Table 1Stakeholder ranking of methods issues

Methods Issue QuestionWeightedUnweightedRelated PICO Element
Measurement
Which validated outcomes instruments should be used in all studies?8 7 O
What is a minimal clinically important difference in key outcomes?9 7 O
Which promising and/or controversial interventions should be studied?4 4 I
What set of consistent definitions of rotator cuff pathology, including concomitant pathology, should be used across providers and imaging reports?4 4 P
What diagnostic imaging (MRI, ultrasound, surgical inspection, arthrogram) best determines the extent of rotator cuff pathology at baseline, and when is it indicated?5 5
What imaging is best to evaluate cuff integrity post-surgery, and when is it indicated?4 4
Which imaging is best for cuff tears superimposed on pre-existing pathology?11
What provider training and experience thresholds are required for accurate imaging interpretation (tear classification) for rotator cuff for pathology?00
How should ‘cuff integrity’ be defined for (1) nonoperative/preoperative and (2) postoperative patients?33
What constitutes a good or acceptable repair?33
What surgeon factors are associated with better operative repair and/or better outcomes?00
Should minimum thresholds, such as number of cases or training, be required for complex repairs or revisions?00
Which patient factors should be collected at baseline across all studies?55 P
Design and Reporting
Should classification of study participants be pathology based or impairment based?33
Which patient groups (for example, acute/chronic, older active/inactive, worker’s compensation) should special care be given to assure representation in research samples?22
What should the minimum followup duration be? Define “long-term.”22
Identify additional outcomes data sources (health plan, CMS, VA, other) and develop guidelines for use and reporting (STROBE, other). Is a registry necessary to accrue sufficient patients to examine natural history, baseline factors, and outcomes?4 3

CMS = Centers for Medicare and Medicaid Services; MRI = magnetic resonance imaging; PICO = population, intervention, comparison, outcome; STROBE = strengthening the reporting of observational studies in epidemiology; VA = U.S. Department of Veterans Affairs

Item was ranked in the top quartile. Each stakeholder had six stars to assign to issues deemed high priority. Up to three stars could be assigned to any one issue.

Item was ranked in the top quartile. Each stakeholder had six stars to assign to issues deemed high priority. Up to three stars could be assigned to any one issue.

From: Results

Cover of Nonoperative and Operative Treatments for Rotator Cuff Tears: Future Research Needs
Nonoperative and Operative Treatments for Rotator Cuff Tears: Future Research Needs: Identification of Future Research Needs From Comparative Effectiveness Review No. 22 [Internet].
Future Research Needs Papers, No. 39.
Butler M, Forte M, Braman J, et al.

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