2 33 ICON 2023: Core Outcomes for Achilles Tendinopathy test14-16 and 3) evaluating pain after activity using a Visual Analogue Scale (VAS, from 0-10, with 0 indicating no pain). There were no measurements that were excluded at this stage (i.e., ≥70% disagreement). On 19 (86%) of the outcome measurement instruments, the a-priori decision criteria (either ≥70% agree or disagree) were not reached. These 19 outcome measurement instruments were evaluated in Step 5. Step 5 - Defining the COS-AT during a consensus meeting at ISTS 2023 (third and final round Delphi procedure) During the ISTS 2023 in Valencia (Spain) 11 professional participants (33% of the total clinician/researcher panel) and 1 patient (man) were present. All participants received an email with detailed information about the results of step 3 and 4. An introduction to the session was performed by the steering committee, and the 19 outcome measurement instruments not already included or excluded from the COS, were discussed and voted upon. 1 item was endorsed, 10 provisionally endorsed and 8 were not endorsed (online supplementary file 6, Table 1). In combination with the results of Step 4 a COS could be defined, comprising 4 outcome measurement instruments, which are displayed in Table 2. Table 2. Endorsed outcome measurement instruments for the Core Outcome Set for Achilles tendinopathy (COS-AT). Outcome measurement instrument Domain Endorsement (rate of agreement) VISA-A questionnaire. Disability Endorsed in 2nd Delphi round (86%) Single-leg heel rise test.* Physical function capacity Endorsed in 2nd Delphi round (76%) Evaluating pain after activity using a VAS (0 -10) Pain on activity/loading Endorsed in 2nd Delphi round (72%) Evaluating pain on activity/ loading using a VAS (0-10) Pain on activity/loading Endorsed after in-person consensus meeting (75%%) Abbreviations; VISA-A: Victorian Institute of Sports Assessment-Achilles, VAS: Visual Analog Scale, * Testing Calf muscle strength by asking the patient to perform a maximum number of single leg heel raises. [Unable/ Able, number of heel raises, Work (Joule), cm above the ground (measured from the heel)] Notes during the in-person consensus meeting During the final in-person consensus meeting, several key topics emerged, underlining the perspectives of the professional participants and the patient. All participants agreed that outcome measurement instruments should be as straightforward as possible; simpler measures are deemed more reliable, while those that are more extensive are often seen as having less construct validity. For example, a 0-10 Visual Analogue Scale (VAS), should be preferred over a 0-100 VAS. Additionally, there was a call for greater specificity in certain outcome measurement instruments, such as evaluating pain after activity.
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