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Chapman LS, Flurey CA, Redmond AC, Richards P, Hofstetter C, Tapster B, Emmel J, Helliwell PS, Menz HB, Hannan MT, Shea B, Siddle HJ. Living with foot and ankle disorders in rheumatic and musculoskeletal diseases: A systematic review of qualitative studies to inform the work of the OMERACT Foot and Ankle Working Group. Semin Arthritis Rheum 2023; 61:152212. [PMID: 37207417 DOI: 10.1016/j.semarthrit.2023.152212] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVES This study aimed to determine outcome domains of importance to patients living with foot and ankle disorders in rheumatic and musculoskeletal diseases (RMDs), by exploring the symptoms and impact of these disorders reported in existing qualitative studies. METHODS Six databases were searched from inception to March 2022. Studies were included if they used qualitative interview or focus group methods, were published in English, and involved participants living with RMDs (inflammatory arthritis, osteoarthritis, crystal arthropathies, connective tissue diseases, and musculoskeletal conditions in the absence of systemic disease) who had experienced foot and ankle problems. Quality was assessed using the Critical Appraisal Skills Programme qualitative tool and confidence in the findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach. All data from the results section of included studies were extracted, coded and synthesised to develop themes. RESULTS Of 1,443 records screened, 34 studies were included, with a total of 503 participants. Studies included participants with rheumatoid arthritis (n = 18), osteoarthritis (n = 5), gout (n = 3), psoriatic arthritis (n = 1), lupus (n = 1), posterior tibial tendon dysfunction (n = 1), plantar heel pain (n = 1), Achilles tendonitis (n = 1), and a mixed population (n = 3), who live with foot and ankle disorders. Seven descriptive themes were generated from the thematic synthesis: pain, change in appearance, activity limitations, social isolation, work disruption, financial burden and emotional impact. Descriptive themes were inductively analysed further to construct analytical themes relating to potential outcome domains of importance to patients. Foot or ankle pain was the predominant symptom experienced by patients across all RMDs explored in this review. Based on grading of the evidence, we had moderate confidence that most of the review findings represented the experiences of patients with foot and ankle disorders in RMDs. CONCLUSIONS Findings indicate that foot and ankle disorders impact on multiple areas of patients' lives, and patients' experiences are similar regardless of the RMD. This study will inform the development of a core domain set for future foot and ankle research and are also useful for clinicians, helping to focus clinical appointments and measurement of outcomes within clinical practice.
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Affiliation(s)
- Lara S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK.
| | - Caroline A Flurey
- School of Social Sciences, College of Health, Science, and Society, University of the West of England, Bristol, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK
| | | | | | - Bethany Tapster
- Library and Information Service, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jenny Emmel
- Library Service, Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Hylton B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Marian T Hannan
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Beverley Shea
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Ong EKM, Fryer C, Graham K, Causby RS. Investigating the experience of receiving podiatry care in a tertiary care hospital clinic for people with diabetes related foot ulcers. J Foot Ankle Res 2022; 15:50. [PMID: 35778745 PMCID: PMC9248168 DOI: 10.1186/s13047-022-00556-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes related foot ulcers can have physical, social, emotional, and financial impacts on the daily life and wellbeing of many people living with diabetes. Effective treatment of diabetes related foot ulcers requires a multi-faceted, multi-disciplinary approach involving a podiatrist, other healthcare professionals, and the person with diabetes however, limited research has been conducted on the lived experience of podiatric treatment for diabetes related foot ulcers to understand how people are engaged in their ulcer management. Therefore, this study aimed to explore the lived experience of receiving podiatric treatment for diabetes related foot ulcers in a tertiary care outpatient setting. METHODS Ten participants were interviewed. All were male, with mean age of 69 (SD 15) years and currently undergoing podiatric treatment for a diabetes related foot ulcer in a tertiary care setting. Participants with diabetes related foot ulcers were purposively recruited from the outpatient podiatry clinic at a tertiary hospital in a metropolitan region of South Australia. Semi-structured interviews were conducted to gain insight into the lived experience of people receiving podiatric treatment for their foot ulcer and understand how this experience impacts their regular lifestyle. Data were analysed using a thematic analysis method. RESULTS Four themes were identified that add an understanding of the lived experience of participants: 'Trusting the podiatrists with the right expertise', 'Personalised care', 'Happy with the service, but not always with prescribed care', and 'It's a long journey'. Participants described professional behaviour including high organisation and hygiene practices and demonstrated expertise as key factors influencing their trust of a podiatrist's care. Information tailored to individual needs was helpful for participants. Offloading devices and ulcer dressings were often burdensome. Podiatric treatment for foot ulcers was a lengthy and onerous experience for all participants. CONCLUSIONS The findings of this study suggest podiatrists can use practical strategies of maintaining consistency in who provides podiatry care for the person, demonstration of high organisational and hygiene standards, and using innovation to adapt information and equipment to suit an individual's lifestyle to support positive experiences of podiatric ulcer care. There is a need for further research to understand how a person's experience of podiatric ulcer care differs amongst genders, cultural groups, and healthcare settings to facilitate positive care experiences and reduce treatment burden for all people with diabetes requiring podiatric ulcer treatment.
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Affiliation(s)
- Emilee Kim Ming Ong
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, 5001, Australia.
| | - Caroline Fryer
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, 5001, Australia
| | - Kristin Graham
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, 5001, Australia
| | - Ryan Scott Causby
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, 5001, Australia
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Dando C, Bacon D, Borthwick A, Bowen C. Stakeholder views of podiatry services in the UK for people living with arthritis: a qualitative study. J Foot Ankle Res 2020; 13:58. [PMID: 32972443 PMCID: PMC7517686 DOI: 10.1186/s13047-020-00427-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to explore the views of stakeholders in podiatry services, patients, commissioners and general practitioners (GP), to further understand experiences of referral, access and provision of treatment in the National Health Service (NHS) for foot problems for patients living with arthritis. METHOD To explore in-depth individual views and experiences of stakeholders in podiatry services, 19 patients who had arthritis (osteoarthritis and/or rheumatoid arthritis) participated in one of four focus groups. In addition, seven commissioners and/or GPs took part in semi structured interviews. A purposive sampling strategy was adopted for all focus groups and semi structured interviews. To account for geographical variations, the focus groups and semi structured interviews were conducted across two predetermined regions of the United Kingdom (UK), Yorkshire and Hampshire. Data was rendered anonymous and transcribed verbatim. Thematic analysis was employed to identify key meanings and report patterns within the data. RESULTS Five key themes derived from the focus groups and interviews suggest a variety of factors influencing referral, access and provision of treatment for foot problems within the UK. 1. Systems working together (navigation of different care pathways, access and referral opportunities for people with OA or RA, education around foot health services for people with OA or RA); 2.Finance (financial variations, different care systems, wasting resources); 3. Understanding what podiatry services have to offer (podiatrists are leaders in foot health services, service requirements in relation to training standards and health needs); 4. Person factors of foot pain (arthritis is invisible, affects quality of life, physical and mental wellbeing); 5. Facilitators of foot care (NICE guidelines, stakeholder events, supporting self-management strategies). CONCLUSION The findings indicate that patients, commissioners and GPs have very similar experiences of referral, access and provision of treatment for foot problems, for patients living with arthritis. Essentially, commissioners and GPs interviewed called for a transformational approach in current systems to include newer models of care that meet the footcare needs of individual patient circumstances. Patients interviewed called for better signposting and information about the different services available to help them manage their foot health needs. To address this, we have formulated a signposting pack for all stakeholders to help them facilitate access to appropriate clinicians 'at the right time, in the right place' to manage foot health problems.
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Affiliation(s)
- Charlotte Dando
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Highfield Campus Building 67, University Road, Southampton, Hampshire, SO17 1BJ, UK. .,The Academy of Research and Improvement, Solent NHS Trust, Southampton, UK.
| | - Dawn Bacon
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Highfield Campus Building 67, University Road, Southampton, Hampshire, SO17 1BJ, UK
| | - Alan Borthwick
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Highfield Campus Building 67, University Road, Southampton, Hampshire, SO17 1BJ, UK
| | - Catherine Bowen
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Highfield Campus Building 67, University Road, Southampton, Hampshire, SO17 1BJ, UK.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Southampton, UK
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Edwards K, Borthwick A, McCulloch L, Redmond A, Pinedo-Villanueva R, Prieto-Alhambra D, Judge A, Arden N, Bowen C. Evidence for current recommendations concerning the management of foot health for people with chronic long-term conditions: a systematic review. J Foot Ankle Res 2017; 10:51. [PMID: 29201147 PMCID: PMC5700544 DOI: 10.1186/s13047-017-0232-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/09/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Research focusing on management of foot health has become more evident over the past decade, especially related to chronic conditions such as diabetes. The level of methodological rigour across this body of work however is varied and outputs do not appear to have been developed or translated into clinical practice. The aim of this systematic review was to assess the latest guidelines, standards of care and current recommendations relative to people with chronic conditions to ascertain the level of supporting evidence concerning the management of foot health. METHODS A systematic search of electronic databases (Medline, Embase, Cinahl, Web of Science, SCOPUS and The Cochrane Library) for literature on recommendations for foot health management for people with chronic conditions was performed between 2000 and 2016 using predefined criteria. Data from the included publications was synthesised via template analysis, employing a thematic organisation and structure. The methodological quality of all included publications was appraised using the Appraisal for Research and Evaluation (AGREE II) instrument. A more in-depth analysis was carried out that specifically considered the levels of evidence that underpinned the strength of their recommendations concerning management of foot health. RESULTS The data collected revealed 166 publications in which the majority (102) were guidelines, standards of care or recommendations related to the treatment and management of diabetes. We noted a trend towards a systematic year on year increase in guidelines standards of care or recommendations related to the treatment and management of long term conditions other than diabetes over the past decade. The most common recommendation is for preventive care or assessments (e.g. vascular tests), followed by clinical interventions such as foot orthoses, foot ulcer care and foot health education. Methodological quality was spread across the range of AGREE II scores with 62 publications falling into the category of high quality (scores 6-7). The number of publications providing a recommendation in the context of a narrative but without an indication of the strength or quality of the underlying evidence was high (79 out of 166). CONCLUSIONS It is clear that evidence needs to be accelerated and in place to support the future of the Podiatry workforce. Whilst high level evidence for podiatry is currently low in quantity, the methodological quality is growing. Where levels of evidence have been given in in high quality guidelines, standards of care or recommendations, they also tend to be strong-moderate quality such that further strategically prioritised research, if performed, is likely to have an important impact in the field.
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Affiliation(s)
- Katherine Edwards
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alan Borthwick
- Faculty of Health Sciences, University of Southampton, Highfield Campus Building 45, University Road, Southampton, Hampshire SO17 1BJ UK
| | - Louise McCulloch
- Faculty of Health Sciences, University of Southampton, Highfield Campus Building 45, University Road, Southampton, Hampshire SO17 1BJ UK
| | - Anthony Redmond
- Faculty of Medicine and Health, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Rafael Pinedo-Villanueva
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nigel Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Catherine Bowen
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Faculty of Health Sciences, University of Southampton, Highfield Campus Building 45, University Road, Southampton, Hampshire SO17 1BJ UK
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Patient and clinician views on the quality of foot health care for rheumatoid arthritis outpatients: a mixed methods service evaluation. J Foot Ankle Res 2016; 9:1. [PMID: 26740821 PMCID: PMC4702354 DOI: 10.1186/s13047-015-0133-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background Feet are often the first site of joint involvement in rheumatoid arthritis (RA) and get progressively worse if unmanaged, leading to permanent disability and negatively impacting patients’ quality of life. Podiatrists are specialists in the assessment, diagnosis and management of foot and ankle problems, however, RA outpatients often rely on referral from rheumatology clinicians to gain access to musculoskeletal podiatry services on the UK National Health Service (NHS). Therefore, the aim of this evaluation was to identify the foot health needs of rheumatoid arthritis patients and if they are being met by rheumatology clinicians. Methods A mixed methods approach was used: collecting qualitative data from patients and quantitative data from clinicians. Two focus groups were conducted with nine RA patients from a tertiary rheumatology outpatient clinic in the UK and the data were thematically analysed to inform a clinician survey. Thirteen rheumatology clinicians, from the same centre, completed the online survey. Resultant data were analysed to produce descriptive statistics. Results Patient focus group data generated four main themes: (1) need for foot health information, (2) feet ignored during routine consultations, (3) frequency of foot examination and (4) access to podiatry. Survey data highlighted that (i) 69–85 % of clinicians provided patients with foot health information sometimes, (ii) feet were examined in 47 % of routine consultations, (iii) 54 % of clinicians did not examine feet routinely because they are not included in the disease activity score with 28 joints (DAS-28), (iv) 31 % of clinicians referred patients to podiatry upon RA diagnosis, (v) 0 % of clinicians referred patients to podiatry for periodic review, (vi) 54 % of clinicians believed patients will self-report foot problems and (vii) 62 % of clinicians felt competent in foot examination. Conclusions RA patients’ foot health needs were not being fully met by rheumatology clinicians. Patients want foot health information and easy access to podiatry services. Rheumatology outpatient consultations need to have a wider focus than the DAS-28 and incorporate foot examination as standard. Clinicians need to ensure they have sufficient training and follow current national foot health guidance to provide optimal foot health care and outcomes for their RA patients. Electronic supplementary material The online version of this article (doi:10.1186/s13047-015-0133-2) contains supplementary material, which is available to authorized users.
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Firth J, Waxman R, Law G, Nelson EA, Helliwell P, Siddle H, Otter S, Butters V, Baker L, Hryniw R, Bradley S, Loughrey L, Alcacer-Pitarch B, Davies S, Tranter J. The predictors of foot ulceration in patients with rheumatoid arthritis. Clin Rheumatol 2013; 33:615-21. [DOI: 10.1007/s10067-013-2428-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/04/2013] [Accepted: 10/24/2013] [Indexed: 11/28/2022]
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