solving

    BMJ

    (1995)
  • R.G. Marx et al.

    Updating the assignment of levels of evidence

    J Bone Joint Surg

    (2015)
  • A.B. Haidich

    Meta-analysis in medical research

    Hippokratia

    (2010)
  • M.H. Murad et al.

    New evidence pyramid

    Evid Based Med

    (2016)
  • H.J. Eysenck

    Meta-analysis and its problems

    BMJ

    (1994)
  • H.J. Eysenck

    An exercise in mega silliness

    Am Psychol

    (1978)
  • J.P.A. Ioannidis

    The mass production of redundant, misleading and conflicting systematic reviews and meta-analysis

    Milbank Q

    (2016)
  • M.R. Tonnelli

    In defense of expert opinion

    Acad Med

    (1999)
  • M.R. Tonnelli

    Integrating evidence into clinical practice: An alternative to evidence-based approaches

    J Eval Clin Pract

    (2006)
  • J.R. Hampton

    Evidence-based medicine, opinion-based medicine, and real-world medicine

    Perspect Biol Med

    (2002)
  • J. Jones et al.

    Consensus methods for medical and health services research

    BMJ

    (1995)
  • S.S. McMillan et al.

    Using the nominal group technique: How to analyse across multiple groups

    Health Serv Outcomes Res Method

    (2014)

    • Cited by (0)

    The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

    View full text
    © 2018 by the Arthroscopy Association of North America