Prioritising conditions resulting in chronic lower limb musculoskeletal pain in children and adolescents for development of clinical practice guidelines: an Australian Delphi study

Background: Children and adolescents with chronic lower limb pain may experience delayed diagnosis, misdiagnosis, insufficient or inappropriate treatment initiation or type. Developing condition-specific clinical practice guidelines is one approach to address these healthcare challenges. This research aimed to prioritise the top 10 conditions resulting in chronic lower limb musculoskeletal pain in children that would benefit from the development of Australian clinical practice guidelines.

Methods: We conducted a modified three round eDelphi. Three multidisciplinary panels were provided a summary of current available evidence and any clinical practice guidelines currently available for 124 conditions identified as resulting in chronic lower limb pain. Panels rated their agreement on the need for the development of clinical practice guidelines and ranked the top 10 conditions. In the final round, parents of children with chronic lower limb musculoskeletal pain rated the appropriateness of the top 10 conditions for guideline development.

Results: Forty-four Australian health care professionals (22 allied health, 7 paediatric medical specialists, and 13 general practitioners) participated in Rounds 1 and 2 with a retention rate of 100%. Sixteen parents participated in the confirmatory round. The top 10 conditions prioritised for clinical practice guideline development were generalised joint hypermobility, growing pains, musculoskeletal pain, Juvenile Idiopathic Arthritis, joint instability, avascular necrosis, Legg-Calve-Perthes, flat foot, slipped capital femoral epiphysis and patellofemoral pain syndrome.

Conclusion: Healthcare professionals prioritised 10 conditions that require development of clinical practice guidelines. Parents of children and adolescents with chronic lower limb pain provided feedback on the appropriateness of the 10 prioritised conditions for guideline development. These guidelines should be multidisciplinary, co-designed with families and relevant to all health settings.