Exploration and choice of method
Two explorative face-to-face meetings with three experts in VFF were conducted to scope the problem, and to select the most adequate method for developing the CCP from a multidisciplinary perspective. The RAND/UCLA Appropriateness Method, a modified Delphi technique, was chosen because it allows combining evidence from both clinical studies and clinical practice to establish patient-specific recommendations.
Expert panel study
A panel of 12 experts from key disciplines (interventional radiology, neurosurgery, pain medicine, orthopaedic surgery) was selected on the basis of their scientific and clinical knowledge of VFF. The panel process consisted of two individual rating rounds and two plenary sessions.
Clinical care pathway
The work resulted in a comprehensive CCP including:
- Ten key signs and symptoms for the suspicion of VFF
- Recommendations on the appropriateness of various diagnostic procedures for patients suspected of VFF
- Appropriateness criteria for treatment choice within 576 clinical scenarios
- Recommendations on 11 potential contraindications
- Recommendations on follow-up after treatment
It is planned to incorporate the CCP in Electronic Medical Record systems in medical and surgical practices in the USA.