BackgroundOver the past decades, opioid prescriptions have increased in the Netherlands. The Dutch general practitioners’ guideline on pain was recently updated and now aims to reduce opioid... Show moreBackgroundOver the past decades, opioid prescriptions have increased in the Netherlands. The Dutch general practitioners’ guideline on pain was recently updated and now aims to reduce opioid prescriptions and high-risk opioid use for non-cancer pain. The guideline, however, lacks practical measures for implementation.ObjectiveThis study aims to determine practical components for a tool that should assist Dutch primary care prescribers and implements the recently updated guideline to reduce opioid prescriptions and high-risk use.MethodsA modified Delphi approach was used. The practical components for the tool were identified based on systematic reviews, qualitative studies, and Dutch primary care guidelines. Suggested components were divided into Part A, containing components designed to reduce opioid initiation and stimulate short-term use, and Part B, containing components designed to reduce opioid use among patients on long-term opioid treatment. During three rounds, a multidisciplinary panel of 21 experts assessed the content, usability, and feasibility of these components by adding, deleting, and adapting components until consensus was reached on the outlines of an opioid reduction tool.ResultsThe resulting Part A consisted of six components, namely education, opioid decision tree, risk assessment, agreements on dosage and duration of use, guidance and follow-up, and interdisciplinary collaboration. The resulting Part B consisted of five components, namely education, patient identification, risk assessment, motivation, and tapering.ConclusionsIn this pragmatic Delphi study, components for an opioid reduction tool for Dutch primary care-givers are identified. These components need further development, and the final tool should be tested in an implementation study. Show less
Luca, K. de; Chiarotto, A.; Cicuttini, F.; Creemers, L.; Schepper, E. de; Ferreira, P.H.; ... ; Ferreira, M.L. 2023
Objective. To determine consensus among an international, multidisciplinary group of experts regarding defini-tions of spinal osteoarthritis for research and for clinical practice.Methods. A 15... Show moreObjective. To determine consensus among an international, multidisciplinary group of experts regarding defini-tions of spinal osteoarthritis for research and for clinical practice.Methods. A 15-member, multidisciplinary steering committee generated 117 statements for a 3-round Delphi study. Experts in back pain and/or osteoarthritis were identified and invited to participate. In round 1, participants could propose additional statements for voting. All statements were rated on a 1-9 Likert scale, and consensus was set at >= 70% of respondents agreeing or disagreeing with the statement and < 15% of respondents providing the opposite response.Results. In total, 255 experts from 11 different professional backgrounds were invited. From 173 available experts, 116 consented to participate. In round 1, 103 participants completed the survey, followed by 85 of 111 participants in round 2 (77%) and 87 of 101 participants in round 3 (86%). One-third of participants were from Europe (30%), most were male (58%), one-fifth were physical therapists (21%), and over one-third had been in their profession for 11-20 years (35%). Of 131 statements, consensus was achieved for 71 statements (54%): 53 in agreement (75%) and 18 in disagreement (25%).Conclusion. Although there was consensus for statements for definitions of spinal osteoarthritis that were analogous to definitions of osteoarthritis in appendicular joints, a future definition still needs refinement. Importantly, this Delphi highlighted that a future definition should be considered across a spectrum of structural changes and patient symptoms and expressed on a progressive scale. Show less
