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Peer-reviewedCC BY-NC 4.0BMJ Open

Clinician stakeholder priorities for improving the management of non-traumatic wrist disorders in the UK: a nominal group technique study

  • Thomas G C Mitchell1
  • R Mallett2
  • Sionnadh McLean3
  • Nick Hamilton4
  • Benjamin Dean5
  • George Peat6,7
7 affiliations
  1. 1Centre for Applied Health & Social Care Research (CARe), Sheffield Hallam University, Sheffield, UK
  2. 2Sheffield Hallam University, Sheffield, UK
  3. 3Faculty of Health, Charles Darwin University, Darwin, Northern Territory, Australia
  4. 4Sports Engineering Research Group, Sheffield Hallam University - City Campus, Sheffield, UK
  5. 5Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, England, UK
  6. 6Centre for Applied Health & Social Care (CARe), Sheffield Hallam University, Sheffield, UK
  7. 7Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
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Abstract

Introduction: Increasingly detailed investigation confirms that the best management of those with non-traumatic wrist disorders (NTWD) remains elusive, and considerable potential for improvements to care exists. This study aimed to use a modified virtual nominal group technique (vNGT) to facilitate clinician stakeholder discussions to create consensus statements and recommend priorities for future improvements in the management of NTWD in the UK.

Methods: We created knowledge-gap topic areas and developed statements to reflect these. Preliminary ranking, silent reflection and idea generation occurred prior to the workshop. Two 2-hour vNGT workshops were conducted (n=8 and n=7; specialist hand therapists (8), first contact practitioners (2), generalist secondary care physiotherapists (2), wrist and hand specialist orthopaedic surgeons (2), specialist rheumatology physiotherapist) during which five nominal questions were discussed to create consensus statements (November 2025). Ranking of statements from all activities occurred 1 week following completion of the final workshop.

Results: Direction was given for key components of assessment noting that specific diagnosis should be attempted, and de Quervain’s tenosynovitis should be considered a distinct entity to grouped NTWD. Where specific diagnosis was deemed unattainable, a transition to a non-specific approach was recommended. Participants emphasised the importance of considering patient’s lived experience and functional goals when informing management decisions. Prognosis and self-management strategies should be prioritised, avoiding either over-investigation for non-specific problems or generic management for distinct treatable conditions.

Conclusions: UK-based clinician stakeholders, predominantly from secondary care, developed consensus-based priority statements regarding future improvements for the management of people with NTWD. Competing clinician perspectives were found regarding diagnostic specificity, resulting in apparently contradictory consensus priorities and highlighting underlying divisions in how NTWD are conceptualised and managed.

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Cite

BibTeXRIS
BibTeX
@article{mitchell2026clinician,
  title = {{Clinician stakeholder priorities for improving the management of non-traumatic wrist disorders in the UK: a nominal group technique study}},
  author = {Thomas G C Mitchell and R Mallett and Sionnadh McLean and Nick Hamilton and Benjamin Dean and George Peat},
  journal = {BMJ Open},
  year = {2026},
  month = oct,
  doi = {10.1136/bmjopen-2026-118301},
  url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-118301},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Clinician stakeholder priorities for improving the management of non-traumatic wrist disorders in the UK: a nominal group technique study
AU  - Thomas G C Mitchell
AU  - R Mallett
AU  - Sionnadh McLean
AU  - Nick Hamilton
AU  - Benjamin Dean
AU  - George Peat
PY  - 2026
DA  - 2026/10/05
JO  - BMJ Open
DO  - 10.1136/bmjopen-2026-118301
UR  - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-118301
AB  - Introduction: Increasingly detailed investigation confirms that the best management of those with non-traumatic wrist disorders (NTWD) remains elusive, and considerable potential for improvements to care exists. This study aimed to use a modified virtual nominal group technique (vNGT) to facilitate clinician stakeholder discussions to create consensus statements and recommend priorities for future improvements in the management of NTWD in the UK.  Methods: We created knowledge-gap topic areas and developed statements to reflect these. Preliminary ranking, silent reflection and idea generation occurred prior to the workshop. Two 2-hour vNGT workshops were conducted (n=8 and n=7; specialist hand therapists (8), first contact practitioners (2), generalist secondary care physiotherapists (2), wrist and hand specialist orthopaedic surgeons (2), specialist rheumatology physiotherapist) during which five nominal questions were discussed to create consensus statements (November 2025). Ranking of statements from all activities occurred 1 week following completion of the final workshop.  Results: Direction was given for key components of assessment noting that specific diagnosis should be attempted, and de Quervain’s tenosynovitis should be considered a distinct entity to grouped NTWD. Where specific diagnosis was deemed unattainable, a transition to a non-specific approach was recommended. Participants emphasised the importance of considering patient’s lived experience and functional goals when informing management decisions. Prognosis and self-management strategies should be prioritised, avoiding either over-investigation for non-specific problems or generic management for distinct treatable conditions.  Conclusions: UK-based clinician stakeholders, predominantly from secondary care, developed consensus-based priority statements regarding future improvements for the management of people with NTWD. Competing clinician perspectives were found regarding diagnostic specificity, resulting in apparently contradictory consensus priorities and highlighting underlying divisions in how NTWD are conceptualised and managed.
SN  - 2044-6055
SN  - 2044-6055
ER  -