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• W3156069727 abstract "Purpose: To obtain consensus among an international, multidisciplinary group of subject matter experts regarding statements for structural changes and symptoms, as well as general statements on spinal osteoarthritis, for research and clinical purposes. Methods: After eliciting opinions from a steering committee of 15 international and multidisciplinary academics, 117 statements regarding definitions of spinal osteoarthritis for research and clinical purposes relating to specific structural changes and symptoms, as well as general statements on spinal osteoarthritis, were developed. In March 2020, subject matter experts were identified through a structured Web of Science search and also recommended by the steering committee to ensure a degree of heterogeneity across disciplines and geographic regions. In July 2020, an invitation to participate in a three-round, online Delphi study was sent to 255 identified subject matter experts with expertise in back pain and/or osteoarthritis and/or spondylosis, from 11 different professional backgrounds. In the first round of the Delphi, participants could propose additional statements for voting. Each statement was rated on a 1-9 Likert scale, and consensus was a priori set at ≥70% of respondents agreeing or disagreeing with the statement, with a concurrent <15% of respondents providing the opposite response. This study received human research ethics approval through Macquarie University, number: 52020783517249; Project ID: 7835. Results: Of 255 identified subject matter experts, 82 were uncontactable, leaving 173 invited to participate in the study. 116 participants provided consent and completed the first round (67% response rate). In August 2020, 85 of 111 (77%) completed the second round, and in October 2020, 87 of 101 (86%) completed the third round. In the first round, 14 additional statements were suggested from participants. In round one, most participants came from Europe (30.2%), were male (57.8%), were a physiotherapist (20.6%) and had been in their profession for 11-20 years (35.3%). From all 131 statements, consensus in round three was achieved on 74 statements; 56 in agreement and 18 in disagreement. From all statements, the highest consensus proportion for agreement (98%) was for the general statement “spinal osteoarthritis should be considered across a spectrum of structural changes AND patient symptoms, for research purposes” and the structural statement “severe structural spinal osteoarthritis on imaging can be present without significant symptoms”. The highest consensus proportion for disagreement was for the symptomatic statement “palpable warmth is the most important symptom for a symptomatic definition of spinal osteoarthritis” (95%) and the structural statement “spinal radiograph is the preferred method of imaging for facet joint changes, for research purposes” (93%). For both structural and symptomatic spinal osteoarthritis, the consensus proportion for the statement “An internationally recognised definition of spinal osteoarthritis is important, for research purposes”, was 97% and 95% respectively. Two of six statements regarding individual parameters of a structural definition of spinal osteoarthritis, for clinical practice, had consensus for disagreement. Four of eight statements regarding individual parameters of a symptomatic definition of spinal osteoarthritis had consensus (three for agreement and one for disagreement), for both research purposes and clinical practice. For general statements on spinal osteoarthritis, the highest consensus proportions were “spinal osteoarthritis should be considered a collection of different phenotypes where pathology in some, but not necessarily all, anatomical structures is present, for research purposes” (98%), “spinal osteoarthritis should be considered across a spectrum of structural changes and patient symptoms, for clinical practice” (95%) and that “separate definitions for structural and symptomatic spinal osteoarthritis are needed, for research purposes” (94%). For structural spinal osteoarthritis, the highest consensus proportions were for “an internationally recognised definition of structural spinal osteoarthritis is important, for research purposes” (97%), “there should be international agreement for a scale of severity of structural changes of the functional spinal unit on imaging, for research purposes” (97%) and “MRI as the preferred imaging method for intervertebral disc changes, for research purposes” (96%). While 75% of respondents agreed that CT-scan is the preferred method of imaging for facet joint changes, 70% also agreed that MRI is the preferred method of imaging for facet joint changes. For symptomatic spinal osteoarthritis, the highest consensus proportions were for “having an international definition of symptomatic spinal osteoarthritis, for research purposes” (95%), “chronic and/or recurrent spinal pain to be considered in symptomatic definition of spinal OA, for research purposes” (94%) and “limitations in physical function should be considered in symptomatic definition of spinal OA for research purposes and clinical practice” (93% and 93%). Conclusions: An international, multidisciplinary Delphi study, including 116 subject matter experts in back pain and osteoarthritis, achieved consensus regarding more than half of the 131 statements regarding spinal osteoarthritis, for research and clinical purposes. The retention rate of participants to round three was excellent (86%). Consensus for agreement on statements was mostly higher for those concerning research purposes, than for clinical practice. While there is a strong desire for a definition of spinal osteoarthritis in research and in clinical practice (98%) and there was high a proportion of consensus for statements for definitions of spinal osteoarthritis not unlike definitions for osteoarthritis in other joints (82%), the essential elements of a future definition for spinal osteoarthritis still need to be defined. Importantly, this Delphi reveals that a future definition should be considered across a spectrum of structural changes and patient symptoms. In addition, while consensus proportions for the use of imaging for structural spinal osteoarthritis for research purposes was often high, there is lack of consensus for the use of imaging in the clinical setting, which needs further clarification." @default.
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• W3156069727 date "2021-04-01" @default.
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• W3156069727 title "An international, multi-disciplinary Delphi study regarding statements for the definition of spinal osteoarthritis" @default.
• W3156069727 doi "https://doi.org/10.1016/j.joca.2021.02.354" @default.
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