The Use of the Analytic Hierarchy Process to Aid Decision Making in Acquired Equinovarus Deformity

van Til JA, Renzenbrink GJ, Dolan JG, IJzerman MJ. The use of the analytic hierarchy process to aid decision making in acquired equinovarus deformity. Objective: To increase the transparency of decision making about treatment in patients with equinovarus deformity poststroke. Design: The analytic hierarchy process (AHP) was used as a structured methodology to study the subjective rationale behind choice of treatment. Setting: An 8-hour meeting at a centrally located rehabilitation center in The Netherlands, during which a patient video was shown to all participants (using a personal computer and a large screen) and the patient details were provided on paper. Participants: A panel of 10 health professionals from different backgrounds. Interventions: Not applicable. Main Outcome Measures: The performance of the applicable treatments on outcome, impact, comfort, cosmetics, daily effort, and risks and side effects of treatment, as well as the relative importance of criteria in the choice of treatment. Results: According to the model, soft-tissue surgery (.413) ranked first as the preferred treatment, followed by orthopedic footwear (.181), ankle-foot orthosis (.147), surface electrostimulation (.137), and finally implanted electrostimulation (.123). Outcome was the most influential consideration affecting treatment choice (.509), followed by risk and side effects (.194), comfort (.104), daily effort (.098), cosmetics (.065), and impact of treatment (.030). Conclusions: Soft-tissue surgery was judged best on outcome, daily effort, comfortable shoe wear, and cosmetically acceptable result and was thereby preferred as a treatment alternative by the panel in this study. In contrast, orthosis and orthopedic footwear are usually preferred in daily practice. The AHP method was found to be suitable methodology for eliciting subjective opinions and quantitatively comparing treatments in the absence of scientific evidence.