ArticleFrontiers in neurology2026
Protocol for developing an evidence-based expert consensus on efficacy evaluation and comorbidity management of integrated Chinese and Western medicine for pediatric tic disorders: a GRADE-based modified Delphi study.
Article in Frontiers in neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Pediatric tic disorders (TD) are common neurodevelopmental conditions frequently complicated by attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, anxiety, and depression. Integrated Chinese and Western medicine is widely used in China, but its efficacy evaluation and comorbidity management lack standardized, evidence-anchored consensus methodologies. Objective: To describe the protocol for developing an evidence-based expert consensus on efficacy evaluation and comorbidity management of integrated Chinese-Western medicine for pediatric TD, using a GRADE-informed modified Delphi process. Methods: The consensus will be developed in six phases: (1) setup and scoping, including a multidisciplinary, cross-regional Development Panel and identification of core clinical questions; (2) systematic literature search, quality appraisal (AMSTAR 2, RoB 2, ROBINS-I, QUADAS-2, AGREE II, and JBI checklists), and GRADE certainty assessment; (3) a three-round modified Delphi survey with ≥75% consensus threshold, anonymous voting, and controlled feedback; (4) a planned hybrid consensus meeting to adjudicate unresolved items, with two-stage voting (adoption then strength) and predefined decision rules; (5) drafting, external review, and final endorsement; and (6) dissemination and updating. Good Practice Statements (GPS) will be distinguished from evidence-based recommendations. Expected outcomes: This protocol seeks to generate: (1) core recommendation statements; (2) an integrated efficacy evaluation framework spanning tic severity, TCM syndromes, and functional status; (3) targeted management pathways for prevalent comorbidities (ADHD, OCD, anxiety/depression); and (4) standardized safety monitoring principles. Conclusion: This protocol presents a transparent, reproducible, and GRADE-aligned methodology for developing an integrative consensus in pediatric TD. It may serve as a methodological reference for future integrative guideline development.
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