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Table 1 Development of the recommendations

From: Multidisciplinary recommendations for diagnosis and treatment of foot problems in people with rheumatoid arthritis

Phase 1. Development of research-questions and semi-definitive frameworks for diagnosis and treatment
a Preliminary literature search in books, protocols and review articles
b Semi-structured interviews with 4 RA patients experienced with foot problems and related treatments
c Field consultation among 39 RA footcare professionals (medical doctors/allied healthcare professionals) by assessing a semi-structured interview (n = 6) or by using a questionnaire during an expert meeting (n = 33). The overall question to be answered: “Which questions would you like to see answered by the recommendations? Regarding to your field of expertise (diagnostics and treatment) and in the context of a multidisciplinary approach”
d Draft research questions and draft frameworks (for diagnosis and treatment) were developed, by the core members of the expert group (MTD, MvdL, TPMVV and JD), based on the results of point a-c.
e Discussion with the experts on the draft research questions and frameworks, during the first expert group meeting.
f Refining draft research questions and frameworks into definitive research questions and semi-definitive frameworks with the expert group, during the first expert group meeting.
Phase 2. Development of draft recommendations
g A search strategy was developed for each research question (see Additional file 1). Literature was searched in PubMed by MTD. The available (systematic) reviews on the subject of interest were used. When no (systematic) review were available, core publications (according to the expert group) were used.
h Draft recommendations were formulated (by the core members) based on the literature found at point g.
Phase 3. Development of definitive recommendations and frameworks with a level of evidence
i Discussion with the experts on the draft recommendations and semi-definitive frameworks, during the second expert group meeting and 2 email-rounds.
j Refining draft recommendations and semi-definitive frameworks into definitive recommendations and frameworks, during the second expert group meeting and 2 email-rounds.
k Determining the level of evidence for each definitive recommendation/framework according to “Evidence-Based Guideline Development” of the Quality Institute for Public Healthcare in The Netherlands. Five levels of evidence were distinguished (ranging from 1 to 4b). When a recommendation was based on a review or guideline, the level of evidence reported in the review/guideline was used. If the level of evidence was not reported, the original sources were retrieved (individual studies/ expert opinion).
Phase 4. Determining the level of agreement for the definitive recommendations and frameworks
l During the third expert group meeting an anonymous voting procedure was followed. For each recommendation/framework a numeric rating scale for agreement (NRS-agreement) from 0 (total disagreement) to 10 (total agreement) was assessed.
m The mean and range of the level of agreement for each recommendation was calculated. A recommendation was approved when ≥70% of the expert group voted an NRS-agreement ≥7.