Abstract
Background
The aim of this Delphi study was to reach consensus about definition, operationalization and assessment of visual pursuit (VP) and visual fixation (VF).
Methods
In a three-round international Delphi study, clinical and research experts on disorders of consciousness indicated their level of agreement on 87 statements using a 5-point Likert scale. Consensus for agreement was defined by a median of 5, an interquartile range (IQR) ≤ 1, and ≥ 80% indicating moderate or strong agreement.
Results
Forty-three experts from three continents participated, 32 completed all three rounds. For VP, the consensus statements with the highest levels of agreement were on the term ‘pursuit of a visual stimulus’, the description ‘ability to follow visually in horizontal and/or vertical plane’, a duration > 2 s, tracking in horizontal and vertical planes, and a frequency of more than 2 times per assessment. For VF, consensus statements with the highest levels of agreement were on the term ‘sustained VF’, the description ‘sustained fixation in response to a salient stimulus’, a duration of > 2 s and a frequency of 2 or more times per assessment. The assessment factors with the highest levels of agreement were personalized stimuli, the use of eye tracking technology, a patient dependent time of assessment, sufficient environmental light, upright posture, and the necessity to exclude ocular/oculomotor problems.
Conclusion
This first international Delphi study on VP and VF in patients with disorders of consciousness provides provisional operational definitions and an overview of the most relevant assessment factors.
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Data availability
Anonymized data will be shared upon reasonable request.
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Acknowledgements
We thank all the experts for participating in this study. We thank the IBIA special interest group on diagnosis/prognosis of DoC for their help in recuitment of experts and discussing the study. We thank ‘Stichting St. Joannes de Deo’ and ‘Het Coma-Hospitium’ for funding this study. We thank Anita Oude Bos, research assistant of the Radboud University Medical Center for developing and processing the online survey and calculating the results. We thank Camille Chatelle PhD and Theresa Bender-Pape PhD for reviewing the survey.
Funding
This study was funded by ‘Het Coma-Hospitium’ and ‘Stichting St. Joannes de Deo’.
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BO contributed to the design of the study protocol, acquisition and analysis of the data and drafted the manuscript. JL contributed to the design of the study protocol, analysis of the data and drafted a significant proportion of the manuscript. SvG contributed to the review of the study protocol, interpretatation of the data and revision of the manuscript. DK contributed to the review of the study protocol, interpretatation of the data and revision of the manuscript. HE contributed to the design of the study protocol, analysis of the data and drafted a significant proportion of the manuscript. RK contributed to the design of the study protocol, analysis of the data and drafted a significant proportion of the manuscript.
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The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendsments or comparable ethical standards.
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Informed consent was obtained from the participating experts prior to the start of the study.
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Overbeek, B.U.H., Lavrijsen, J.C.M., van Gaal, S. et al. Towards consensus on visual pursuit and visual fixation in patients with disorders of consciousness. A Delphi study. J Neurol 269, 3204–3215 (2022). https://doi.org/10.1007/s00415-021-10905-y
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DOI: https://doi.org/10.1007/s00415-021-10905-y