Protocol for a virtual nominal group technique to develop expert consensus on graded return to sports, exercise and physical activity during intermediate and late-phase rehabilitation following spinal fusion in AIS

Introduction: Adolescent idiopathic scoliosis (AIS) is a common paediatric spinal deformity with large curves surgically managed through spinal fusion. However, postoperative rehabilitation remains inconsistent and varies depending on clinician, hospital or location. Our international e-Delphi consensus established a broad range of statements from preoperative care until 12 months postoperatively. However, rehabilitation and graded return to sport between 3 and 12 months remains vague and further consensus work is needed. This study aims to understand the intermediate and late stages of rehabilitation in order to guide return to sport, exercise and physical activity. The primary objective is to explore content of rehabilitation and milestones between 3 and 12 months postoperatively. This understanding of postoperative care will form the basis for future postoperative guidance.

Methods and analysis: This protocol for a nominal group technique (NGT) study is written in accordance with the Accurate Consensus Reporting Document guidelines. A national sample of expert surgeons, physiotherapists and nurses in AIS will be recruited. The NGT will take place virtually and will consist of six stages: stage 1: idea generation; stage 2: round robin idea sharing; stage 3: discussion and clarification; stage 4: anonymous voting; stage 5: results feedback; and stage 6: discussion and final voting. This NGT will be preceded by a scoping review which will be disseminated a priori to inform stage 1 idea generation. The population, concept, context framework will be used to explore postoperative rehabilitation towards sports, exercise or physical activities following any kind of spinal surgery. The study steering group and patient and public involvement representative have been involved from conceptualisation and will continue to be involved until final dissemination.