Multi-centre modified Delphi exercise to identify candidate items for classifying early-stage symptomatic knee osteoarthritis

L K King; J W Liew; A Mahmoudian; Q Wang; N E J Jansen; I Stanaitis; V Hung; F Berenbaum; S Das; C Ding; C A Emery; S R Filbay; M C Hochberg; M Ishijima; M Kloppenburg; N E Lane; E Losina; A Mobasheri; A Turkiewicz; J Runhaar; I K Haugen; C T Appleton; L S Lohmander; M Englund; T Neogi; G A Hawker; OARSI Early-stage Symptomatic Knee Osteoarthritis Initiative

doi:10.1016/j.joca.2024.10.016

Multi-centre modified Delphi exercise to identify candidate items for classifying early-stage symptomatic knee osteoarthritis

Osteoarthritis Cartilage. 2025 Jan;33(1):155-165. doi: 10.1016/j.joca.2024.10.016. Epub 2024 Nov 8.

Authors

L K King¹, J W Liew², A Mahmoudian³, Q Wang⁴, N E J Jansen⁵, I Stanaitis⁶, V Hung⁷, F Berenbaum⁸, S Das⁹, C Ding¹⁰, C A Emery¹¹, S R Filbay¹², M C Hochberg¹³, M Ishijima¹⁴, M Kloppenburg¹⁵, N E Lane¹⁶, E Losina¹⁷, A Mobasheri¹⁸, A Turkiewicz¹⁹, J Runhaar²⁰, I K Haugen²¹, C T Appleton²², L S Lohmander²³, M Englund²⁴, T Neogi²⁵, G A Hawker²⁶; OARSI Early-stage Symptomatic Knee Osteoarthritis Initiative

Affiliations

¹ Department of Medicine, University of Toronto, Toronto, Canada. Electronic address: [email protected].
² Boston University Chobanian & Avedisian School of Medicine, Boston, USA. Electronic address: [email protected].
³ Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden; Department of Movement Sciences and Health, University of West Florida, Pensacola, USA. Electronic address: [email protected].
⁴ Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai, China. Electronic address: [email protected].
⁵ Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands. Electronic address: [email protected].
⁶ Research and Innovation Institute, Women's College Hospital, Toronto, Canada. Electronic address: [email protected].
⁷ Research and Innovation Institute, Women's College Hospital, Toronto, Canada. Electronic address: [email protected].
⁸ Sorbonne University INSERM, Department of Rheumatology, AP-HP Saint-Antoine Hospital, Paris, France. Electronic address: [email protected].
⁹ Department of Rheumatology, Era's University, Lucknow, India. Electronic address: [email protected].
¹⁰ Clinical Research Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. Electronic address: [email protected].
¹¹ Sport Injury Prevention Research Centre, Faculty of Kinesiology and Cumming School of Medicine, University of Calgary, Alberta, Canada. Electronic address: [email protected].
¹² Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia. Electronic address: [email protected].
¹³ Department of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA. Electronic address: [email protected].
¹⁴ Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan. Electronic address: [email protected].
¹⁵ Department of Rheumatology, Leiden University Medical Center, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, the Netherlands. Electronic address: [email protected].
¹⁶ Department of Medicine, UC Davis Health, Sacramento, USA. Electronic address: [email protected].
¹⁷ Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, USA; Department of Orthopedic Surgery, Harvard Medical School, Boston, USA. Electronic address: [email protected].
¹⁸ Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania; Department of Joint Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Université de Liège, Liège, Belgium. Electronic address: [email protected].
¹⁹ Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden. Electronic address: [email protected].
²⁰ Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands. Electronic address: [email protected].
²¹ Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway. Electronic address: [email protected].
²² Department of Physiology and Pharmacology Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada; Department of Medicine, The University of Western Ontario, London, Canada; Western Bone and Joint Institute, London, Canada. Electronic address: [email protected].
²³ Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden. Electronic address: [email protected].
²⁴ Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden. Electronic address: [email protected].
²⁵ Boston University Chobanian & Avedisian School of Medicine, Boston, USA. Electronic address: [email protected].
²⁶ Department of Medicine, University of Toronto, Toronto, Canada; Research and Innovation Institute, Women's College Hospital, Toronto, Canada. Electronic address: [email protected].

PMID: 39521366
DOI: 10.1016/j.joca.2024.10.016

Abstract

Objective: To generate a list of candidate items potentially useful for discriminating individuals with Early-stage Symptomatic Knee Osteoarthritis (EsSKOA) from those with other conditions and from established osteoarthritis (OA), and to reduce this list based on expert consensus.

Design: We conducted a three-round online international modified Delphi exercise with OA clinicians and researchers ("OA experts"). In Round 1, participants reviewed 84 candidate items and nominated additional item(s) potentially useful for EsSKOA classification; those nominated by ≥3 participants were added. In Round 2, participants rated perceived usefulness of 108 items (1 [not at all useful] to 9 [extremely useful]). In Round 3, participants could revise their ratings after reviewing Round 2 group median and quartiles. Following Round 3, we retained items with a median usefulness score >5 and ≥33.3% of participants categorised the item as useful (7 to 9), overall and in subgroup analysis by clinician field.

Results: There were 128 participants in Round 1 and 113 (88%) completed all rounds. We retained 77 items that spanned multiple domains (demographics, symptoms, physical exam, performance-based measures, imaging, laboratory investigations, and gross inspection/arthroscopy). Highly rated items included (median usefulness score): prior knee joint injury (8), diagnosis of OA in a different joint (7), and activity-related knee pain (7). The interquartile range was most often 3.

Conclusion: We identified 77 items that OA experts consider potentially useful for EsSKOA classification. The results highlight experts' uncertainty around item usefulness. Next, candidate items will be further assessed and reduced using data-driven and multicriteria decision analysis methods.

Keywords: Classification criteria; Delphi; Early-stage; Knee osteoarthritis; Symptoms.

Publication types

Multicenter Study

MeSH terms

Aged
Consensus
Delphi Technique*
Female
Humans
Male
Middle Aged
Osteoarthritis, Knee* / classification
Osteoarthritis, Knee* / diagnosis
Severity of Illness Index