Developing an exercise intervention to minimise hip bone mineral density loss following traumatic lower limb amputation: a Delphi study

Objective: To elicit expert opinion and gain consensus on specific exercise intervention parameters to minimise bone mineral density (BMD) loss following traumatic lower limb amputation.

Methods: In three Delphi rounds, statements were presented to a panel of 13 experts from 6 countries. Experts were identified through publications or clinical expertise. Round 1 involved participants rating their agreement with 22 exercise prescription statements regarding BMD loss post amputation using a 5-point Likert scale. Agreement was deemed as 3-4 on the scale (agree/strongly agree). Statements of <50% agreement were excluded. Round 2 repeated remaining statements alongside round 1 feedback. Round 3 allowed reflection on round 2 responses considering group findings and the chance to change or maintain the response. Round 3 statements reaching ≥70% were deemed to reach consensus.

Results: All 13 experts completed round 1, 2 and 3 (100% completion). Round 1 excluded 12 statements and added 1 statement (11 statements for rounds 2-3). Round 3 reached consensus on 9 statements to guide future exercise interventions. Experts agreed that exercise interventions should be performed at least 2 days per week for a minimum of 6 months, including at least 3 different resistance exercises at an intensity of 8-12 repetitions. Interventions should include weight-bearing and multiplanar exercises, involve high-impact activities and be supervised initially.

Conclusion: This expert Delphi process achieved consensus on 9 items related to exercise prescription to minimise BMD loss following lower limb amputation. These will be implemented in a future interventional trial.