Broken Bones of the Upper Limb in People over 50 PSP Question Verification Form

The purpose of this Question Verification Form is to enable Priority Setting Partnerships (PSPs) to describe clearly how they checked that their questions were unanswered, before starting the interim prioritisation stage of the process.

The JLA requires PSPs to be transparent and accountable in defining their own scope and evidence checking process. This will enable researchers and other stakeholders to understand how individual PSPs decided that their questions were unanswered, and any limitations of their evidence checking.

Name of the PSP

Broken Bones of the Upper Limb in People over 50

Please describe the scope of the PSP

The scope of the PSP was any unanswered questions about the best management of upper limb fractures in people over 50.

These questions could relate to any aspect of living with, caring for, or treating these injuries, such as pain relief, nutrition, rehabilitation, surgery, anaesthesia, information for patients and carers and the emotional impact of fractures.

This PSP did not cover questions connected to prevention of fractures. This included medications and investigations for prevention of fractures.

It also did not include questions relating to falls prevention (investigation and treatment). However, questions about the ‘fear of falling’ and its social consequences were included.

Please provide a brief overview of your approach to checking whether the questions were unanswered

Guidelines were reviewed to determine whether the question was already answered. If there were guidelines, the evidence that formed the guidelines was reviewed. If low quality evidence, the question was not excluded.

Cochrane reviews were searched using keywords. If there was a review that showed further research was required, the question was not excluded. If the systematic review was older than 3 years old, recent RCTs were also searched to ensure the question had not been answered recently.

Database searches on Open Athens and Google scholar were conducted using keywords. All RCTs were reviewed and if no strong conclusion could be drawn from the study, the question remained. The level of evidence of each RCT was reviewed.

If no good quality RCTs, other trials were also reviewed but as level of evidence was usually low, this did not exclude the question.

Any ongoing studies were also reviewed but did not exclude the question – this was taken into account to help prioritise the 25 questions that were taken to the final workshop.

Please list the type(s) of evidence you used to verify your questions as unanswered

National Guidelines

Systematic Reviews / Cochrane Reviews

If systematic reviews were older than 3 years, recent RCTs were reviewed

If no systematic reviews available, any RCTs were reviewed

Smaller trials were reviewed as well

All relevant guidelines were reviewed

Ongoing and future trials

Please list the sources that you searched in order to identify that evidence

OpenAthens (https://openathens.nice.org.uk) (databases included Pubmed, CINAHL, AMED, BNI, EMBASE, HBE, Medline, and PschINFO);

Cochrane Central Register of Controlled Trials (https://www.cochranelibrary.org)

Google scholar (https://scholar.google.co.uk);

the WHO International Clinical Trials Registry Platform Search Portal (https://www.who.int/ictrp/en),

Current Controlled trials (http://www.isrctn.com),

the US National Institute of Health Trials Registry (https://clinicaltrials.gov)

Published UK national guidelines – NICE; BSSH

What search terms did you use?

Keywords of each question were used in each database.

Examples of keywords were:

Upper limb; humerus; ulna; radius; scapula; clavicle; elbow; shoulder; wrist

Fracture/s; Broken bones

Operative; non-operative; surgery; conservative

Psychology; support;

Rehabilitation; Physical Therapy, Physiotherapy; Occupational Therapy; exercise/s

Information; flying; employment; work; driving

Casts; slings; splints

Imaging; radiographs; x-rays

Pain relief; medication

Manipulation; reduction

Please describe the parameters of the search (eg time limits, excluded sources, country/language) and the rationale for any limitations

All guidelines were in English. All studies were included however, recent evidence in the last 3 years was seen to be stronger than older evidence.

Names of individuals who undertook the evidence checking

Warren Sheehan

On what date was the question verification process completed?

31st August 2018

Any other relevant information

None