Introduction Physiotherapists and surgeons have a significant role in promoting participation and offering a graded return to sports, exercise, and physical activity following spinal fusion in adolescent idiopathic scoliosis (AIS). However, there is a lack of evidence to guide post-operative rehabilitation and variability worldwide. This study aims to obtain consensus on 1) when it is safe and 2) how an individual with AIS might return to sports, exercise, and physical activity.

Methods and analysis An international electronic 3 round Delphi study was conducted and reported. Eligible expert surgeons or physiotherapists had either specific clinical or research experience in AIS. Round 1 included a series of open-ended questions. Round 2 provided a summary of the existing literature for participants to review and rate items. Round 3 participants were asked to re-rate responses. Consensus was determined through content analysis of open statements >1 participant, round 2 statements achieving >75% on a 5-point Likert scale, and round 3 Kendall’s coefficient of concordance.

Results From 53 recruited participants (18 countries, 1 unknown), 41 responded to round 1, 32 to round 2, and 29 to Round 3 (14 surgeons, 15 physiotherapists). Round 1 generated 85 statements under 19 themes surrounding graded return to sports, rehabilitation milestones, philosophical approaches, and treatment modalities. Round 2 generated 63 statements with >75% agreement. Round 2 open comments generated 22 statements. The 66 statements agreed in round 3 generated 9 themes with corresponding statements regarding different phases of care. All round 3 statements demonstrated significant (p<0.001) moderate agreement (W=0.5). A Wilcoxon Sum-rank result (p<0.05) showed stability between rounds 2 and 3. An additional 5 statements (total 71 statements) were generated from round 3 open comments.

Conclusion This Delphi study provides the first international consensus of 71 statements on return to sports, exercise, and physical activity following spinal fusion in AIS.

The authors have declared no competing interest.

https://doi.org/10.1136/bmjopen-2024-084487

https://bmjopen.bmj.com/content/14/9/e084487.info

Yes

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Full ethical approval has been provided by the University of Birmingham, Reference number: ERN_1617-Nov2023.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Amendments: No amendments have been made to this protocol.

Support: This project has been fully funded by the Birmingham Orthopaedic Charity (grant number BOC3-Tucker). Support was given from the University of Birmingham (UoB) School of Sport Exercise and Rehabilitation Sciences.

All relevant data are within the manuscript and its Supporting Information files.