{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T07:58:22Z","timestamp":1771919902052,"version":"3.50.1"},"reference-count":51,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,16]],"date-time":"2025-11-16T00:00:00Z","timestamp":1763251200000},"content-version":"unspecified","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Birmingham Orthopaedic Charity","award":["BOC3-Tucker"],"award-info":[{"award-number":["BOC3-Tucker"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,22]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The University of Birmingham has provided ethical approval: ERN_4201-Jun2025. Dissemination will take place through conference presentation and peer-reviewed publications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107478","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T05:40:35Z","timestamp":1763358035000},"page":"e107478","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["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"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5224-8548","authenticated-orcid":false,"given":"Susanna","family":"Tucker","sequence":"first","affiliation":[{"name":"School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham - Edgbaston Campus, Birmingham, England, UK"},{"name":"Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7599-3674","authenticated-orcid":false,"given":"Nicola R","family":"Heneghan","sequence":"additional","affiliation":[{"name":"School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"Gardner","sequence":"additional","affiliation":[{"name":"Institute of Health and Neurodevelopment, Aston University, Birmingham, England, UK"},{"name":"Spinal Services, Royal Orthopaedic Hospital, Birmingham, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8114-7669","authenticated-orcid":false,"given":"Alison B","family":"Rushton","sequence":"additional","affiliation":[{"name":"School of Physical Therapy, Western University Faculty of Health Sciences, London, England, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Russell","sequence":"additional","affiliation":[{"name":"Buckinghamshire Healthcare NHS Trust, Amersham, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5118-5872","authenticated-orcid":false,"given":"Andrew","family":"Soundy","sequence":"additional","affiliation":[{"name":"School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham - Edgbaston Campus, Birmingham, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,16]]},"reference":[{"key":"2025120413272241000_15.11.e107478.1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.4103\/0019-5413.58601","article-title":"The natural history of adolescent idiopathic scoliosis","volume":"44","author":"Wong","year":"2010","journal-title":"Indian J Orthop"},{"key":"2025120413272241000_15.11.e107478.2","doi-asserted-by":"publisher","DOI":"10.1007\/s11832-012-0457-4"},{"key":"2025120413272241000_15.11.e107478.3","doi-asserted-by":"crossref","unstructured":"Bettany-Saltikov J , Weiss H-R , Chockalingam N , et al . Surgical versus non-surgical interventions in people with adolescent idiopathic scoliosis. Cochrane Database Syst Rev 2015;2015. doi:10.1002\/14651858.CD010663.pub2","DOI":"10.1002\/14651858.CD010663.pub2"},{"key":"2025120413272241000_15.11.e107478.4","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s12998-017-0143-1","article-title":"Prevalence of low back pain in adolescents with idiopathic scoliosis: a systematic review","volume":"25","author":"Th\u00e9roux","year":"2017","journal-title":"Chiropr Man Therap"},{"key":"2025120413272241000_15.11.e107478.5","doi-asserted-by":"crossref","first-page":"102697","DOI":"10.1016\/j.ctim.2021.102697","article-title":"The effects of exercise therapy on adolescent idiopathic scoliosis: an overview of systematic reviews and meta-analyses","volume":"58","author":"Zhou","year":"2021","journal-title":"Complement Ther Med"},{"key":"2025120413272241000_15.11.e107478.6","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1302\/2633-1462.411.BJO-2023-0128","article-title":"Bracing Adolescent Idiopathic Scoliosis (BASIS) study - night-time versus full-time bracing in adolescent idiopathic scoliosis: study protocol for a multicentre, randomized controlled trial","volume":"4","author":"Swaby","year":"2023","journal-title":"Bone Jt Open"},{"key":"2025120413272241000_15.11.e107478.7","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1007\/s43390-021-00330-6","article-title":"Resumption of sport after spinal fusion for adolescent idiopathic scoliosis: a review of the current literature","volume":"9","author":"Barile","year":"2021","journal-title":"Spine Deform"},{"key":"2025120413272241000_15.11.e107478.8","doi-asserted-by":"crossref","first-page":"133","DOI":"10.3233\/PPR-190365","article-title":"Functional deficits in post-operative adolescent idiopathic scoliosis","volume":"41","author":"Rafferty","year":"2020","journal-title":"PPR"},{"key":"2025120413272241000_15.11.e107478.9","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1007\/s43390-024-01010-x","article-title":"Guidelines for returning to activity after spinal deformity surgery","volume":"13","author":"Turtle","year":"2025","journal-title":"Spine Deform"},{"key":"2025120413272241000_15.11.e107478.10","doi-asserted-by":"crossref","unstructured":"Rushton A , Eveleigh G , Petherick E-J , et al . Physiotherapy rehabilitation following lumbar spinal fusion: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2012;2. doi:10.1136\/bmjopen-2012-000829","DOI":"10.1136\/bmjopen-2012-000829"},{"key":"2025120413272241000_15.11.e107478.11","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e31824b285f"},{"key":"2025120413272241000_15.11.e107478.12","doi-asserted-by":"crossref","unstructured":"Lonner B , Ren YPM , Rieger MMD , et al . Level of play: return to sports following surgery for adolescent idiopathic scoliosis. Spine J 2014;14. doi:10.1016\/j.spinee.2014.08.126","DOI":"10.1016\/j.spinee.2014.08.126"},{"key":"2025120413272241000_15.11.e107478.13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.318.7182.527"},{"key":"2025120413272241000_15.11.e107478.14","doi-asserted-by":"crossref","unstructured":"Willson LR , Klootwyk M , Rogers LG , et al . Timelines for returning to physical activity following pediatric spinal surgery: recommendations from the literature and preliminary data. BMC Res Notes 2021;14. doi:10.1186\/s13104-021-05571-2","DOI":"10.1186\/s13104-021-05571-2"},{"key":"2025120413272241000_15.11.e107478.15","doi-asserted-by":"crossref","unstructured":"Tucker S , Heneghan NR , Rushton A , et al . n.d. International consensus on sports, exercise, and physical activity participation during post-operative interventions for adolescent idiopathic scoliosis: an e-delphi study. medRxiv. doi:10.1101\/2025.03.23.25324479","DOI":"10.1101\/2025.03.23.25324479"},{"key":"2025120413272241000_15.11.e107478.16","doi-asserted-by":"crossref","unstructured":"Skivington K , Matthews L , Simpson SA , et al . A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ 2021;374. doi:10.1136\/bmj.n2061","DOI":"10.1136\/bmj.n2061"},{"key":"2025120413272241000_15.11.e107478.17","doi-asserted-by":"crossref","first-page":"2886","DOI":"10.1200\/JCO.2001.19.11.2886","article-title":"Ensuring quality cancer care by the use of clinical practice guidelines and critical pathways","volume":"19","author":"Smith","year":"2001","journal-title":"J Clin Oncol"},{"key":"2025120413272241000_15.11.e107478.18","doi-asserted-by":"publisher","DOI":"10.1007\/s11096-016-0257-x"},{"key":"2025120413272241000_15.11.e107478.19","doi-asserted-by":"publisher","DOI":"10.1258\/135581906778476553"},{"key":"2025120413272241000_15.11.e107478.20","doi-asserted-by":"crossref","unstructured":"Gattrell WT , Logullo P , van Zuuren EJ , et al . ACCORD (ACcurate COnsensus Reporting Document): a reporting guideline for consensus methods in biomedicine developed via a modified Delphi. PLoS Med 2024;21. doi:10.1371\/journal.pmed.1004326","DOI":"10.1371\/journal.pmed.1004326"},{"key":"2025120413272241000_15.11.e107478.21","unstructured":"Equator Network . ACCORD (accurate consensus reporting document): a reporting guideline for consensus methods in biomedicine developed via a modified delphi [web page]. 2024. Available: https:\/\/www.equator-network.org\/reporting-guidelines\/accord-accurate-consensus-reporting-document-a-reporting-guideline-for-consensus-methods-in-biomedicine"},{"key":"2025120413272241000_15.11.e107478.22","doi-asserted-by":"publisher","DOI":"10.1111\/hex.13384"},{"key":"2025120413272241000_15.11.e107478.23","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-0434.19"},{"key":"2025120413272241000_15.11.e107478.24","doi-asserted-by":"crossref","unstructured":"Eysenbach G . Peer-review and publication of research protocols and proposals: a role for open access journals. J Med Internet Res 2004;6. doi:10.2196\/jmir.6.3.e37","DOI":"10.2196\/jmir.6.3.e37"},{"key":"2025120413272241000_15.11.e107478.25","doi-asserted-by":"publisher","DOI":"10.3310\/hta2030"},{"key":"2025120413272241000_15.11.e107478.26","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1111\/ijpp.12218","article-title":"Employing the nominal group technique to explore the views of pharmacists, pharmacy assistants and women on community pharmacy weight management services and educational resources","volume":"24","author":"Fakih","year":"2016","journal-title":"Int J Pharm Pract"},{"key":"2025120413272241000_15.11.e107478.27","first-page":"479","article-title":"IMBA-ICF linking by integrating consensus methods: How group consensus of experts can contribute to in-depth linking of instruments to the ICF","volume":"75","author":"Hennaert","year":"2023","journal-title":"Work"},{"key":"2025120413272241000_15.11.e107478.28","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.ijnurstu.2016.04.015","article-title":"The use of Delphi and Nominal Group Technique in nursing education: a review","volume":"60","author":"Foth","year":"2016","journal-title":"Int J Nurs Stud"},{"key":"2025120413272241000_15.11.e107478.29","doi-asserted-by":"crossref","unstructured":"Lee SH , ten Cate O , Gottlieb M , et al . The use of virtual nominal groups in healthcare research: an extended scoping review. PLoS ONE 2024;19. doi:10.1371\/journal.pone.0302437","DOI":"10.32920\/27922062"},{"key":"2025120413272241000_15.11.e107478.30","doi-asserted-by":"publisher","DOI":"10.1016\/0030-5073(78)90037-5"},{"key":"2025120413272241000_15.11.e107478.31","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1186\/s12874-024-02362-8","article-title":"An example of the adaptation of the Nominal Group Technique (NGT) to a virtual format (vNGT) within healthcare research","volume":"24","author":"Riley-Bennett","year":"2024","journal-title":"BMC Med Res Methodol"},{"key":"2025120413272241000_15.11.e107478.32","doi-asserted-by":"crossref","unstructured":"Tucker S , Heneghan NR , Gardner A , et al . Promotion of sports, exercise and physical activity participation during postoperative interventions for adolescent idiopathic scoliosis: protocol for an international e-Delphi study. BMJ Open 2024;14. doi:10.1136\/bmjopen-2024-084487","DOI":"10.1136\/bmjopen-2024-084487"},{"key":"2025120413272241000_15.11.e107478.33","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1186\/s12874-016-0242-z","article-title":"Comparing two sampling methods to engage hard-to-reach communities in research priority setting","volume":"16","author":"Valerio","year":"2016","journal-title":"BMC Med Res Methodol"},{"key":"2025120413272241000_15.11.e107478.34","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1177\/0193945917740706","article-title":"Using facebook and linkedin to recruit nurses for an online survey","volume":"41","author":"Stokes","year":"2019","journal-title":"West J Nurs Res"},{"key":"2025120413272241000_15.11.e107478.35","doi-asserted-by":"publisher","DOI":"10.1001\/jama.300.4.436"},{"key":"2025120413272241000_15.11.e107478.36","unstructured":"Peters MD , Godfrey CM , McInerney P , et al . The joanna briggs institute reviewers\u2019 manual 2015: methodology for JBI scoping reviews. 2015."},{"key":"2025120413272241000_15.11.e107478.37","doi-asserted-by":"publisher","DOI":"10.1080\/1364557032000119616"},{"key":"2025120413272241000_15.11.e107478.38","doi-asserted-by":"publisher","DOI":"10.11124\/JBIES-20-00167"},{"key":"2025120413272241000_15.11.e107478.39","doi-asserted-by":"publisher","DOI":"10.1097\/XEB.0000000000000050"},{"key":"2025120413272241000_15.11.e107478.40","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-5-69"},{"key":"2025120413272241000_15.11.e107478.41","doi-asserted-by":"publisher","DOI":"10.7326\/M18-0850"},{"key":"2025120413272241000_15.11.e107478.42","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2016.01.021"},{"key":"2025120413272241000_15.11.e107478.43","doi-asserted-by":"crossref","unstructured":"Archibald D , Patterson R , Haraldsdottir E , et al . Mapping the progress and impacts of public health approaches to palliative care: a scoping review protocol. BMJ Open 2016;6. doi:10.1136\/bmjopen-2016-012058","DOI":"10.1136\/bmjopen-2016-012058"},{"key":"2025120413272241000_15.11.e107478.44","doi-asserted-by":"crossref","first-page":"65","DOI":"10.3928\/01484834-20200122-02","article-title":"The nominal group technique: generating consensus in nursing research","volume":"59","author":"Cooper","year":"2020","journal-title":"J Nurs Educ"},{"key":"2025120413272241000_15.11.e107478.45","doi-asserted-by":"crossref","first-page":"35","DOI":"10.7748\/nr.2024.e1933","article-title":"A reflection on the use of virtual nominal group technique in health policy and research priority consensus studies","volume":"32","author":"Al-Yateem","year":"2024","journal-title":"Nurse Res"},{"key":"2025120413272241000_15.11.e107478.46","unstructured":"Liamputtong P . Consensus Methods: Nominal Group. Technique: Springer, 2019."},{"key":"2025120413272241000_15.11.e107478.47","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7240.976"},{"key":"2025120413272241000_15.11.e107478.48","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1007\/s43390-025-01065-4","article-title":"The impact of the social determinants of health on adolescent idiopathic scoliosis: a systematic review","volume":"13","author":"Paradkar","year":"2025","journal-title":"Spine Deform"},{"key":"2025120413272241000_15.11.e107478.49","doi-asserted-by":"crossref","unstructured":"Tucker S , Heneghan NR , Gardner A , et al . Factors influencing participation in physical activity, sports, and exercise in children and adolescents with spinal pain or spinal conditions: a systematic review and meta-ethnography. Behav Sci (Basel) 2023;13. doi:10.3390\/bs13060486","DOI":"10.3390\/bs13060486"},{"key":"2025120413272241000_15.11.e107478.50","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2015.11.017"},{"key":"2025120413272241000_15.11.e107478.51","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-2-40"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-107478","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T21:29:20Z","timestamp":1764883760000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-107478"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":51,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,16]]},"published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1136\/bmjopen-2025-107478"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-107478","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]}}}