International Consensus on Sports, Exercise, and Physical Activity participation during post-operative interventions for Adolescent Idiopathic Scoliosis: an e-Delphi study

Introduction: Physiotherapists and surgeons have a significant role in promoting participation and offering a graded return to sports, exercise, and physical activity following spinal fusion in adolescent idiopathic scoliosis (AIS). However, there is a lack of evidence to guide post-operative rehabilitation and variability worldwide. This study aims to obtain consensus on 1) when it is safe and 2) how an individual with AIS might return to sports, exercise, and physical activity.   Methods and analysis: An international electronic 3 round Delphi study was conducted and reported. Eligible expert surgeons or physiotherapists had either specific clinical or research experience in AIS. Round 1 included a series of open-ended questions. Round 2 provided a summary of the existing literature for participants to review and rate items. Round 3 participants were asked to re-rate responses. Consensus was determined through content analysis of open statements >1 participant, round 2 statements achieving >75% on a 5-point Likert scale, and round 3 Kendall’s coefficient of concordance.    Results: From 53 recruited participants (18 countries, 1 unknown), 41 responded to round 1, 32 to round 2, and 29 to Round 3 (14 surgeons, 15 physiotherapists). Round 1 generated 85 statements under 19 themes surrounding graded return to sports, rehabilitation milestones, philosophical approaches, and treatment modalities. Round 2 generated 63 statements with >75% agreement. Round 2 open comments generated 22 statements. The 66 statements agreed in round 3 generated 9 themes with corresponding statements regarding different phases of care. All round 3 statements demonstrated significant (p<0.001) moderate agreement (W=0.5). A Wilcoxon Sum-rank result (p<0.05) showed stability between rounds 2 and 3. An additional 5 statements (total 71 statements) were generated from round 3 open comments.    Conclusion: This Delphi study provides the first international consensus of 71 statements on return to sports, exercise, and physical activity following spinal fusion in AIS.