Original research
A Delphi survey and international e-survey evaluating the Doha agreement meeting classification system in groin pain: Where are we 5 years later?

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Abstract

Objectives

To evaluate the adoption of and opinions on the Doha agreement meeting classification in groin pain in athletes.

Design

Delphi survey and e-survey.

Methods

A 2-round Delphi survey among the Doha agreement meeting expert group, and a separate international e-survey among clinicians who regularly assess athletes with groin pain. Clinical cases were presented, and participants provided their preferred terms for the diagnoses. All participants reported if they had adopted the Doha agreement meeting classification system in their practice. The Doha agreement meeting experts also shared opinions on amendments to the classification system, and reported their level of agreement with suggested statements.

Results

In the Delphi survey, the Doha agreement meeting experts (n = 21) reported 8–11 different terms for their primary diagnosis of each presented case. The Doha agreement meeting terminology was used by 50–67% of these experts. In the international e-survey (n = 51), 12–15 different diagnostic terms were reported in each clinical case, and 43–55% of clinicians used the Doha agreement meeting terminology. Adoption of the Doha agreement classification system in practice was reported by 73–82% of the Doha agreement meeting experts and 57–69% of the clinicians in the international e-survey. The experts suggested 49 statements regarding amendments to the classification system. Seven of these reached >75% agreement or disagreement.

Conclusions

Five years after publication, the majority of the Doha agreement expert group and independent international clinicians report adopting the Doha agreement meeting classification system. There is still considerable heterogeneity in diagnostic terminology when clinical cases are presented, and disagreement on statements related to amendments of the current classification system.

Section snippets

Practical implications

  • The high adoption of the Doha agreement meeting classification system indicates a good perceived clinical utility by clinicians.

  • The Doha agreement meeting classification system can assist in clear communication among clinicians.

  • Future consensus statements should include a structured knowledge transfer and dissemination plan, as well as evaluating their recommendations over time.

Methods

We undertook: (1) a 2-round Delphi survey among the members of the Doha agreement meeting expert group2 and; (2) a separate international e-survey among clinicians who regularly assess and treat athletes with groin pain. The protocols for these surveys were registered online prior to commencement: (dx.doi.org/10.17504/protocols.io.8m7hu9n and dx.doi.org/10.17504/protocols.io.bgkfjutn). An ethics exemption was obtained from the Institutional Review Board of the Amsterdam Medical Centre, the

Results

Delphi survey. Twenty-three experts (96%) responded to Delphi survey round 1. For the clinical cases, 21 experts were eligible for reporting diagnoses (AW, RJdV excluded). The responses from 1 expert for diagnoses after imaging were not recorded due to a technical issue, while 1 expert did not register a diagnosis for case 3. Demographic characteristics of the experts are described in Table 1.

All reported terms for diagnoses for the 3 clinical cases are presented in Supplementary Appendix E.

Discussion

Five years after publication, the majority of the Doha agreement meeting expert group (73–82%) and independent international clinicians (57–69%) report adopting the terminology of the Doha agreement meeting classification system. However, when clinical cases were presented, only 50–67% of the Doha agreement meeting experts and 43–55% of the independent international clinicians used the actual terminology to describe their diagnosis according to agreed definitions.2 Compared to the original 2015

Conclusion

Five years after publication, the majority of the Doha agreement meeting expert group and independent international clinicians report adopting the Doha agreement meeting classification system. There is still considerable heterogeneity in diagnostic terminology when clinical cases are presented, and disagreement on statements related to amendments of the current classification system.

Patient consent for publication

Not required. Potential identifiers for the presented clinical cases were adjusted to ensure anonymity.

Funding information

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of interest statement

The authors declare no financial conflict of interest. Seven out of the nine authors of this study were also author of the Doha agreement meeting on terminology and definitions in groin pain in athletes. The authors declare that this did not influence execution or reporting of this study.

Confirmation of ethical compliance

An ethics exemption was obtained from the Institutional Review Board of the Amsterdam Medical Centre, the Netherlands. All participants gave their informed consent.

Acknowledgments

We would like to sincerely thank all Doha agreement meeting experts, and all e-survey participants from the FIFA Medical Centres of Excellence and the IOC research centers for sharing their opinions. We also would like to thank Chelsea Oester (FIFA medical), Alexis Weber (FIFA Medical) and Professor Roald Bahr (IOC Medical Commission) for their assistance with distributing the e-survey invitations.

References (19)

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