Modified Delphi study to identify priority clinical questions for the Australian living guidelines for the management of Juvenile Idiopathic Arthritis

Abstract

Background Juvenile Idiopathic Arthritis (JIA) is the most common rheumatic inflammatory disease in childhood. Optimal management requires clinicians to be up to date with the rapidly evolving evidence base. ‘Living’ evidence-based clinical practice guidelines, which integrate new evidence as soon as it is available, are a novel method to enhance the translation of research into practice. To determine the most relevant questions that should be prioritised in national Australian JIA living guidelines, we invited Australian and New Zealand paediatric rheumatologists and other relevant health professionals to identify and rank their most important questions in order of priority. Methods All 47 members of the Australian Paediatric Rheumatology Group (APRG) were invited to participate in a modified Delphi study comprising two rounds. The first round identified demographic information of respondents, current attitudes to guideline use and invited submission of priority management questions. The second round asked respondents to rank 27 collated and refined questions identified in round one in order of priority. Results There were 29 (62%) and 28 (60%) responses to the first and second survey rounds respectively. About two thirds were rheumatologists or trainees (66, 68%), nearly half had more than 10 years of experience (45, 46%) and practice setting was largely hospital (79, 86%) and urban (86, 75%). Most respondents used clinical guidelines in their practice (72% sometimes, 24% often), most frequently American College of Rheumatology (ACR) (66%) and European Alliance of Associations for Rheumatology (EULAR) (59%) guidelines. Reported barriers to guideline use included that they are not up to date and access difficulties. Most respondents (83%) considered Australian guidelines were necessary and two-thirds indicated they would use them if integrated into practice software. The highest ranked topics were down-titration and discontinuation of disease modifying anti-rheumatic drugs (ranked first), best outcome measures (second) and treatment targets in JIA (third). Conclusions There is strong clinician support for the development of Australian living guidelines for JIA. Consensus was reached on the ten top-ranked priority questions. Our guidelines will develop evidence-based recommendations for these high priority questions that will be updated in real time as needed to facilitate rapid translation of evidence into clinical practice.

Clinical trial learning needs of musculoskeletal researchers: an inter-disciplinary consensus study by the Australia & New Zealand Musculoskeletal Clinical Trials Network

“…Analysis was based on methods used in previous prioritisation studies conducted by ANZMUSC. (15,16) Each topic was assigned a 'ranking score' using results of the Round 2 survey, with 10 points allocated to any topic each time it was ranked rst by a participant, to 1 point for any topic each time it was ranked tenth by a participant. A ranked list was created based on the sum of scores obtained for each topic.…”

“…Custom surveys were developed by the Steering Group, informed by a previous prioritisation study conducted by ANZMUSC. (15) Each survey was piloted by at least 6 musculoskeletal researchers for feedback on clarity, format of questions, completion time and suggestions for additional questions. The surveys were constructed in the Research Electronic Data Capture platform (REDCap), with each round taking approximately 5-10 minutes to complete.…”

Prioritization of clinical questions for the Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis

“…We have performed a similar prioritization exercise to inform the development of an Australian Living Guideline for the Management of Juvenile Idiopathic Arthritis (JIA) 16 . Several questions that are relevant to the management of both adult and juvenile inflammatory arthritis were identified in both surveys, including questions regarding DMARD tapering and discontinuation, switching DMARDs in those who have not responded adequately to treatment, the best investigations before instituting DMARDs, and the choice of outcome measures 17 . Questions regarding pain management, vaccinations, and the best approach to the use of glucocorticoids were also identified in both studies.…”

Prioritisation of clinical trial learning needs of musculoskeletal researchers: an inter-disciplinary modified Delphi study by the Australia & New Zealand musculoskeletal clinical trials network

“…osteoarthritis, gout), autoimmune rheumatic conditions (e.g., systemic lupus erythematosus), regional specific or non-specific musculoskeletal conditions (e.g., low back pain), fractures, and osteoporosis [ 20 ]. We adopted methodology used in previous ANZMUSC studies to identify priority clinical questions to inform clinical guidelines [ 21 , 22 ]. This process incorporates key features of the Delphi methodology, in order to generate a ranked list of priority topics.…”

“…Custom surveys were developed by the Steering Group, informed by a previous prioritisation study conducted by ANZMUSC [ 21 ]. Each survey was piloted by at least 6 musculoskeletal researchers for feedback on clarity, format of questions, completion time and suggestions for additional questions.…”