Developing Consensus for an Upper and Lower Limb Athlete Pain Assessment Framework – A Real-time Delphi Study with International Sports Physiotherapists

OBJECTIVE: We sought to develop recommendations to inform a framework for comprehensively assessing upper and lower limb pain in athletes including the key assessment items sports physiotherapists should consider. DESIGN: Real-time Delphi. METHODS: We recruited sports physiotherapists who were currently working with athletes through the International Federation of Sports Physical Therapists and Irish Society of Chartered Physiotherapists. Participants voted on 86 pain assessment items chosen using best available evidence. The real-time Delphi method facilitated independent anonymous voting, commenting, and immediate review of consensus. Participants indicated level of agreement for inclusion in an upper and lower limb athlete pain assessment framework on a 6-point Likert scale from strongly disagree to strongly agree, and how often they are/will be required in practice on a 5-point scale from never to always. Criteria for consensus agreement and inclusion were (1) >70% sports physiotherapists voting agree/strongly agree AND (2) median vote selected by physiotherapists was agree or strongly agree. RESULTS: Forty-one sports physiotherapists (female, n = 20; male, n = 21), visited the survey an average of 5.3 times (±5), resulting in a completion rate of 98%. Sixty-four assessment items (neurophysiological, n = 20; biomechanical, n = 15; affective, n = 8; cognitive, n = 3; socioenvironmental, n = 10; general assessment aspects of assessment, n = 8) met the criteria for consensus. Frequency of use in practice was always for 28 items often for 32 items and sometimes for 4 items. CONCLUSION: We have presented stakeholder-generated recommendations and priorities for assessing athletes’ pain. J Orthop Sports Phys Ther 2025;55(1):1-11. Epub 22 November 2024. https://doi.org/10.2519/jospt.2024.12807