Infectious diseases of poverty (IDoP) affect disproportionately resource-limited and marginalized populations, resulting in spatial patterns of vulnerability across various geographical areas. Currently, no spatial indices exist to quantify vulnerability to IDoP at a fine geographical level within countries, such as municipalities or provinces. Without such an index, policymakers cannot effectively allocate resources or target interventions in the most vulnerable areas. This protocol aims to specify a methodological approach to measure spatial variation in vulnerability to IDoP. We will evaluate this methodological approach using surveillance and seroprevalence data from the Dominican Republic (DR) as part of a broader effort to develop a regional index for the Caribbean region. The study will consist of three main components. The first component involves identifying the relevant factors associated with IDoP in the Caribbean region through a scoping review, supplemented by expert-elicited opinion. The second component will apply a Fuzzy Analytic Hierarchy Process to weigh the aforementioned factors and develop a spatial composite index, using open data and available national surveys in the DR. In the final component, we will evaluate and validate the index by analysing the prevalence of at least three IDoPs at a fine-grained municipal level in the DR, using seroprevalence data from a 2021 national field study and other national surveillance programs. The spatial vulnerability index framework developed in this study will assess the degree of vulnerability to IDoP across different geographical scales, depending on data availability in each country.

Antimicrobial resistance (AMR) has emerged as a significant global challenge and Southeast Asia with rapid economic and population growth faces substantial challenge in dealing with emerging infectious diseases and antimicrobial resistance. Here we present the recommendations of a workshop that explored the challenges and opportunities for One Health approach towards AMR research in three countries of AEAN, namely, Cambodia, Laos, and Vietnam.

A workshop was organised in Hanoi, Vietnam in August 2023, involving participants involved in AMR research across varied sectors from three participating countries to prioritise the strategies that can be implemented in the region to fructify the One Health approach to tackle AMR. A modified Delphi approach was used to prioritise the top 10 Global Priority Research Questions for the region as developed by the Quadripartite (FAO, WHO, WOAH and UNEP). An iterative process was adopted to map priorities according to their impact and feasibility of application.

Collaborative initiatives, such as a common platform for listing the research goals, a web-based surveillance mechanism, and an enhanced AMR awareness curricula were identified as the steps forward. A consensus statement highlighting the critical needs for improved technical and infrastructure capacity, collaboration between sectors, increased funding, and systematic data analysis was drafted.

The participating countries have National Action Plans guided by the World Health Organization's Global Action Plan on AMR, but limited collaboration between human health and other sectors has impeded the benefits that One Health approach may achieve in the region. The recommendations include the need for improved technical and infrastructure capacity, and data collection across One Health sectors, besides increasing awareness at multiple levels.

A collaborative and coordinated effort to apply One Health initiatives for tackling AMR in the ASEAN region is imperative. The workshop formulated a roadmap for future direction by identifying priorities aimed at enhancing collaboration, addressing infrastructure gaps, and contributing to an effective intervention in the fight against AMR in the region.

Delphi studies have established themselves in the health sciences as a means to systematically and, ideally, synthesize expert opinions into a consensus on concrete issues. As participatory health research increases in relevance, lifeworld experts (e.g., patients, caregiving relatives) are being included in Delphi surveys and their opinions placed alongside those of professional and scientific experts. Looking at the theory and methodology, we discuss the opportunities and challenges concerning result quality and derive practical implications for conducting Delphi studies involving lifeworld experts alongside scientific and/or professional experts. Delphi techniques are understood here to be social interaction processes whose outcomes are a result of the participating experts' conscious, cognitive judgment processes, and also shaped by individual, situational and cultural factors. The more heterogeneous the expert panel, in particular when lifeworld experts are participating, the more these influences vary. Expert panel composition and how diversity is handled prove significant to Delphi study results. Our argument is based on an in-depth analysis of a systematic review of Delphi studies with lifeworld experts. We found that the inclusion of lifeworld experts in Delphi studies usually occurs relatively unsystematically and, furthermore, that results are not analysed separately according to expert group, although there would be good reasons for this. We have oriented the reporting here on PRISMA. To enhance the outcomes of Delphi studies that incorporate lifeworld experts alongside scientific and/or professional experts, we put forward specific recommendations that address potential biases arising from the participation of lifeworld experts.

This study aimed to develop best practice recommendations for physiotherapists providing telerehabilitation to First Nations people.

Modified Delphi study.

Eighteen experts from four groups were selected: (a) physiotherapists who provide telerehabilitation to First Nations people, (b) Carrier Sekani Family Services leaders (CSFS, First Nations-led health organization/research partners), (c) telehealth experts from British Columbia (BC), Canada, and (d) First Nations individuals (end users) with experience in telerehabilitation.

Panelists rated recommendations on telehealth best practices in two rounds using an online questionnaire. Recommendations were synthesized from a scoping review and two qualitative studies. Each statement was rated on a four-point Likert scale indicating whether it was essential, useful, not useful, or unnecessary for inclusion in the best practices. Statements endorsed by ≥80% of panel members were considered for inclusion in the final document.

Following the Delphi process, 77 recommendations covering foundational components, information technology utilization, professional expertise, therapeutic relationships, cultural safety, and the telehealth visit were validated for inclusion in the policy document. Participants also validated the methodology.

The recommendations offer a valuable resource for continuing education and professional development, empowering physiotherapists to enhance their skills and competencies in delivering culturally competent telerehabilitation to the First Nations population. The adoption of these best practices ensures that First Nations people are getting the best standard of care, potentially enhancing uptake and experiences with telehealth. It also enables healthcare organizations and policymakers to monitor adherence to established standards and identify areas for improvement. CONTRIBUTION OF THE PAPER.

Artificial intelligence (AI) holds the potential to fundamentally transform how public health authorities use risk communication, community engagement and infodemic management (RCCE-IM) to prepare for, manage and mitigate public health emergencies. As research on this crucial transformation remains limited, we conducted a modified Delphi study on the impact of AI on RCCE-IM.

In two successive surveys, 54 experts-scholars with expertise in public health, digital health, health communication, risk communication and AI, as well as RCCE-IM professionals-from 27 countries assessed opportunities, challenges and risks of AI, anticipated future scenarios, and identified principles and actions to facilitate the responsible use of AI. The first Delphi round followed an open, exploratory approach, while the second sought to prioritise and rank key findings from the initial phase. Qualitative thematic analysis and statistical methods were applied to evaluate responses.

According to the expert panel, AI could be highly beneficial, particularly for risk communication (eg, tailoring messages) and infodemic management (eg, social listening), while its utility for fostering community engagement was viewed more critically. Challenges and risks affect all three components of RCCE-IM equally, with algorithmic bias and privacy breaches being of particular concern. Panellists anticipated both optimistic (eg, democratisation of information) and pessimistic (eg, erosion of public trust) future scenarios. They identified seven principles for the responsible use of AI for public health practices, with equity and transparency being the most important. Prioritised actions ranged from regulatory measures, resource allocation and feedback loops to capacity building, public trust initiatives and educational training.

To responsibly navigate the multifaceted opportunities, challenges and risks of AI for RCCE-IM in public health emergencies, clear guiding principles, ongoing critical evaluation and training as well as societal collaboration across countries are needed.

Management of cytomegalovirus (CMV) viremia/disease in transplant recipients may be complicated by toxicities and resistance to conventional antivirals, adding to the overall healthcare burden. Despite advances in analyzing real-world data in current years, little is known about refractory and resistant CMV. This study therefore aimed to characterize treatment patterns and patient numbers with special focus on refractory and resistant CMV.

Two classical three-round Delphi consensus panels with German clinical experts in CMV following solid organ transplantations (SOT) and hematopoietic stem cell transplantations (HSCT) were held between October and December 2021 using online questionnaires. Consensus was defined as agreement of 75% of participants.

Following SOT, experts agreed that on average 65% of SOT patients are not affected by CMV at all, while 35% of patients experience CMV viremia or disease. Of SOT patients treated with antiviral therapies, experts agreed that 90% respond to their first-line treatment and 10% do not. For HSCT, experts agreed that 62% of patients experience no CMV, while 38% of patients are diagnosed with either CMV viremia or CMV disease. It was further estimated that 23% HSCT patients receiving antiviral treatment do not respond to their first-line CMV treatment. Experts reached consensus on the reasons for non-response, suggesting that among non-responders, 55% were intolerant, while 45% of non-responders were refractory/resistant to first-line treatment.

Based on the current incidence of transplantations in Germany, experts estimated that 103 SOT and 225 HSCT patients need second-line CMV treatment annually.

This study explores the impact of cognitive and affective trust on the utilization of family doctor services based on McAllister's theory. It also analyzes the factors influencing these forms of trust.

A cross-sectional study using stratified random sampling gathered data from 325 adult patients registered with family doctors in six community health centers in Wuhan, China. PLS-SEM was employed to examine the relationships among cognitive trust, affective trust, and the utilization of family doctor services. Logistic regression was utilized to identify the factors influencing cognitive and affective trust.

Higher cognitive trust significantly influenced affective trust (β = 0.549, p < 0.01) and was positively associated with service utilization (β = 0.524, p < 0.01). Affective trust also showed a positive association with service utilization (β= 0.481, p < 0.01). Occupation and marital status were found to have a significant impact on both cognitive and affective trust. Specifically, professional and technical workers(OR=9.699, p=0.001;OR=2.309, p=0.011) and non-married individuals(OR=7.591, p=0.001;OR=2.737, p=0.002) demonstrated higher trust levels.

The study reveals the importance of cognitive and affective trust in patient engagement with family doctor services. It suggests that family doctors should enhance their professionalism while also demonstrating emotional care to improve overall healthcare quality. Additionally, attention should be given to the influence of factors such as occupation and marital status on patients' trust in family doctors.

Mild traumatic brain injury (mTBI) is frequently overlooked in polytrauma patients due to the overshadowing of more severe injuries, a fact that makes its identification in post-acute settings challenging since symptoms overlap with other conditions and no validated diagnostic tools exist. To address this gap, this scoping review explored the literature on mTBI diagnosis in post-acute civilian polytrauma settings.

By utilizing the Arksey and O'Malley framework and PRISMA-ScR guidelines, the review focused on studies from 2010 to 2024 related to delayed mTBI diagnosis in adults. Of the 696 studies identified, only six met the inclusion criteria, highlighting the limited research in this area.

The review assessed various diagnostic tools including the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), neuropsychological tests, advanced imaging, and oculomotor assessments. However, these tools are limited in their ability to confirm whether an mTBI has occurred. The American Congress of Rehabilitation Medicine's updated mTBI criteria may offer the best diagnostic potential but require validation.

According to the findings, there is a significant gap in validated diagnostic tools for mTBI in post-acute settings, which may negatively affect patient outcomes. Developing and validating effective screening tools for mTBI in the post-acute polytrauma setting should be the priority of future research in this area.

In healthcare facilities, clinicians' legal literacy may influence the implementation of the law, which is one of the determinants of service quality. Studies regarding the association between clinicians' legal literacy and the quality of services provided by medical facilities were insufficient.

To evaluate the association between clinicians' legal literacy and the quality of primary healthcare services in the Greater Bay Area, China.

This study was a cross-sectional design. A general linear model was employed to assess the association between clinicians' legal literacy and the service quality of community health service institutions (CHSIs), controlling for confounding variables. From September 2023 to April 2024, 477 physicians and nurses from 58 CHSIs in the Greater Bay Area, China, engaged in this study. A self-administered questionnaire was utilized to evaluate the clinicians' legal literacy, encompassing legal knowledge, legal attitude, and legal compliance, which was validated by the Delphi method. The National Committee for Quality Assurance Patient-Centered Medical Home (NCQA-PCMH) was employed to assess the service quality of CHSIs.

In the adjusting models, higher scores of legal literacy were related to higher scores of NCQA-PCMH significantly (aβ = 1.360, 95%CI = 0.091-2.630, P = 0.036). Among the six domains of PCMH, PCMH1 (aβ = 0.184, 95%CI = 0.080-0.287, P = 0.001), PCMH3 (aβ = 0.330, 95%CI = 0.052-0.608, P = 0.020), and PCMH4 (aβ = 0.660, 95%CI = 0.256-1.063, P = 0.001) were found to be related to clinicians' legal literacy.

This study demonstrated an association between clinicians' legal literacy and the quality of services provided by primary healthcare institutions. The findings offered novel evidence for policymakers and administrators of medical institutions to enhance clinicians' legal literacy with continuing medical education programs, which could improve the overall management framework of contemporary medical facilities.

The level of labor integration of people with disability (PwD) is notably lower than that of people without disabilities. In order to evaluate the success of the labor market integration of people with disabilities, it is necessary to establish a series of indicators that go beyond hiring rates. Hence, the objective of this study is to develop a list of indicators with their specified individual weight that will serve to evaluate the success of the labor market insertion of PwD in conventional companies.

The Delphi method was used. In Phase 1, an open-ended questionnaire was distributed to 48 human resources and disability experts. From this qualitative analysis, a list of 52 indicators was drawn up and the experts were asked to evaluate their importance using a scale from 0 to 10 points. The convergence of opinion was obtained in the third phase. To evaluate the degree of stability of the experts' responses in the different phases, the Wilcoxon test was applied. Finally, a factor analysis was carried out in relation to the indicators.

After the development of the three phases and the factor analysis, a list of 26 indicators was obtained to measure the success of inclusive employability, structured in four factors: Work Performance, Labor Management, Social and Organizational Impact, Competency Assessment.

This project has provided a list of indicators that can be the basis for the creation of a scale to assess the successful integration of people with disabilities in the conventional company.

Researchers and insurers use "home time," or an individual's time at home compared to time in different health care settings, as a population-level quality of life (QoL) or quality of care measure. With varying definitions, it is unknown which components of a home time measure most closely reflect QoL. Our objective is to develop a person-centered universal home time measure agnostic to condition.

We used an iterative, structured approach based on Delphi methods to obtain expert input on what a measure should include, using qualitative and quantitative evidence from prior work. A total of 28 expert panelists, including Veterans Affairs (VA) leaders, clinician researchers, and non-clinician researchers, participated. In the first round, panelists voted on components (settings, weights, timeframes) to include in a home time measure. In the second round, panelists discussed results. The third round was final voting and explanations of choices and caveats.

Qualitative and quantitative data suggested that emergency department, inpatient care, and post-acute care settings all affect older adults' QoL in different ways, supporting inclusion; 75% of the experts endorsed all settings, and discussion suggested that future work should limit ED days to visits resulting in an inpatient admission. Our data did not reveal a clear indication for weighting settings: 56% of the expert panel suggested continuing to explore the use of weights to arrive at values that would reflect qualitative differences in settings, and 44% did not support the use of any weights. Our 6-month models resulted in QoL outcomes for all settings, and 30% of experts endorsed a 6-month timeframe, while 65% said that timeframe would depend on the situation.

A "1.0" universal person-centered home time measure that reflects QoL should include days in the emergency department, inpatient care, and post-acute care. Expert input revealed domains of agreement and disagreement. Future validation efforts that incorporate expert input are needed to iterate and arrive at the optimal measure.

Chronic limb-threatening ischemia (CLTI) presents significant challenges in both diagnosis and management, with a lack of standardized preoperative assessment and optimization frameworks. This study aimed to establish a contemporary consensus among vascular specialists on the perioperative care of CLTI patients across diverse health-care systems.

A modified Delphi methodology was used, involving iterative rounds of consultation with 42 expert vascular surgeons from the United Kingdom, Ireland, Australia, and New Zealand. Four broad domains were explored: availability of services, preoperative assessment, perioperative optimization, and the role of multidisciplinary teams (MDTs). Consensus was defined as ≥70% agreement RESULTS: A total of 59 consensus statements were established, covering key areas such as rapid access clinics, the value of preoperative investigations and anemia. Unanimous agreement was reached regarding the necessity of clear referral pathways, and a strong majority supported the importance of MDTs in complex cases. However, significant uncertainty remained about the utility of existing risk prediction models, with only 53% endorsing tools like the American College of Surgeons Risk Calculator. Notably, 81% agreed that if preoperative investigations could change the type of intervention a patient received, this investigation should be performed prior to surgery even at the expense of delayed intervention.

This Delphi consensus study highlights the complexity in managing patients with CLTI and the necessity of a multifaceted, interdisciplinary approach to preoperative care. The findings advocate for improved primary care management, selective use of preoperative investigations and emphasizes the importance of interdisciplinary care. While consensus was reached on several key aspects of care, the study highlights ongoing uncertainties around risk prediction and cardiac stress testing therefore highlighting the need for further research to validate current tools and practices. These results lay the groundwork for future clinical guidelines aimed at reducing practice variability and improving patient outcomes.

Off-label use of drugs is an integral part of everyday clinical practice in palliative medicine. However, it is associated with many uncertainties, that is, drug therapy safety or legal issues including cost coverage. Healthcare professionals often lack time and resources for comprehensive literature search and patient-specific risk-benefit analyses.

The aim of this project is to develop, evaluate and rate agreement/disagreement on treatment recommendations for off-label use in adult palliative medicine.

Online Delphi study with two rounds each to rate agreement/disagreement with treatment recommendations for off-label use in adult palliative medicine. An international expert panel consisting of physicians, pharmacists and nurses working in palliative care evaluated previously developed recommendations based on the best available evidence.

/participants:Professionals (physicians, pharmacists, nursing staff) working in inpatient and home palliative care involved in the medication process were recruited as experts to participate. Between 64 and 75 experts participated in the first two Delphi studies.

A total of 64/68 recommendations on 21 drugs and 14 applications were agreed upon. Topics related to routes of administration as well as indications for sialorrhea, bronchorrhea, xerostomia, pruritus, singultus, fistula, gastroparesis and hot flashes. Recommendations that reached consensus are available to health care professionals via a free of charge database.

For many off-label use applications, it is likely that there will be no registration studies and therefore no drug approvals in the future. The consensus-based recommendations are intended to facilitate individual treatment planning for prescribers and to enable a more reflected handling of off-label use.

The gut microbiome comprises trillions of microorganisms and profoundly influences human health by modulating metabolism, immune responses and neuronal functions. Disruption in gut microbiome composition is implicated in various inflammatory conditions, metabolic disorders and neurodegenerative diseases. However, determining the underlying mechanisms and establishing cause and effect is extremely difficult. Preclinical models offer crucial insights into the role of the gut microbiome in diseases and help identify potential therapeutic interventions. The Human Microbiome Action Consortium initiated a Delphi survey to assess the utility of preclinical models, including animal and cell-based models, in elucidating the causal role of the gut microbiome in these diseases. The Delphi survey aimed to address the complexity of selecting appropriate preclinical models to investigate disease causality and to study host-microbiome interactions effectively. We adopted a structured approach encompassing a literature review, expert workshops and the Delphi questionnaire to gather insights from a diverse range of stakeholders. Experts were requested to evaluate the strengths, limitations, and suitability of these models in addressing the causal relationship between the gut microbiome and disease pathogenesis. The resulting consensus statements and recommendations provide valuable insights for selecting preclinical models in future studies of gut microbiome-related diseases.

Limited data are available to inform clinicians on how to manage concurrent substance use in the context of repetitive transcranial magnetic stimulation (rTMS) for the treatment of depressive, obsessive-compulsive, psychotic, or trauma-related disorders. The authors convened an international panel of 24 rTMS experts, representative of different geographic regions and subspecialities, and created a consensus guideline for clinicians and researchers on approaches to concurrent substance use in patients receiving rTMS as treatment for primary psychiatric disorders.

A Delphi method survey and expert opinion elicited over consecutive rounds of surveys were used, with feedback and discussion after each round. Recommendation statements were established upon very high (≥80%) agreement.

Three rounds of surveys and feedback were sufficient to reach a consensus for most topics; where consensus could not be reached, the panel discussed limitations in the current evidence base. Informed by a synthesis of the literature and practice-based evidence, the expert panel provides several consensus recommendations on the topics of screening, monitoring, risk assessment, and mitigation associated with various degrees of substance use, and specific considerations for alcohol, cannabis, stimulants, and opioids. Instead of excluding all people who use substances, a nuanced approach should be taken based on an assessment of risk factors for clinical instability and severity of use. The most important safety risk with substance use is the presence of intoxication or withdrawal states, with the most data supporting seizure risk in unstable alcohol or nonmedical stimulant use. Although there is no evidence of reduced rTMS efficacy for a psychiatric disorder in the presence of concurrent substance use, the lack of data in this area warrants caution.

These recommendations can be readily implemented clinically and provide a framework for future research. In patients receiving rTMS for a primary psychiatric disorder, assessment and management of co-occurring substance use is complex, requiring greater attention, standardization, and further study.

The lack of a triage system for urgent surgical patients leads to non-standardized decision-making. Developing an instrument to objectively identify the complexity of care required for each case is challenging. The aim of this report is to develop and validate an urgent surgical patient classification instrument using the Delphi technique.

The study was conducted in several stages: (1) definition of the construct; (2) item elaboration; (3) expert analysis; (4) item selection; (5) pretest. In the first study, scale items were designed and content validity was confirmed. In the second study, the factorial structure was analyzed. In the third study, alternative measurement models were tested. In the fourth study, criterion validity was analyzed.

Experts validated 14 items (31.81%) from Domain 1 with 75% agreement and specific items from Domain 2 with 100% agreement. Factor analysis indicated a two-factor solution explaining 58.4% of the variance. The bifactor model presented the best fit (χ2/df = 1.51; CFI = 0.95; TLI = 0.94; RMSEA = 0.051; SRMR = 0.043). Factors showed excellent internal consistency (α > 0.88; CR > 0.90; ω > 0.92).

This pioneering study developed and validated the content of the first specific instrument for classifying urgent surgical patients regarding their priority for care. The instrument was deemed valid in terms of content, based on expert consensus. Further studies are recommended to evaluate its practical application and perform additional psychometric measures. This instrument has the potential to enhance the organization of emergency services and operating theaters, promoting patient safety and efficient resource management in healthcare institutions. Its implementation should align with current health guidelines and policies to optimize the triage and prioritization process for urgent surgical patients.

We conducted a comprehensive analysis of the usefulness of the Delphi technique for facilitating community participation in local health needs assessments within the Andalusian Local Health Action Network, Spain. We developed an ad hoc online questionnaire based on the Social Determinants of Health model and applied it to a panel of experts in two municipalities in the province of Seville (Andalusia, Spain) between May and June 2021. Our results reflected good panelist participation. The questionnaire successfully enabled the prioritization of both new and original items, some of which were incorporated into local health policies. We concluded that the Delphi method was effective for facilitating participation in local health needs assessments offering a replicable, cost-effective approach that accelerated local policy development and supported the implementation of Health in All Policies within local government.

The Independent Panel for Pandemic Preparedness and Response issued a series of recommendations for future pandemic preparedness and response. Latin America's COVID-19-related deaths represented 25 % of the global demises, despite harboring less than 8 % of the world's population. As little data exists to support whether the Panel's recommendations reflect public health professionals' priorities in the region the study aimed to define these priorities utilizing a Delphi study.

A consensus-building modified Delphi technique.

For the first two rounds, participants were asked to rank a list of topics across seven domains on a 4-point Likert scale. Topics voted by at least 75 % of participants in either round as very important were included in the final round. Participants ranked the topics from each of the seven domains in numeric order to define top priorities.

A total of 115 responses were obtained across three rounds. Most respondents were involved in direct efforts against COVID-19 (75·0-86·%) and a considerable proportion had more than 16 years of public health experience (37·3-50·0 %). The top priority issues were zoonotic disease-pathogen surveillance systems (27·4 points), robust infection and prevention control programs (22·8 points), and indicator and event-based monitoring and reporting systems (22·1 points).

Establishing priorities for future pandemics is critical to ensure better health outcomes. The region should strengthen collaboration and enhance its capacities while conducting country-level analysis and defining priorities for future arrangements.

The physiotherapy workforce is going through a staggering period of change, amidst an evolving technological landscape. Whilst the profession has cautiously begun to embrace digital physiotherapy practice, there remains a lack of clear, evidence-based standardized guidance regarding tangible activities that demonstrate relevant clinical competence with digital health technologies in practice.

Establish the world's first international consensus on entrustable professional activities (EPAs) for digital physiotherapy practice.

International Delphi study of experts over three rounds, to establish consensus on digital physiotherapy practice EPAs and associated specifications.

Fifty-five participants completed the study (which was an 83.3% retention rate from round 1). Participants represented 16 countries. Over 50% were academics, and over 30% were clinicians. The final framework consisted of nine EPAs and 56 specifications for digital physiotherapy practice. The highest percentage rated specification was for "obtaining informed consent" for using digital health.

This Delphi study is a seminal international consensus on the core EPAs for digital physiotherapy practice. These EPAs materialize competency. As global attention to digital health continues to increase, our workforce will need to continue to mature in this space. This international consensus will support employers, universities, peak bodies, and individual physiotherapists alike to develop alongside technology. With greater evidence and the establishment of international standards, confidence in the outcomes of digital physiotherapy practice will increase.

The role of obstetric nurses in the management of gestational diabetes mellitus (GDM) is becoming increasingly important, and their management level will directly affect the patient's health education and even the pregnancy outcome. However, there is a lack of tools to measure the competencies of GDM management among obstetric nurses.

The questionnaire was developed in two stages: (a) creation of an initial questionnaire based on the definition of competency, literature review, and semi-structured interviews, followed by two rounds of Delphi expert inquiry; (b) evaluation of the questionnaire via piloting study on 30 obstetric nurses and testing of validity and reliability on 239 obstetric nurses.

A questionnaire containing dimensions of professional knowledge, professional skills, professional competence and personal attitude was developed. Correlation analysis revealed statistically significant correlations (p < 0.01) between each item and the total score, although two items had r-values <0.4, indicating weak correlations, so they were removed. The initial Cronbach's α coefficient of 0.970 indicated that no items needed to be excluded. Five experts evaluated the content validity, yielding an S-CVI/Ave of 0.95 and the I-CVI values range from 0.80 to 1.00, meeting the reference standard. The Cronbach's α coefficients for the four dimensions ranged from 0.793 to 0.928, while the overall Cronbach's α coefficient of the questionnaire was 0.970. The retest reliability was 0.907, and the fold-half reliability was 0.950. The results of the reliability tests all met the measurement requirements of the questionnaire and could be used to evaluate the competency of obstetric nurses in the management of GDM patients.

This study developed an assessment tool for evaluating the management ability of obstetric nurses for GDM patients, which consists of four dimensions and 35 items. The dimensions and items demonstrate the content of the competence theory, and the questionnaire shows good stability and reliability and validity.

It is recommended that healthcare institutions integrate this questionnaire into training and evaluation programs for obstetric nurses to improve care quality for GDM patients. Regular use will ensure nurses have the knowledge, skills, and attitudes needed to provide optimal care.

Schoolteachers' personal health and wellbeing are priority to ensure quality teaching, positive student outcomes and improving teacher retention. With limited-availability of validated tools to measure teacher food and nutrition (FN) as a component of wellbeing, this study aims to evaluate the content validity of the Teacher Food and Nutrition-related health and wellbeing Questionnaire (TFNQ) to fill this gap.

A two-round Delphi was used to refine the questionnaire and establish content validity. Round-one reviewed constructs and lifestyle covariates (LC) for inclusion. Round-two considered construct phrasing, appropriateness of scales and questionnaire order. Descriptive and thematic analyses were conducted.

Round-one included 23 international experts, with 19 also participating in round-two. After round-one, seven constructs and three LC were removed with two constructs revised into four concise new groupings to refine the TFNQ. In round-two 83% of experts agreed with questionnaire order, and feedback indicated only minor adjustments. The final TFNQ contains 26 FN and wellbeing constructs and three LC.

This Delphi study established content validity of the TFNQ to appropriately measure key aspects of FN as a component of wellbeing in schoolteachers. Future testing will evaluate the TFNQ construct validity and reliability.

A nurse new to home peritoneal dialysis (PD) undoubtedly has to learn all the steps for continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) procedures, along with basics such as hand hygiene, ordering supplies, disposing of supplies, recognizing signs and symptoms of peritonitis. However, it is not always clear what else the new PD nurse needs to know in order to successfully teach a patient all that a patient (and care partner) starting home PD training need to know, as well as to support that patient overtime once the patient is performing PD at home. To answer this question, using a modified Delphi technique, members of the International Society for Peritoneal Dialysis (ISPD) Nursing and Allied Health Professional Committee identified the top 10 practice advice (tips) these nurse members thought all new home PD nurses should know and be aware of. For each tip, we justified the importance of the tip and how it could be implemented. The 10 tips were quite varied and highlighted both the breadth and the depth of knowledge a new PD nurse needs to acquire over and above basic knowledge and skills such as performing CAPD and APD and recognizing signs and symptoms of peritonitis. The members of the ISPD Nursing and Allied Health Professional Committee who compiled this list of the top 10 tips, believe that through understanding the importance, justification, and implementation of each of these tips, the nurse new to a home PD program can, in turn, appreciate more how to individualize home PD training sessions, improve the quality of life for patients on PD, as well as extend the patients' time on PD.

Metabolomics is a postgenomic, systems-based discipline offering valuable applications in nutrition research, including the use of objective biomarkers to characterize dietary intake and metabolic responses more accurately. A scoping review identified the need for reporting guidance on dietary information in the form of a checklist to ensure reproducibility of human feeding studies that are measuring the diet-related metabolome. In this study, we aimed to gain consensus on a core outcome set pertaining to diet-related item details (DIDs) and recommendations for reporting DIDs to inform development of a reporting checklist. The goal of this checklist is to guide researchers on the minimum level of content and detail required for reporting dietary information in human feeding studies measuring the metabolome. A 2-stage online Delphi process encompassing 5 survey rounds with international experts in clinical trial design, feeding study intervention implementation, metabolomics, and/or human biospecimen analyses was conducted. A core outcome set encompassing 29 DIDs and accompanying recommendations was developed across 5 domains: dietary intervention-modeling (8 DIDs), dietary intervention-implementation (3 DIDs), dietary assessment (9 DIDs), adherence and compliance monitoring (4 DIDs), and bias (5 DIDs). The reporting guideline (DID-METAB Checklist) was generated and accepted by the international expert working group in the final survey round. All experts agreed that relevant journals should include the checklist as a suggested reporting tool for relevant studies and/or used alongside existing reporting tools. This report provides examples, explanations and elaboration for each recommendation including examples from published literature and references. The DID-METAB Checklist will be a key tool to advance the standardized reporting for feeding studies assessing the metabolome. Implementation of this tool will enable the ability to better interpret data and ensure global utility of results for furthering the advancement of metabolomics in nutrition research and future precision and personalized nutrition strategies.

Pediatric dystonias are associated with a broad spectrum of etiologies, resulting in a heterogeneous patient population in whom clinical presentation, evolution, and therapeutic needs may differ. These neurological symptoms are particularly common in children and adolescents with life-limiting and life-threatening conditions requiring pediatric palliative care (PPC). The impact on the child's quality of life is significant, as is distress for caregivers. Addressing and alleviating dystonia is key to providing good palliative care; however, there is limited evidence. A greater recognition and management of dystonia in this setting is urgently needed to provide appropriate interventions and care.

To develop a standardized approach to dystonia in PPC.

A two-round Delphi process explored the views of experts on the definition, assessment, monitoring, and treatment of dystonia in PPC. Professionals from different backgrounds and disciplines were invited worldwide. The final panel comprised 71 participants who completed a multi-statement online questionnaire.

Fifty-three items were endorsed, providing expert, consensus-based recommendations.

The limited clinical knowledge of childhood dystonia represents a challenge, especially in children with palliative care needs. This study is a first international consensus on dystonia in PPC and offers novel approaches to improving the dystonia-related burden and advancing clinical practice in this vulnerable population.

The purpose of this study was to develop a maternal health care exercise and pelvic abdominal rehabilitation curriculum for obstetric medical professionals. Maternal health care exercise and pelvic abdominal rehabilitation can effectively prevent and alleviate pelvic-floor-rehabilitation problems in pregnant women and improve their quality of life. However, there is a lack of standardized courses for training obstetric medical professionals.

This study used the Delphi method to design two rounds of expert consultation. A group of 17 specialists from the fields of gynecology, obstetrics, and rehabilitation, who are involved in clinical teaching and management, participated in the study. Data were collected between October and December 2023.

The effective recovery rates of the two rounds of questionnaires were 85.0% and 94.1%. The expert-authority coefficients were 0.90 and 0.88. The Kendall coordination coefficient was 0.35-0.41. The average importance score for each index ranged from 3.25 to 4.94. The coefficient of variation for each index ranged from 0.07 0.20. Based on the curricular topics, we constructed four first-level indicators, 16 second-level indicators, and 58 third-level indicators of exercise and pelvic and abdominal rehabilitation for obstetric medical professionals.

The training curriculum provides obstetric medical professionals with the basis for obstetric rehabilitation. The training system is clear and coherent, and the content is clear and comprehensive, which enriches global obstetrical rehabilitation education resources. It is helpful to guide and educate on maternal obstetric rehabilitation to improve the quality of life of the women.

The Delphi technique has become established in public health research, yet there is a lack of methodological standards in questionnaire development. We here demonstrate how the Delphi technique can be used in an interdisciplinary public health topic for framework development, and we highlight methodological challenges and possible solutions.

We developed the questionnaire through a comprehensive literature review and the generation of an item pool based on the rules of item construction. We used cognitive interviews, a Delphi experts assessment and group discussions to refine the questionnaire and to ensure content validity. Finally, we carried out a pre-test of the online questionnaire.

The questionnaire consists of three main sections, namely gender (norms), the social environment and the mental health of adolescents, and another section on characteristics of the panelists. It comprises a total of 32 questions and includes rating and ranking questions, content-related and comment questions, open and closed questions as well as questions on personal characteristics and evaluation questions.

To address challenges in the development process, interdisciplinary researchers need to be involved. They should consider certain aspects of the development process to provide more structure and clarity, such as comprehensively preprocessing the content, and disentangling and simplifying the theoretical concepts. They should consider a rigorous approach to develop more complex frameworks for interdisciplinary public health topics. Future research should focus on developing methodological guidelines and testing their applicability for different objectives of the Delphi technique (e.g., framework development).

Acute lymphoblastic leukaemia (ALL) is a rare and heterogeneous disease. The ALLTogether consortium has implemented a treatment protocol to improve outcome and reduce treatment-related toxicity across much of Europe. The consortium provides the opportunity to design translational research on patient material stored in national biobanks. However, there are currently no standardized guidelines for the types of material, processing, and storage for leukaemia biobanking. To address this gap, we conducted a modified Delphi survey among 53 experts in different roles related to leukaemia. The first round consisted of 63 statements asking for level of agreement. The second round refined some to reach consensus, using yes-no and multiple-option answers. Key recommendations include cryopreservation of cells from diagnosis, post-induction, post-consolidation, and relapse, with at least two aliquots of plasma and serum, and cerebrospinal fluid from diagnosis, day15, and post-induction. It was advised to distribute cells across multiple vials for various research projects, and to collect data on sample processing, cell viability, and blast percentage. Quality monitoring and user feedback were strongly recommended. The Delphi survey resulted in strong recommendations that can be used by national biobanks to harmonize storage of samples from patients with ALL and ensure high-quality cryopreserved cells for research studies.

Methodological heterogeneity and reporting bias complicate interpreting endodontic outcomes. Supported by the American Association of Endodontists and its Foundation, this study developed the Core Outcome Set in Endodontics (COS-ENDO) to standardize reporting for studies of Nonsurgical Root Canal Treatment/Retreatment, Surgical Endodontics, Vital Pulp Therapy, Apexification, and Regenerative Endodontics. This article, the last in a 5-part series, focuses on COS-ENDO for Apexification and Regenerative Endodontics, while other parts address the remaining treatments.

Outcomes were identified through scoping reviews and a web-based survey of American Association of Endodontists practicing members. In a 2-round Delphi survey, clinicians, patients, and researchers rated outcomes on a 9-point scale. Ratings were assessed against consensus criteria, and a virtual meeting finalized COS-ENDO.

Of the 97 invited participants to Round 1, 77 registered, and 73 (24 Academicians/Researchers, 26 Clinicians, and 23 Patients or their parents/caregivers) assessed 51 outcomes, with 18 excluded. The remaining outcomes-7 achieving consensus for inclusion and 26 lacking consensus-advanced to Round 2 for re-rating by 70 participants. This resulted in 14 outcome achieving consensus for inclusion, and 19 lacking consensus. In the final meeting, 16 participants finalized the COS-ENDO for Apexification and Regenerative Endodontics, including Tooth survival, Pain, Signs of infection, Radiographic evidence of periradicular healing, Continued root development, Success, Functional tooth, Need for further intervention, and Adverse events/Complications.

COS-ENDO is an important step in standardizing outcome reporting in endodontics, ensuring consistent reporting and enhancing research utility. Further efforts are needed to establish optimal measurement methods.

Methodological heterogeneity and reporting bias complicate interpreting endodontic outcomes. Supported by the American Association of Endodontists and its Foundation, this study developed the Core Outcome Set in Endodontics (COS-ENDO) to standardize reporting for studies of nonsurgical root canal treatment/retreatment, surgical endodontics, vital pulp therapy, apexification, and regenerative endodontics. This article, part 3 of a 5-part series, focuses on COS-ENDO for surgical endodontics, while other parts address the remaining treatments.

Outcomes were identified through a scoping review, a qualitative study with patients, and a web-based survey of American Association of Endodontists practicing members. In a 2-round Delphi survey, clinicians, patients, and researchers rated outcomes on a 9-point scale. Ratings were assessed against consensus criteria, and a virtual meeting finalized COS-ENDO.

Of the 97 invited participants to round 1, 77 registered, and 73 (24 academicians/researchers, 26 clinicians, and 23 patients or their parents/caregivers) assessed 46 outcomes, with 17 excluded. The remaining outcomes-7 achieving consensus for inclusion and 22 lacking consensus-advanced to round 2 for rerating by 70 participants. This resulted in 1 outcome achieving consensus for exclusion, 10 for inclusion, and 18 lacking consensus. In the final meeting, 16 participants finalized the COS-ENDO for surgical endodontics, including Tooth survival, Pain, Signs of infection, Radiographic evidence of periradicular healing, Success, Functional tooth, Need for further intervention, and Adverse events/Complications.

COS-ENDO is an important step in standardizing outcome reporting in endodontics, ensuring consistent reporting and enhancing research utility. Further efforts are needed to establish optimal measurement methods.

Methodological heterogeneity and reporting bias complicate interpreting endodontic outcomes. Supported by the American Association of Endodontists and its Foundation, this study developed the Core Outcome Set in Endodontics (COS-ENDO) to standardize reporting for studies of Nonsurgical Root Canal Treatment/Retreatment, Surgical Endodontics, Vital Pulp Therapy, Apexification, and Regenerative Endodontics. This article, Part 2 of a 5-part series, focuses on COS-ENDO for Nonsurgical Root Canal Treatment/Retreatment, while other parts address the remaining treatments.

Outcomes were identified through scoping reviews, a qualitative study with patients, and a web-based survey of American Association of Endodontists practicing members. In a 2-round Delphi survey, clinicians, patients, and researchers rated outcomes on a 9-point scale. Ratings were assessed against consensus criteria, and a virtual meeting finalized COS-ENDO.

Of the 97 invited participants to Round 1, 77 registered, and 73 (24 Academicians/Researchers, 26 Clinicians, and 23 Patients (or their parents/caregivers)) assessed 39 outcomes, with 18 excluded. The remaining outcomes-7 achieving consensus for inclusion and 14 lacking consensus-advanced to Round 2 for re-rating by 70 participants. This resulted in 9 outcomes achieving consensus for inclusion, and 12 lacking consensus. In the final meeting, 16 participants finalized the COS-ENDO for Nonsurgical Root Canal Treatment/Retreatment, including Tooth survival, Pain, Signs of infection, Radiographic evidence of periradicular healing, Success, Functional tooth, Need for further intervention, and Adverse events/Complications.

COS-ENDO is an important step in standardizing outcome reporting in endodontics, ensuring consistent reporting and enhancing research utility. Further efforts are needed to establish optimal measurement methods.

Methodological heterogeneity and reporting bias complicate interpreting endodontic outcomes. Supported by the American Association of Endodontists and its Foundation, this study developed the Core Outcome Set in Endodontics (COS-ENDO) to standardize reporting for studies of nonsurgical root canal treatment/retreatment, surgical endodontics, vital pulp therapy, apexification, and regenerative endodontics. This article, the first in a 5-part series, outlines the methods for developing COS-ENDO, with detailed findings for each treatment presented in subsequent parts.

Outcomes were identified through scoping reviews, a qualitative study with patients, and a web-based survey of American Association of Endodontists practicing members. In a 2-round Delphi survey, clinicians, patients, and researchers rated outcomes on a 9-point scale. Ratings were assessed against consensus criteria, and a virtual meeting finalized COS-ENDO.

Of the 97 invited participants to round 1, 77 (79%) registered and 73 (95%) completed the survey, including 24 academicians/researchers, 26 clinicians, and 23 patients (or their caregivers/parents). They rated 64 outcomes, totaling 182 occurrences across treatments: 39 for nonsurgical root canal treatment/retreatment, 46 for surgical endodontics, 46 for vital pulp therapy, and 51 for apexification/regenerative endodontics. The outcomes that achieved consensus for inclusion and those lacking consensus (either for inclusion or exclusion) advanced to round 2 for rerating by 70 participants. During the final consensus meeting, 16 participants discussed the outcomes and finalized the COS-ENDO.

COS-ENDO is an important step toward standardizing outcome reporting in endodontics. Its implementation will ensure consistent reporting, enhancing research utility and evidence synthesis. Further efforts are needed to establish optimal measurement methods.

Methodological heterogeneity and reporting bias complicate interpreting endodontic outcomes. Supported by the American Association of Endodontists and its Foundation, this study developed the Core Outcome Set for Endodontics (COS-ENDO) to standardize reporting for studies of Nonsurgical Root Canal Treatment/Retreatment, Surgical Endodontics, Vital Pulp Therapy, Apexification, and Regenerative Endodontics. This article, Part 4 of a 5-part series, focuses on COS-ENDO for Vital Pulp Therapy, while other parts address the remaining treatments.

Outcomes were identified through a scoping review and a web-based survey of American Association of Endodontists practicing members. In a 2-round Delphi survey, clinicians, patients, and researchers rated outcomes on a 9-point scale. Ratings were assessed against consensus criteria, and a virtual meeting finalized COS-ENDO.

Of the 97 invited participants to Round 1, 77 registered, and 73 (24 Academicians/Researchers, 26 Clinicians, and 23 Patients or their parents/caregivers) assessed 46 outcomes, with 17 excluded. The remaining outcomes-4 achieving consensus for inclusion and 25 lacking consensus-advanced to Round 2 for re-rating by 70 participants. This resulted in 10 outcomes achieving consensus for inclusion, and 19 lacking consensus. In the final meeting, 16 participants finalized the COS-ENDO for Vital Pulp Therapy studies, including Tooth survival, Pain, Signs of infection, Radiographic evidence of maintained periradicular health, Continued root development, Success, Functional tooth, Need for further intervention, and Adverse events/Complications.

COS-ENDO is an important step in standardizing outcome reporting in endodontics, ensuring consistent reporting and enhancing research utility. Further efforts are needed to establish optimal measurement methods.

Practice guidelines may reduce health inequities by addressing preventable and unjust differences in health. However, health equity considerations are often inadequately integrated into the guideline planning and development process. This article describes a pragmatic approach to enhancing health equity considerations within guidelines by introducing an extension to the GIN-McMaster Guideline Development Checklist (GDC).

We reviewed the latest guidance on enhancing health equity considerations in guideline development to draft the checklist and deployed a global online survey from March 27th, 2024, to May 13th, 2024 to gather consensus. We conducted a methodological review of guideline development handbooks to identify best practices in health equity considerations. An advisory board comprised of diverse interest-holders informed the development of the checklist. We made revisions based on the survey feedback and review findings.

We present 21 extension items spanning 16 of the 18 guideline development topics from the GIN-McMaster GDC. Key additions include planning for engagement with individuals experiencing inequities in guideline development activities, applying an equity lens, and considering health equity in recommendation formulation, dissemination and implementation strategies. This checklist gives value to lived experiences to enrich health equity assessments, complementing empirical evidence to inform guideline recommendations. Guideline developers should assess guideline sensitivity to health equity to determine resource prioritization for optimal implementation of the extension items.

The GIN-McMaster health equity extension provides guidance for the streamlined integration of health equity considerations throughout the guideline development process. Using this tool alongside the original GIN-McMaster GDC may lead to more equitable and impactful guidelines.

This project was partially funded by Public Health Agency of Canada. The funder was not involved in the conceptualization or design or the conduct of the project.

Stepped-care approaches can improve the support for the bereaved. This requires the selection of interventions according to individual support needs. Grief counsellors are in a position to identify bereaved persons possibly suffering from a psychological disorder and to refer them to psychotherapeutic or medical treatment. However, it remains unclear what knowledge regarding psychological disorders and which skills grief counsellors need for this task.

We conducted an online Delphi consensus study with 17 experts of grief counselling in three consecutive survey rounds. The first round qualitatively identified the required knowledge regarding psychological disorders and the respective skills. In the subsequent rounds, the experts rated the topics concerning their relevance, whether they should be part of a training curriculum and whether they are adequately considered in current curricula. Descriptive analyses were applied. Consensus was reached if at least 50 % of the experts rated a topic as rather relevant, and 80 % endorsed the topic for a training curriculum. Expert comments were used to generate recommendations that were evaluated for consensus.

The qualitative analysis identified 39 topics, and 26 reached a consensus. Of these, six referred to "knowledge about grief", five to "knowledge about psychological disorders", and 15 to professional, interpersonal, and relationship and communication skills. Experts' opinions on whether sufficient consideration is given to these topics in current curricula varied greatly between the topics.

The experts reached a consensus regarding the areas of knowledge about psychological disorders and the specific skills to be taught. At the same time, there appears to be a high degree of heterogeneity between the various training and continuing education programmes with regard to imparting knowledge to identify the need for therapeutic support.

The present recommendations can be used to inform and optimise the content of training curricula for grief counsellors with regard to the identification of bereaved persons with increased therapeutic support needs.

The main purpose of this project was to capture experts' opinion on hyperkalaemia management and form best practice recommendations for cardiorenal patients in Greece. A steering committee of nephrologists and cardiologists developed 37 statements. An online questionnaire completed by 32 experts in cardiorenal management in Greece. Median score used to determine the level of agreement and disagreement index (DI) used to determine the level of consensus for each statement. Statements divided in four sectors: hyperkalaemia risk management, preventative measures, treatment and collaboration between specialties. The rate of the first round of the consensus was 94.6%. Median score was >7 for 36 of 37 statements and DI ≤ 1 for 35 of 37. Among other statements, consensus reached for recognizing levels K+ > 5.0 mEq/L as associated with elevated mortality risk; retaining renin-angiotensin-aldosterone system inhibitors (RAASi) on maximum recommended dose for cardiorenal patients; and using novel K+ binders to help enabling guideline-recommended doses of RAASi therapy. Cardiologists compared to nephrologists showed higher reluctance to discontinue down-titrate RAASi and MRA in patients with K+ levels above 5 mEq/L. Additionally, 88.9% of nephrologists and 71.4% of cardiologists agreed that cross-specialty alignment on a serum K+ concentration level (K > 5.5 mEq/L) is needed to initiate hyperkalaemia treatment. Both cardiologists and nephrologists showed disagreement with the statement on keeping titration in cardiorenal patients with K+ > 5.5 mEq/L or preserving fruit and vegetable consumption when moderate or severe hyperkalaemia exhibits. This Delphi project pointed out nephrologists' and cardiologists' agreement on hyperkalaemia management in cardiorenal patients; thus, it can help a cross-specialty optimal management of cardiorenal patients, with hyperkalaemia not being an obstacle for disease-optimizing therapy. Novel potassium binding agents can enable guideline-recommended doses of potassium-sparing medication.

In severe cases of necrotizing enterocolitis (NEC) in preterm neonates, surgery may be the only option for survival. However, the consequences of active treatment are not always in the infant's best interest, urging parents and physicians to consider palliative care as an alternative. This study aims to identify key factors parents prioritize when making this decision, as a preliminary step towards developing a decision support tool.

Three Dutch parent panels (without experience with NEC/preterm birth, with experience but without loss, and with loss due to NEC/preterm birth) were asked to rate 31 literature-based and self-suggested decision factors. Factors were rated on a scale of 1 to 9 in a two-round Delphi study. Factors that reached a median score of six or higher by one or more panels after the second Delphi round were discussed in a consensus meeting of the steering committee.

Sixty-six participants completed both Delphi rounds. Nine factors were excluded after the final round, including parental physical and mental health, finances, and religion. Of the other 22 factors, the steering committee decided upon 15 key factors to serve as a base for the decision support tool. Most important factors included chance of death, short- and long-term physical consequences, and future independence. Additionally, parents were influenced by doctors' opinions and feelings of responsibility and hope.

This study highlights fifteen decision factors for Dutch parents facing surgical NEC. These insights will inform the development of a decision support tool aiding parents in making informed end-of-life decisions.

To describe and analyze the methodological characteristics and quality of cross-sectional studies that have validated an ICF-CS.

A systematic review was conducted to identify empirical studies published in English that validated any ICF-CS using a cross-sectional design. Databases searched included Web of Science, Scopus, CINAHL, PubMed, Embase, and PsycINFO. The search was conducted in November 2022 with an update in October 2023. Two independent reviewers coded studies that met the inclusion criteria and assessed their methodological quality and risk of bias using the AXIS tool. Synthesis was performed by calculating frequencies and percentages.

87 articles validating 24 ICF-CSs were analyzed. Most articles showed strengths in consistency between study objectives and the outcome variables measured. However, a large majority did not report sample size calculation (up to 94.2% in Delphi studies), and few validation studies were conducted in the WHO regions of Africa and the Eastern Mediterranean.

The quality of cross-sectional studies validating ICF-CSs was satisfactory, although several articles did not describe aspects such as sample size calculation. Validity evidence for ICF-CS studies could be improved by conducting more multicenter studies, replicating ICF-CS validation studies in different WHO regions, and through synthesis of existing research.