BMJ open · 2026
Clinician stakeholder priorities for improving the management of non-traumatic wrist disorders in the UK: a nominal group technique study.
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Mitchell Thomas G C, Mallett R, McLean Sionnadh, Hamilton Nick, Dean Benjamin, Peat George
Аннотация
INTRODUCTION: Increasingly detailed investigation confirms that the best management of those with non-traumatic wrist disorders (NTWD) remains elusive, and considerable potential for improvements to care exists. This study aimed to use a modified virtual nominal group technique (vNGT) to facilitate clinician stakeholder discussions to create consensus statements and recommend priorities for future improvements in the management of NTWD in the UK.
METHODS: We created knowledge-gap topic areas and developed statements to reflect these. Preliminary ranking, silent reflection and idea generation occurred prior to the workshop. Two 2-hour vNGT workshops were conducted (n=8 and n=7; specialist hand therapists (8), first contact practitioners (2), generalist secondary care physiotherapists (2), wrist and hand specialist orthopaedic surgeons (2), specialist rheumatology physiotherapist) during which five nominal questions were discussed to create consensus statements (November 2025). Ranking of statements from all activities occurred 1 week following completion of the final workshop.
RESULTS: Direction was given for key components of assessment noting that specific diagnosis should be attempted, and de Quervain's tenosynovitis should be considered a distinct entity to grouped NTWD. Where specific diagnosis was deemed unattainable, a transition to a non-specific approach was recommended. Participants emphasised the importance of considering patient's lived experience and functional goals when informing management decisions. Prognosis and self-management strategies should be prioritised, avoiding either over-investigation for non-specific problems or generic management for distinct treatable conditions.
CONCLUSIONS: UK-based clinician stakeholders, predominantly from secondary care, developed consensus-based priority statements regarding future improvements for the management of people with NTWD. Competing clinician perspectives were found regarding diagnostic specificity, resulting in apparently contradictory consensus priorities and highlighting underlying divisions in how NTWD are conceptualised and managed.
METHODS: We created knowledge-gap topic areas and developed statements to reflect these. Preliminary ranking, silent reflection and idea generation occurred prior to the workshop. Two 2-hour vNGT workshops were conducted (n=8 and n=7; specialist hand therapists (8), first contact practitioners (2), generalist secondary care physiotherapists (2), wrist and hand specialist orthopaedic surgeons (2), specialist rheumatology physiotherapist) during which five nominal questions were discussed to create consensus statements (November 2025). Ranking of statements from all activities occurred 1 week following completion of the final workshop.
RESULTS: Direction was given for key components of assessment noting that specific diagnosis should be attempted, and de Quervain's tenosynovitis should be considered a distinct entity to grouped NTWD. Where specific diagnosis was deemed unattainable, a transition to a non-specific approach was recommended. Participants emphasised the importance of considering patient's lived experience and functional goals when informing management decisions. Prognosis and self-management strategies should be prioritised, avoiding either over-investigation for non-specific problems or generic management for distinct treatable conditions.
CONCLUSIONS: UK-based clinician stakeholders, predominantly from secondary care, developed consensus-based priority statements regarding future improvements for the management of people with NTWD. Competing clinician perspectives were found regarding diagnostic specificity, resulting in apparently contradictory consensus priorities and highlighting underlying divisions in how NTWD are conceptualised and managed.