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Consensus on Exercise Reporting Template (CERT): Modified Delphi Study

Susan C. Slade, Clermont E. Dionne, Martin Underwood, Rachelle Buchbinder, Belinda Beck, Kim Bennell, Lucie Brosseau, Leonardo Costa, Fiona Cramp, Edith Cup, Lynne Feehan, Manuela Ferreira, Scott Forbes, Paul Glasziou, Bas Habets, Susan Harris, Jean Hay-Smith, Susan Hillier, Rana Hinman, Ann Holland, Maria Hondras, George Kelly, Peter Kent, Gert-Jan Lauret, Audrey Long, Chris Maher, Lars Morso, Nina Osteras, Tom Peterson, Ros Quinlivan, Karen Rees, Jean-Philippe Regnaux, Marc Rietberg, Dave Saunders, Nicole Skoetz, Karen Sogaard, Tim Takken, Maurits van Tulder, Nicoline Voet, Lesley Ward, Claire White
DOI: 10.2522/ptj.20150668 Published 1 October 2016
Susan C. Slade
S.C. Slade, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute, 183 Wattletree Rd, Ste 41, Malvern, Victoria, Australia, and Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.
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Clermont E. Dionne
C.E. Dionne, PhD, Department of Rehabilitation, Faculty of Medicine, Laval University, Québec City, Québec, Canada.
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Martin Underwood
M. Underwood, MD, Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
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Rachelle Buchbinder
R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute, and Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University.
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Belinda Beck
Belinda Beck, PhD, School of Allied Health Sciences, Griffith University, Queensland, Australia.
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Kim Bennell
Kim Bennell, PT, PhD, Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, Melbourne, Australia.
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Lucie Brosseau
Lucie Brosseau, PT, PhD, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada.
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Leonardo Costa
Leonardo Costa, PT, PhD, Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
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Fiona Cramp
Fiona Cramp, PhD, Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom.
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Edith Cup
Edith Cup, OT, PhD, Rehabilitation Department, Radboud University Medical Centre Nijmegen; Donders Centre for Neuroscience, Nijmegen, the Netherlands.
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Lynne Feehan
Lynne Feehan, PT, PhD, Physical Therapy Department, University of British Columbia, Vancouver, British Columbia, Canada.
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Manuela Ferreira
Manuela Ferreira, PT, PhD, The Institute of Bone and Joint Research, The Kolling Institute & The George Institute of Global Health, Sydney Medical School, The University of Sydney, New South Wales, Australia.
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Scott Forbes
Scott Forbes, PhD, Human Kinetics Department, Okanagan College, Kelowna, British Columbia, Canada.
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Paul Glasziou
Paul Glasziou, MD, PhD, Faculty of Health Sciences and Medicine Bond University, Queensland, Australia.
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Bas Habets
Bas Habets, MSc, Sports Medicine Center, Arnhem, the Netherlands.
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Susan Harris
Susan Harris, PT, PhD, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Jean Hay-Smith
Jean Hay-Smith, PT, PhD, Department of Medicine, Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand.
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Susan Hillier
Susan Hillier, PT, PhD, International Centre for Allied Health Evidence, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia.
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Rana Hinman
Rana Hinman, PT, PhD, Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, Melbourne, Australia.
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Ann Holland
Ann Holland, PT, PhD, Physiotherapy Department, LaTrobe University, Melbourne, Australia.
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Maria Hondras
Maria Hondras, DC, PhD, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
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George Kelly
George Kelly, PhD, Biostatistics Department, West Virginia University, Morgantown, West Virginia.
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Peter Kent
Peter Kent, DC, PT, PhD, Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
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Gert-Jan Lauret
Gert-Jan Lauret, MD, PhD, Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands.
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Audrey Long
Audrey Long, PT, MSc, Bonavista Physical Therapy, Calgary, Alberta, Canada.
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Chris Maher
Chris Maher, PT, PhD, The George Institute for Global Health, The University of Sydney, New South Wales, Australia.
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Lars Morso
Lars Morso, PT, PhD, Centre for Quality, Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark.
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Nina Osteras
Nina Osteras, PT, PhD, Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
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Tom Peterson
Tom Petersen, PT, Back Center, Copenhagen, Denmark.
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Ros Quinlivan
Ros Quinlivan, MD, PhD, Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
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Karen Rees
Karen Rees, PhD, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
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Jean-Philippe Regnaux
Jean-Philippe Regnaux, PT, PhD, Human & Social Sciences Department, EHESP (French School of Public Health), Rennes, France.
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Marc Rietberg
Marc Rietberg, PT, PhD, Rehabilitation Medicine Department, VU University Medical Center, Amsterdam, the Netherlands.
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Dave Saunders
Dave Saunders, PhD, Physical Activity for Health Research Centre, University of Edinburgh, Scotland, United Kingdom.
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Nicole Skoetz
Nicole Skoetz, MD, PhD, Evidence-Based Oncology, Department 1 of Internal Medicine, University Hospital of Cologne, Germany.
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Karen Sogaard
Karen Sogaard, PhD, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
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Tim Takken
Tim Takken, PhD, Child Development & Exercise, Center University Medical Center Utrecht, the Netherlands.
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Maurits van Tulder
Maurits van Tulder, PhD, Department of Health Sciences, VU University, Amsterdam, the Netherlands.
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Nicoline Voet
Nicoline Voet, MD, Brain Integration Department, Rehabilitation Medical Centre Groot Klimmendaal, Arhhem, the Netherlands.
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Lesley Ward
Lesley Ward, PT, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
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Claire White
Claire White, PhD, Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, Guy's Campus, King's College London, United Kingdom.
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Abstract

Background Exercise interventions are often incompletely described in reports of clinical trials, hampering evaluation of results and replication and implementation into practice.

Objective The aim of this study was to develop a standardized method for reporting exercise programs in clinical trials: the Consensus on Exercise Reporting Template (CERT).

Design and Methods Using the EQUATOR Network's methodological framework, 137 exercise experts were invited to participate in a Delphi consensus study. A list of 41 items was identified from a meta-epidemiologic study of 73 systematic reviews of exercise. For each item, participants indicated agreement on an 11-point rating scale. Consensus for item inclusion was defined a priori as greater than 70% agreement of respondents rating an item 7 or above. Three sequential rounds of anonymous online questionnaires and a Delphi workshop were used.

Results There were 57 (response rate=42%), 54 (response rate=95%), and 49 (response rate=91%) respondents to rounds 1 through 3, respectively, from 11 countries and a range of disciplines. In round 1, 2 items were excluded; 24 items reached consensus for inclusion (8 items accepted in original format), and 16 items were revised in response to participant suggestions. Of 14 items in round 2, 3 were excluded, 11 reached consensus for inclusion (4 items accepted in original format), and 7 were reworded. Sixteen items were included in round 3, and all items reached greater than 70% consensus for inclusion.

Limitations The views of included Delphi panelists may differ from those of experts who declined participation and may not fully represent the views of all exercise experts.

Conclusions The CERT, a 16-item checklist developed by an international panel of exercise experts, is designed to improve the reporting of exercise programs in all evaluative study designs and contains 7 categories: materials, provider, delivery, location, dosage, tailoring, and compliance. The CERT will encourage transparency, improve trial interpretation and replication, and facilitate implementation of effective exercise interventions into practice.

Footnotes

  • Dr Slade, Professor Dionne, Professor Underwood, and Professor Buchbinder designed the study and survey tool, drafted the manuscript with input from all other authors, and performed data analysis. Dr Slade was responsible for implementing the survey. All authors read and approved the final manuscript.

  • The authors thank Dr Bianca Bendermacher (the Netherlands), Professor Jill Cook (Australia), Associate Professor Kjartan Fersum (Norway), Dr Lora Giangregorio (Canada), Professor Jan Hartvigan (Denmark), Dr Melanie Holden (United Kingdom), Associate Professor Per Kjaer (Denmark), Professor Donna MacIntyre (Canada), Dr Nathan Meier (United States), Professor Nicholas Taylor (Australia), and Dr Flavia Vital (Brazil) for their contributions to the study.

  • Peer Reviewers: Belinda Beck (Australia), Kim Bennell (Australia), Lucie Brosseau (Canada), Jill Cook (Australia), Leonardo Costa (Brazil), Fiona Cramp (United Kingdom), Edith Cup (United Kingdom), Lynne Feehan (Canada), Manuela Ferreira (Australia), Scott Forbes (Canada), Paul Glasziou (Australia), Bas Habets (the Netherlands), Susan Harris (Canada), Jan Hartvigan (Denmark), Jean Hay-Smith (New Zealand), Susan Hillier (Australia), Rana Hinman (Australia), Ann Holland (Australia), Maria Hondras (Denmark), George Kelly (United States), Peter Kent (Denmark), Per Kjaer (Denmark), Gert-Jan Lauret (the Netherlands), Audrey Long (Canada), Chris Maher (Australia), Lars Morso (Denmark), Nina Osteras (Norway), Tom Peterson (Denmark), Ros Quinlivan (United Kingdom), Karen Rees (United Kingdom), Jean-Philippe Regnaux (France), Marc Rietberg (the Netherlands) Dave Saunders (United Kingdom), Nicole Skoetz (Denmark), Karen Sogaard (Denmark), Tim Takken (the Netherlands), Nicholas Taylor (Australia), Maurits van Tulder (the Netherlands), Nicoline Voet (the Netherlands), Lesley Ward (New Zealand), Claire White (United Kingdom).

  • This research project was funded by Arthritis Australia (Philip Benjamin, Grant No: 2014GIA03). Professor Buchbinder is funded by an Australian National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship.

  • Received December 10, 2015.
  • Accepted April 28, 2016.
  • © 2016 American Physical Therapy Association
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Vol 96 Issue 10 Table of Contents
Physical Therapy: 96 (10)

Issue highlights

  • Our Future Selves: Unprecedented Opportunities
  • Toward a Transformed Understanding: From Pain and Movement to Pain With Movement
  • Virtual Reality for Stroke Rehabilitation
  • Consensus on Exercise Reporting Template (CERT): Modified Delphi Study
  • Agreement of Mechanical Diagnosis and Therapy Classification in People With Extremity Conditions
  • High-Intensity Interval Training and Moderate-Intensity Continuous Training in Ambulatory Chronic Stroke: Feasibility Study
  • Therapeutic Ultrasound and Treadmill Training Suppress Peripheral Nerve Injury–Induced Pain in Rats
  • A Further Step to Develop Patient-Friendly Implementation Strategies for Virtual Reality–Based Rehabilitation in Patients With Acute Stroke
  • Transitions in the Embodied Experience After Stroke: Grounded Theory Study
  • Neck Posture Clusters and Their Association With Biopsychosocial Factors and Neck Pain in Australian Adolescents
  • Physical Therapists' Role in Health Promotion as Perceived by the Patient: Descriptive Survey
  • Finding the “Right-Size” Physical Therapy Workforce: International Perspective Across 4 Countries
  • Does the Brief-BESTest Meet Classical Test Theory and Rasch Analysis Requirements for Balance Assessment in People With Neurological Disorders?
  • Roland-Morris Disability Questionnaire and Oswestry Disability Index: Which Has Better Measurement Properties for Measuring Physical Functioning in Nonspecific Low Back Pain? Systematic Review and Meta-Analysis
  • Responsiveness of the Balance Evaluation Systems Test (BESTest) in People With Subacute Stroke
  • Use of Rasch Analysis to Evaluate and Refine the Community Balance and Mobility Scale for Use in Ambulatory Community-Dwelling Adults Following Stroke
  • de Morton Mobility Index Is Feasible, Reliable, and Valid in Patients With Critical Illness
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Consensus on Exercise Reporting Template (CERT): Modified Delphi Study
Susan C. Slade, Clermont E. Dionne, Martin Underwood, Rachelle Buchbinder, Belinda Beck, Kim Bennell, Lucie Brosseau, Leonardo Costa, Fiona Cramp, Edith Cup, Lynne Feehan, Manuela Ferreira, Scott Forbes, Paul Glasziou, Bas Habets, Susan Harris, Jean Hay-Smith, Susan Hillier, Rana Hinman, Ann Holland, Maria Hondras, George Kelly, Peter Kent, Gert-Jan Lauret, Audrey Long, Chris Maher, Lars Morso, Nina Osteras, Tom Peterson, Ros Quinlivan, Karen Rees, Jean-Philippe Regnaux, Marc Rietberg, Dave Saunders, Nicole Skoetz, Karen Sogaard, Tim Takken, Maurits van Tulder, Nicoline Voet, Lesley Ward, Claire White
Physical Therapy Oct 2016, 96 (10) 1514-1524; DOI: 10.2522/ptj.20150668

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Consensus on Exercise Reporting Template (CERT): Modified Delphi Study
Susan C. Slade, Clermont E. Dionne, Martin Underwood, Rachelle Buchbinder, Belinda Beck, Kim Bennell, Lucie Brosseau, Leonardo Costa, Fiona Cramp, Edith Cup, Lynne Feehan, Manuela Ferreira, Scott Forbes, Paul Glasziou, Bas Habets, Susan Harris, Jean Hay-Smith, Susan Hillier, Rana Hinman, Ann Holland, Maria Hondras, George Kelly, Peter Kent, Gert-Jan Lauret, Audrey Long, Chris Maher, Lars Morso, Nina Osteras, Tom Peterson, Ros Quinlivan, Karen Rees, Jean-Philippe Regnaux, Marc Rietberg, Dave Saunders, Nicole Skoetz, Karen Sogaard, Tim Takken, Maurits van Tulder, Nicoline Voet, Lesley Ward, Claire White
Physical Therapy Oct 2016, 96 (10) 1514-1524; DOI: 10.2522/ptj.20150668
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