Exercise Recommendations For Adults With Bone Metastases: Outcomes Of A Delphi Consensus Process
Bibliographic record
Abstract
PURPOSE: To understand the current views of an expert panel on exercise screening, assessment, and prescription in adults with bone metastases. METHODS: Medical doctors, researchers, and exercise professionals with expertise in providing medical and/or exercise advice to cancer patients with bone metastases were identified. A 3-round modified online Delphi survey was used to establish consensus with a priori consensus set to 70%. RESULTS: Response rates were 68% (73/107), 81% (59/73) and 97% (57/59) for each round. Key consensus points were: (a) as part of pre-exercise screening, information should be collected on the number, location, and type of bone lesion(s), level of bone pain, and any other bone-related symptom (100% consensus); (b) medical guidance (i.e. communication and medical information from a Physician) is recommended for patients with the following: bone lesions that are unstable (or unknown stability), bone pain, past medical treatment for bone pain, or history of disease-related fractures (90% consensus); (c) exercise testing and prescription in lower risk patients is thought to be safe provided caution is used with any protocol that results in stress on the bone lesion site (74% and 93% consensus, respectively); (d) exercise can be prescribed to higher risk patients but caution is recommended with exercises that place significant load on lesion sites and additional considerations may be required (77-82% consensus, varying by exercise type); (e) for patients classified as ‘unsafe to exercise’, advice on safe activities of daily living was seen as appropriate (91% consensus); (f) professionals best suited to prescribe exercise to lower and higher risk patients with bone metastases were exercise physiologists and Physiotherapists, who have additional cancer exercise training (>70% consensus). Consensus was not reached on the need for medical guidance in lower risk patients, suitable exercise testing protocols for higher risk patients, and the need to limit any specific exercise prescription practices for higher risk patients. CONCLUSIONS: This represents the current views of a range of professionals who provide medical and exercise advice to adults with bone metastases and will inform the guidance document of the International Bone Metastases Exercise Working Group (IBMEWG).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.256 | 0.298 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.002 | 0.011 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".