2 27 ICON 2023: Core Outcomes for Achilles Tendinopathy measurement instrument (adequate/equivocal/poor) and the quality of the methods used in the particular study (good/moderate/poor). Disagreements were resolved by consensus. Studies with a high risk of bias according to this quality assessment were excluded from evidence synthesis. Subsequently, a Summary of Measurement Properties table was made per outcome measurement instrument, based on the OMERACT guidelines. This table covered extracted data of the 1) Truth (target domain); 2) Feasibility; 3) Truth (construct validity which included hypothesis testing [convergent validity] and testing of known group differences) and 4) Discrimination (test-retest reliability, responsiveness, clinical trial discrimination and thresholds of meaning) per included study. We performed a best evidence synthesis, which was based on the quality of the included studies, the number of good quality studies, the consistency across studies and the performance in each property. This resulted in a final synthesis rating that was categorized as 1) Go (green), 2) Cautious (amber), 3) Stop (red) or 4) No data. As we expected evidence for certain outcome measurement instruments to be absent or very limited in the specific population of Achilles tendinopathy patients, we decided not to reject outcome measurement instruments with no available data on clinimetric properties at this stage. Step 4 – An online survey on outcome measurement instruments as COS-AT (second round Delphi procedure) The outcome measurement instruments identified during the systematic review (step 1) that were found to be feasible and within the relevant core domain for tendinopathy (step 2) and assessed for their methodological quality (step 3) were rated during an international Delphi survey. The same international panel of professional participants was invited to participate as well as a new sample (≥10) of patients with Achilles tendinopathy. For each included outcome measurement instrument, we displayed the results of step 1 and 2 to the participants and asked whether this outcome measurement instrument should be part of the COS. The respondents to the survey had three response options: agree (yes), disagree (no), or unsure. An outcome measurement instrument was regarded as part of the COS if it met the a priori criterion decision: ≥70% agree. An outcome measurement instrument was not regarded as part of COS if ≥70% disagree. If 30-70% agree, the outcome measurement instrument was discussed during the in-person meeting (step 5). Step 5 – Defining the COS-AT during a consensus meeting at ISTS 2023 (third round Delphi procedure) The results from the first three steps were collated and circulated to all members of the panel prior to the consensus meeting, which was held at the ISTS 2023 in Valencia (Spain) on November 9th 2023. All professional participants were asked to attend the meeting as well as several patients. At this consensus meeting, any item not already included or excluded from the outcome set (agreement between 30% and 70%), was
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