The Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) sarcopenia diagnosis and management task force: Findings from the consumer expert Delphi process

Abstract

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Consensus guidelines for sarcopenia prevention, diagnosis and management in Australia and New Zealand

“…The importance of the consumer-health professional relationship is highlighted in Statement 12 which was modified prior to Phase 3 to reflect the Consumer Expert Delphi findings. 30 The most clear and unequivocal recommendations arising from our study (as supported by EBR classification) are recommendations regarding diet and exercise for those living with sarcopenia (Statements 13 and 14). Consistent with the recent International Exercise Recommendations in Older Adults consensus guidelines, we recommend all persons with sarcopenia be offered resistance-based exercise tailored to individual abilities and preferences [S18], 40 particularly given there are presently no pharmaceutical treatments for sarcopenia.…”

“…In Phase 1, an online vote was undertaken, and consensus achieved to conduct the parallel Consumer Expert Delphi, and the format of the Topic Expert Delphi (Phases 2 to 4) was defined as described in Figure 1. Phase 2 findings from the Consumer Expert Delphi informed Phase 3 of the Topic Expert Delphi 30 ; detailed outcomes of this process are published separately 30 . This study was approved by Monash Health Human Research Ethics Committee (ERM 64175) and complied with ethical standards 31 .…”

“…‘Certainty’ of evidence was assessed by considering imprecision, risk of bias, inconsistency, publication bias and indirectness 33 . Some statements were modified based on the parallel Consumer Expert Delphi results 30 in accordance with NHMRC standards regarding consumer input 32 . Statements were then classified as one or more of (i) evidence‐based recommendation (EBR); (ii) consensus‐based recommendation (CBR); and (iii) practice‐point (PP) based on criteria (Data S7) arising from NHMRC and GRADE EtD frameworks 32–35 .…”

“…Our study was strengthened by involvement of a wide range of experts across ANZ, coupled with input from the Consumer Expert Delphi. 30 The Topic Expert Delphi adhered to reporting recommendations for Delphi studies 29 and presented clear definitions of levels of evidence, 32,33 and response bias was addressed a priori by high agreement thresholds, anonymity and each response being considered equal. To maximize the accessibility of the survey for health professionals without expertise on operational definitions and diagnosis of sarcopenia, and to minimize the impact of satisficing (i.e., where respondents answer not in reflection of their beliefs or knowledge but to complete a survey in a timely manner), we presented a 'no opinion' option for questions on the preferred sarcopenia definition and measures of muscle strength and physical performance.…”

“…Access to these services is limited in certain settings (e.g., rural and remote locations), and therefore consideration of innovative modes of health care delivery (e.g., telehealth) could be made. 30 Statement 14 recognizes that the effect of adequate protein and energy intake may be optimized by resistance exercise, particularly in those with low habitual protein (energy) intake [S19]. Given the specific skill set required to comprehensively assess and optimize dietary intake, and intervene where indicated, we recommend health professionals consider referring patients with sarcopenia to a dietitian (e.g., Accredited Practising Dietitian in Australia and New Zealand) (Statement 15).…”