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Galloway AM, Keene DJ, Anderson A, Holton C, Redmond AC, Siddle HJ, Richards S, Perry DC. Clinical consensus recommendations for the non-surgical treatment of children with Perthes' disease in the UK. Bone Joint J 2024; 106-B:501-507. [PMID: 38688522 DOI: 10.1302/0301-620x.106b5.bjj-2023-1283.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims The aim of this study was to produce clinical consensus recommendations about the non-surgical treatment of children with Perthes' disease. The recommendations are intended to support clinical practice in a condition for which there is no robust evidence to guide optimal care. Methods A two-round, modified Delphi study was conducted online. An advisory group of children's orthopaedic specialists consisting of physiotherapists, surgeons, and clinical nurse specialists designed a survey. In the first round, participants also had the opportunity to suggest new statements. The survey included statements related to 'Exercises', 'Physical activity', 'Education/information sharing', 'Input from other services', and 'Monitoring assessments'. The survey was shared with clinicians who regularly treat children with Perthes' disease in the UK using clinically relevant specialist groups and social media. A predetermined threshold of ≥ 75% for consensus was used for recommendation, with a threshold of between 70% and 75% being considered as 'points to consider'. Results A total of 40 participants took part in the first round, of whom 31 completed the second round. A total of 87 statements were generated by the advisory group and included in the first round, at the end of which 31 achieved consensus and were removed from the survey, and an additional four statements were generated. A total of 60 statements were included in the second round and 45 achieved the threshold for consensus from both rounds, with three achieving the threshold for 'points to consider'. The recommendations predominantly included self-management, particularly relating to advice about exercise and education for children with Perthes' disease and their families. Conclusion Children's orthopaedic specialists have reached consensus on recommendations for non-surgical treatment in Perthes' disease. These statements will support decisions made in clinical practice and act as a foundation to support clinicians in the absence of robust evidence. The dissemination of these findings and the best way of delivering this care needs careful consideration, which we will continue to explore.
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Affiliation(s)
- Adam M Galloway
- University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David J Keene
- University of Exeter, Exeter, UK
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | | | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and Consultant Podiatrist, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Suzanne Richards
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
| | - Daniel C Perry
- University of Liverpool, Liverpool, UK
- Alder Hey Children's Hospital, Liverpool, UK
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Chapman LS, Alcacer-Pitarch B, Pauling JD, Flurey CA, Redmond AC, Richards P, Herrick AL, Merkel PA, Proudman S, Menz HB, Helliwell PS, Hannan MT, Domsic RT, Saketkoo LA, Shea B, Siddle HJ. Patients' perspectives on systemic sclerosis-related Raynaud's phenomenon in the feet: A qualitative study from the OMERACT Foot and Ankle Working Group. Semin Arthritis Rheum 2024; 65:152372. [PMID: 38325052 DOI: 10.1016/j.semarthrit.2024.152372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To explore, from patients' perspectives, the symptoms and impact of Raynaud's phenomenon (RP) on the feet of patients with systemic sclerosis (SSc-RP), and to identify which foot-related domains are important to patients. METHODS Forty participants (34 women) with SSc-RP took part in one of six focus groups held in the United Kingdom or United States. Participants were purposively sampled to ensure diversity in disease type, duration, and ethnicity. The topic guide included questions on RP impact, self-management, and treatment expectations. Qualitative content analysis was employed to identify key concepts in the data relating to foot-specific symptoms and their impact. Themes were organized by corresponding domains of potential importance. RESULTS Twenty-eight participants (70 %) reported experiencing RP in their feet. Five themes were identified corresponding to domains of potential importance: temperature changes, pain, cramping and stiffness, numbness, and color changes. These issues negatively affected participants' lives, impairing walking, driving, and socializing, and causing issues with footwear and hosiery. CONCLUSIONS This large qualitative study exploring the experiences of patients with SSc-RP in the feet identified several key domains of high importance to patients. SSc-RP is common in the feet, presents in several patterns, and impacts multiple aspects of patients' lives. These findings indicate where future foot-specific interventions for RP could be targeted. Findings from this study improve understanding of what domains are important to patients with SSc-RP affecting the feet and will contribute to the development of a core outcome set for foot and ankle disorders in rheumatic and musculoskeletal diseases.
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Affiliation(s)
- Lara S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - John D Pauling
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath, Bath, UK; University of Bath, 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; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK
| | | | - Ariane L Herrick
- Centre for Musculoskeletal Research, The University of Manchester, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, Division of Clinical Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, USA
| | - Susanna Proudman
- Discipline of Medicine, University of Adelaide and Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Hylton B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Marian T Hannan
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Robyn T Domsic
- University of Pittsburgh Medical Center, Pittsburgh, PA, 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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Rostron H, Wright JM, Gilbert AW, Dillon B, Pini S, Redmond AC, Livermore P. Adoption of technology enabled care to support the management of children and teenagers in rheumatology services: a protocol for a mixed-methods systematic review. BMJ Open 2024; 14:e082515. [PMID: 38387983 PMCID: PMC10882409 DOI: 10.1136/bmjopen-2023-082515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION COVID-19 catalysed a rapid move to provide care away from the hospital using online communication platforms. Technology enabled care (TEC) continues to be an important driver in progressing future healthcare services. Due to the complex and chronic nature of conditions seen within paediatric rheumatology, TEC may lead to better outcomes. Despite some growth in published literature into the adoption of TEC in paediatric rheumatology, there is limited synthesis. The aim of this review is to provide a comprehensive understanding and evaluation of the adoption of TEC by patients in paediatric rheumatology services, to establish best practices. METHODS AND ANALYSIS This proposed mixed-methods systematic review will be conducted by searching a wide variety of healthcare databases, grey literature resources and associated charities and societies, for articles reported in English language. Data extraction will include population demographics, technology intervention, factors affecting adoption of intervention and consequent study outcomes. A parallel-results convergent synthesis design is planned, with independent syntheses of quantitative and qualitative data, followed by comparison of the findings of each synthesis using a narrative approach. Normalisation process theory will be used to identify, characterise and explain implementation factors. The quality of included articles will be assessed using the Mixed Methods Appraisal Tool for research papers and the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist for grey literature. Overall confidence in quality and strength of evidence will be assessed using the Confidence in the Evidence from Reviews of Qualitative Research tool. ETHICS AND DISSEMINATION Ethical approval is not required due to the nature of this mixed-methods systematic review. The findings will be disseminated via a peer-reviewed journal, relevant conferences and any other methods (eg, via NHS Trust or NIHR YouTube channels) as advised by paediatric rheumatology patients. PROSPERO REGISTRATION NUMBER CRD42023443058.
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Affiliation(s)
- Heather Rostron
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Children's Research Team, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Judy M Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Anthony W Gilbert
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | | | - Simon Pini
- Psychological and Social Medicine, University of Leeds, Leeds, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Polly Livermore
- Infection, Immunity & Inflammation Department, University College London, London, UK
- NIHR GOSH Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Anderson AM, McHugh GA, Comer C, Joseph J, Smith TO, Yardley L, Redmond AC. Supporting patients to prepare for total knee replacement: Evidence-, theory- and person-based development of a 'Virtual Knee School' digital intervention. Health Expect 2023; 26:2549-2570. [PMID: 37606150 PMCID: PMC10632615 DOI: 10.1111/hex.13855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Digital delivery of pre-operative total knee replacement (TKR) education and prehabilitation could improve patient outcomes pre- and post-operatively. Rigorously developing digital interventions is vital to help ensure they achieve their intended outcomes whilst mitigating their potential drawbacks. OBJECTIVE To develop a pre-operative TKR education and prehabilitation digital intervention, the 'Virtual Knee School' (VKS). METHODS The VKS was developed using an evidence-, theory- and person-based approach. This involved a mixed methods design with four phases. The first three focused on planning the VKS. The final phase involved creating a VKS prototype and iteratively refining it through concurrent think-aloud interviews with nine patients who were awaiting/had undergone TKR. Meta-inferences were generated by integrating findings from all the phases. ISRCTN registration of the overall project was obtained on 24 April 2020 (ISRCTN11759773). RESULTS Most participants found the VKS prototype acceptable overall and considered it a valuable resource. Conversely, a minority of participants felt the prototype's digital format or content did not meet their individual needs. Participants' feedback was used to refine the prototype's information architecture, design and content. Two meta-inferences were generated and recommend: 1. Comprehensive pre-operative TKR education and prehabilitation support should be rapidly accessible in digital and non-digital formats. 2. Pre-operative TKR digital interventions should employ computer- and self-tailoring to account for patients' individual needs and preferences. CONCLUSIONS Integrating evidence, theory and stakeholders' perspectives enabled the development of a promising VKS digital intervention for patients awaiting TKR. The findings suggest future research evaluating the VKS is warranted and provide recommendations for optimising pre-operative TKR care. PATIENT OR PUBLIC CONTRIBUTION Patient and Public Involvement (PPI) was central throughout the project. For example, PPI representatives contributed to the project planning, were valued members of the Project Advisory Group, had key roles in developing the VKS prototype and helped disseminate the project findings.
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Affiliation(s)
- Anna M. Anderson
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
- NIHR Leeds Biomedical Research CentreLeedsUK
- Present address:
Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | | | - Christine Comer
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
- Musculoskeletal and Rehabilitation ServicesLeeds Community Healthcare NHS TrustLeedsUK
| | - Judith Joseph
- Centre for Clinical and Community Applications of Health PsychologyUniversity of SouthamptonSouthamptonUK
| | - Toby O. Smith
- School of Health SciencesUniversity of East AngliaNorwichUK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesUniversity of OxfordOxfordUK
- Present address:
Warwick Medical SchoolUniversity of WarwickWarwickUK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health PsychologyUniversity of SouthamptonSouthamptonUK
- School of Psychological ScienceUniversity of BristolBristolUK
| | - Anthony C. Redmond
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
- NIHR Leeds Biomedical Research CentreLeedsUK
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Filippou V, Backhouse MR, Redmond AC, Wong DC. Person-Specific Template Matching Using a Dynamic Time Warping Step-Count Algorithm for Multiple Walking Activities. Sensors (Basel) 2023; 23:9061. [PMID: 38005449 PMCID: PMC10675039 DOI: 10.3390/s23229061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/22/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023]
Abstract
This study aimed to develop and evaluate a new step-count algorithm, StepMatchDTWBA, for the accurate measurement of physical activity using wearable devices in both healthy and pathological populations. We conducted a study with 30 healthy volunteers wearing a wrist-worn MOX accelerometer (Maastricht Instruments, NL). The StepMatchDTWBA algorithm used dynamic time warping (DTW) barycentre averaging to create personalised templates for representative steps, accounting for individual walking variations. DTW was then used to measure the similarity between the template and accelerometer epoch. The StepMatchDTWBA algorithm had an average root-mean-square error of 2 steps for healthy gaits and 12 steps for simulated pathological gaits over a distance of about 10 m (GAITRite walkway) and one flight of stairs. It outperformed benchmark algorithms for the simulated pathological population, showcasing the potential for improved accuracy in personalised step counting for pathological populations. The StepMatchDTWBA algorithm represents a significant advancement in accurate step counting for both healthy and pathological populations. This development holds promise for creating more precise and personalised activity monitoring systems, benefiting various health and wellness applications.
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Affiliation(s)
- Valeria Filippou
- Institute of Medical and Biological Engineering, University of Leeds, Leeds LS2 9JT, UK
| | | | - Anthony C. Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, UK;
| | - David C. Wong
- Leeds Institute of Health Informatics, University of Leeds, Leeds LS2 9JT, UK;
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Chapman LS, Jones J, Redmond AC, Flurey CA, Richards P, Hofstetter C, Smith TO, Arnold JB, Hannan MT, Maxwell LJ, Menz HB, Shea B, Golightly YM, Tugwell P, Beaton D, Conaghan PG, Helliwell PS, Siddle HJ. Developing a core outcome set for foot and ankle disorders in rheumatic and musculoskeletal diseases: A scoping review and report from the OMERACT 2022 foot and ankle special interest group session. Semin Arthritis Rheum 2023; 61:152210. [PMID: 37156170 DOI: 10.1016/j.semarthrit.2023.152210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Foot and ankle involvement is common in rheumatic and musculoskeletal diseases, yet high-quality evidence assessing the effectiveness of treatments for these disorders is lacking. The Outcome Measures in Rheumatology (OMERACT) Foot and Ankle Working Group is developing a core outcome set for use in clinical trials and longitudinal observational studies in this area. METHODS A scoping review was performed to identify outcome domains in the existing literature. Clinical trials and observational studies comparing pharmacological, conservative or surgical interventions involving adult participants with any foot or ankle disorder in the following rheumatic and musculoskeletal diseases (RMDs) were eligible for inclusion: rheumatoid arthritis (RA), osteoarthritis (OA), spondyloarthropathies, crystal arthropathies and connective tissue diseases. Outcome domains were categorised according to the OMERACT Filter 2.1. RESULTS Outcome domains were extracted from 150 eligible studies. Most studies included participants with foot/ankle OA (63% of studies) or foot/ankle involvement in RA (29% of studies). Foot/ankle pain was the outcome domain most commonly measured (78% of studies), being the most frequently specified outcome domain across all RMDs. There was considerable heterogeneity in the other outcome domains measured, across core areas of manifestations (signs, symptoms, biomarkers), life impact, and societal/resource use. The group's progress to date, including findings from the scoping review, was presented and discussed during a virtual OMERACT Special Interest Group (SIG) in October 2022. During this meeting, feedback was sought amongst delegates regarding the scope of the core outcome set, and feedback was received on the next steps of the project, including focus group and Delphi methods. CONCLUSION Findings from the scoping review and feedback from the SIG will contribute to the development of a core outcome set for foot and ankle disorders in RMDs. The next steps are to determine which outcome domains are important to patients, followed by a Delphi exercise with key stakeholders to prioritise outcome domains.
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Affiliation(s)
- Lara S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK
| | - Jennifer Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK
| | - Caroline A Flurey
- Department of Health and Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | | | | | | | - John B Arnold
- Alliance for Research in Exercise, Nutrition & Activity (ARENA), Allied Health & Human Performance Unit, University of South Australia, Adelaide, Australia
| | - Marian T Hannan
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Lara J Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hylton B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Beverley Shea
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, NC, USA; College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Peter Tugwell
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dorcas Beaton
- Department of Occupational Science and Occupational Therapy, Institute for Work and Health, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK
| | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK.
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Arnold JB, Halstead J, Martín‐Hervás C, Grainger AJ, Keenan A, Hill CL, Conaghan PG, McGonagle D, Redmond AC. Bone Marrow Lesions and Magnetic Resonance Imaging-Detected Structural Abnormalities in Patients With Midfoot Pain and Osteoarthritis: A Cross-Sectional Study. Arthritis Care Res (Hoboken) 2023; 75:1113-1122. [PMID: 35593411 PMCID: PMC10952448 DOI: 10.1002/acr.24955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/12/2022] [Accepted: 05/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare magnetic resonance imaging (MRI)-detected structural abnormalities in patients with symptomatic midfoot osteoarthritis (OA), patients with persistent midfoot pain, and asymptomatic controls, and to explore the association between MRI features, pain, and foot-related disability. METHODS One hundred seven adults consisting of 50 patients with symptomatic and radiographically confirmed midfoot OA, 22 adults with persistent midfoot pain but absence of radiographic OA, and 35 asymptomatic adults underwent 3T MRI of the midfoot and clinical assessment. MRIs were read for the presence and severity of abnormalities (bone marrow lesions [BMLs], subchondral cysts, osteophytes, joint space narrowing [JSN], effusion-synovitis, tenosynovitis, and enthesopathy) using the Foot Osteoarthritis MRI Score. Pain and foot-related disability were assessed with the Manchester Foot Pain and Disability Index. RESULTS The severity sum score of BMLs in the midfoot was greater in patients with midfoot pain and no signs of OA on radiography compared to controls (P = 0.007), with a pattern of involvement in the cuneiform-metatarsal joints similar to that in patients with midfoot OA. In univariable models, BMLs (ρ = 0.307), JSN (ρ = 0.423), and subchondral cysts (ρ = 0.302) were positively associated with pain (P < 0.01). In multivariable models, MRI abnormalities were not associated with pain and disability when adjusted for covariates. CONCLUSION In individuals with persistent midfoot pain but no signs of OA on radiography, MRI findings suggested an underrecognized prevalence of OA, particularly in the second and third cuneiform-metatarsal joints, where BML patterns were consistent with previously recognized sites of elevated mechanical loading. Joint abnormalities were not strongly associated with pain or foot-related disability.
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Affiliation(s)
- John B. Arnold
- University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK, and IIMPACT in Health, Allied Health and Human Performance, University of South AustraliaAdelaideSouth AustraliaAustralia
| | - Jill Halstead
- University of Leeds, NIHR Leeds Biomedical Research Centre, and Leeds Community Healthcare NHS TrustLeedsUK
| | - Carmen Martín‐Hervás
- La Paz University Hospital, Universidad Autónoma de Madrid and Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine, Ciber‐BBNMadridSpain
| | - Andrew J. Grainger
- University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, and Cambridge University Hospitals NHS Foundation Trust and University of CambridgeCambridgeUK
| | - Anne‐Maree Keenan
- University of Leeds and NIHR Leeds Biomedical Research CentreLeedsUK
| | - Catherine L. Hill
- The Queen Elizabeth Hospital and The University of AdelaideAdelaideSouth AustraliaAustralia
| | | | - Dennis McGonagle
- University of Leeds and NIHR Leeds Biomedical Research CentreLeedsUK
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Stratton-Powell AA, Williams S, Tipper JL, Redmond AC, Brockett CL. Isolation and characterisation of wear debris surrounding failed total ankle replacements. Acta Biomater 2023; 159:410-422. [PMID: 36736850 DOI: 10.1016/j.actbio.2023.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/04/2023]
Abstract
Aseptic loosening and osteolysis continue to be a short- to mid-term problem for total ankle replacement (TAR) devices. The production of wear particles may contribute to poor performance, but their characteristics are not well understood. This study aimed to determine the chemical composition, size and morphology of wear particles surrounding failed TARs. A recently developed wear particle isolation method capable of isolating both high- and low-density materials was applied to 20 retrieved periprosthetic tissue samples from 15 failed TARs of three different brands. Isolated particles were imaged using ultra-high-resolution imaging and characterised manually to determine their chemical composition, size, and morphology. Six different materials were identified, which included: UHMWPE, calcium phosphate (CaP), cobalt chromium alloy (CoCr), commercially pure titanium, titanium alloy and stainless steel. Eighteen of the 20 samples contained three or more different wear particle material types. In addition to sub-micron UHMWPE particles, which were present in all samples, elongated micron-sized shards of CaP and flakes of CoCr were commonly isolated from tissues surrounding AES TARs. The mixed particles identified in this study demonstrate the existence of a complex periprosthetic environment surrounding TAR devices. The presence of such particles suggests that early failure of devices may be due in part to the multifaceted biological cascade that ensues after particle release. This study could be used to support the validation of clinically-relevant wear simulator testing, pre-clinical assessment of fixation wear and biological response studies to improve the performance of next generation ankle replacement devices. STATEMENT OF SIGNIFICANCE: Total ankle replacement devices do not perform as well as total hip and knee replacements, which is in part due to the relatively poor scientific understanding of how they fail. The excessive production of certain types of wear debris is known to contribute to joint replacement failure. This is the first study to successfully isolate and characterise high- and low-density wear particles from tissues collected from patients with a failed total ankle replacement. This article includes the chemical composition and characteristics of the wear debris generated by ankle devices, all of which may affect their performance. This research provides clinically relevant reference values and images to support the development of pre-clinical testing for future total ankle replacement designs.
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Affiliation(s)
- Ashley A Stratton-Powell
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK.
| | - Sophie Williams
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
| | - Joanne L Tipper
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK; School of Biomedical Engineering, University of Technology Sydney, Ultimo 2007, Australia
| | - Anthony C Redmond
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, UK; Leeds Institute for Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, UK
| | - Claire L Brockett
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, UK
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10
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Haque A, Parsons H, Parsons N, Costa ML, Redmond AC, Mason J, Nwankwo H, Kearney RS. Use of cast immobilization versus removable brace in adults with an ankle fracture: two-year follow-up of a multicentre randomized controlled trial. Bone Joint J 2023; 105-B:382-388. [PMID: 36924175 DOI: 10.1302/0301-620x.105b4.bjj-2022-0602.r3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
The aim of this study was to compare the longer-term outcomes of operatively and nonoperatively managed patients treated with a removable brace (fixed-angle removable orthosis) or a plaster cast immobilization for an acute ankle fracture. This is a secondary analysis of a multicentre randomized controlled trial comparing adults with an acute ankle fracture, initially managed either by operative or nonoperative care. Patients were randomly allocated to receive either a cast immobilization or a fixed-angle removable orthosis (removable brace). Data were collected on baseline characteristics, ankle function, quality of life, and complications. The Olerud-Molander Ankle Score (OMAS) was the primary outcome which was used to measure the participant's ankle function. The primary endpoint was at 16 weeks, with longer-term follow-up at 24 weeks and two years. Overall, 436 patients (65%) completed the final two-year follow-up. The mean difference in OMAS at two years was -0.3 points favouring the plaster cast (95% confidence interval -3.9 to 3.4), indicating no statistically significant difference between the interventions. There was no evidence of differences in patient quality of life (measured using the EuroQol five-dimension five-level questionnaire) or Disability Rating Index. This study demonstrated that patients treated with a removable brace had similar outcomes to those treated with a plaster cast in the first two years after injury. A removable brace is an effective alternative to traditional immobilization in a plaster cast for patients with an ankle fracture.
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Affiliation(s)
- Aminul Haque
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Helen Parsons
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Nick Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Matthew L Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Rheumatology, Musculoskeletal and Orthopaedic Sciences, University of Oxford, Oxford, UK
| | - Anthony C Redmond
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - James Mason
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Henry Nwankwo
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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11
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Wilkins RA, Siddle HJ, Chapman GJ, Horn E, Walwyn R, Redmond AC. Decline in health-related quality of life and foot and ankle patient reported outcomes measures in patients with haemophilia and ankle haemarthropathy. J Foot Ankle Res 2023; 16:12. [PMID: 36899385 PMCID: PMC10007846 DOI: 10.1186/s13047-023-00611-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Haemophilia is an X-linked recessive genetic disorder characterised by bleeding within soft tissue and joints. The ankle is disproportionally affected by haemarthropathy when compared to the elbows and knees; reported as the most affected joints in patients with haemophilia. Despite advances in treatment, patients still report ongoing pain and disability, however, the impact has not been evaluated, nor has the effect on health-related quality of life (HRQoL) or foot and ankle patient-reported outcome measures (PROMs). The primary aim of this study was to establish the impact of ankle haemarthropathy in patients with severe and moderate haemophilia A and B. Secondly to identify the clinical outcomes associated with a decline in HRQoL and foot and ankle PROMs. METHODS A cross-sectional multi-centre questionnaire study was conducted across 18 haemophilia centres in England, Scotland and Wales with a recruitment target of 245 participants. The HAEMO-QoL-A and Manchester-Oxford Foot Questionnaire (MOXFQ) (foot and ankle) with total and domain scores measured impact on HRQOL and foot and ankle outcomes. Demographics, clinical characteristics, ankle haemophilia joint health scores, multi-joint haemarthropathy and Numerical Pain Rating Scales (NPRS) of "ankle pain over the past six months" were collected as a measure of chronic ankle pain. RESULTS A total of 243 of 250 participants provided complete data. HAEMO-QoL-A and MOXFQ (foot and ankle) total and index scores indicated worse HRQoL with total scores ranging from a mean of 35.3 to 35.8 (100 best-health) and 50.5 to 45.8 (0 best-health) respectively. NPRS (mean (SD)) ranged from 5.0 (2.6) to 5.5 (2.5), with median (IQR) ankle haemophilia joint health score of 4.5 (1 to 12.5) to 6.0 (3.0 to 10.0) indicating moderate to severe levels of ankle haemarthropathy. Ankle NPRS over six months and inhibitor status were associated with decline in outcome. CONCLUSIONS HRQoL and foot and ankle PROMs were poor in participants with moderate to severe levels of ankle haemarthropathy. Pain was a major driver for decline in HRQoL and foot and ankle PROMs and use of NPRS has the potential to predict worsening HRQoL and PROMs at the ankle and other affected joints.
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Affiliation(s)
- Richard A Wilkins
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK. .,Leeds Haemophilia Comprehensive Care Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Graham J Chapman
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Elizabeth Horn
- Leeds Haemophilia Comprehensive Care Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rebecca Walwyn
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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12
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Wilkins RA, Siddle HJ, Chapman GJ, Horn E, Walwyn R, Redmond AC. The impact of ankle haemarthropathy in patients with moderate haemophilia. Haemophilia 2023; 29:600-607. [PMID: 36528893 DOI: 10.1111/hae.14720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/17/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Moderate haemophilia has traditionally been associated with less complications than severe haemophilia. Changes in treatment recommendations have highlighted the burden of moderate haemophilia with a subset of patients with a severe bleeding phenotype. The ankle joint is disproportionally affected by ankle haemarthropathy however the impact has not been evaluated in moderate haemophilia, nor the effect on health related quality of life (HRQoL) or foot and ankle outcomes. AIMS To establish the impact of ankle haemarthropathy in patients with moderate haemophilia. METHODS A multicentre questionnaire study recruited patients from 11 haemophilia centres in England, Scotland and Wales. The HAEMO-QoL-A and Manchester-Oxford foot and ankle questionnaire (MOXFQ) with total and domain scores measured impact. Measures of pain and ankle haemophilia joint health (HJHS) scores were also collected. RESULTS Twenty-nine participants were recruited. HAEMO-QoL A mean (SD) total scores of 10.8 (5.2) of 100 (best health) and foot and ankle specific MOXFQ total scores of 45.5 (24.7) above zero (best outcome) indicate poor HRQoL and foot and ankle outcomes. Average ankle pain over past 6 months of (0-10) 5.5 (SD2.5) was reported and median (IQR) ankle HJHS of 3.0 (1;12.5) to 4.5 (0;9.5) for the left and right ankles. CONCLUSION HRQoL and foot and ankle specific outcomes are poor in patients with moderate haemophilia and ankle haemarthropathy, driven by chronic levels of ankle joint pain. Despite moderate haemophilia being considered less affected by haemarthrosis and haemarthropathy, patients with a bleeding or haemarthropathy phenotype are clinically similar to patients with severe haemophilia A.
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Affiliation(s)
- Richard A Wilkins
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,Leeds Haemophilia Comprehensive Care Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
| | - Graham J Chapman
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Elizabeth Horn
- Leeds Haemophilia Comprehensive Care Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rebecca Walwyn
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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13
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Chapman LS, Redmond AC, Flurey CA, Richards P, Smith TO, Arnold JB, Beaton D, Conaghan PG, Golightly YM, Hannan MT, Hofstetter C, Maxwell LJ, Menz HB, Shea B, Tugwell P, Helliwell P, Siddle HJ. Developing an Outcome Measures in Rheumatology (OMERACT) Core set of Outcome Measures for FOot and ankle disorders in RheumaTic and musculoskeletal diseases (COMFORT): core domain set study protocol. Trials 2023; 24:65. [PMID: 36709309 PMCID: PMC9883911 DOI: 10.1186/s13063-023-07104-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/18/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Foot and ankle involvement is common in rheumatic and musculoskeletal diseases (RMDs). High-quality evidence is lacking to determine the effectiveness of treatments for these disorders. Heterogeneity in the outcomes used across clinical trials and observational studies hinders the ability to compare findings, and some outcomes are not always meaningful to patients and end-users. The Core set of Outcome Measures for FOot and ankle disorders in RheumaTic and musculoskeletal diseases (COMFORT) study aims to develop a core outcome set (COS) for use in all trials of interventions for foot and ankle disorders in RMDs. This protocol addresses core outcome domains (what to measure) only. Future work will focus on core outcome measurement instruments (how to measure). METHODS COMFORT: Core Domain Set is a mixed-methods study involving the following: (i) identification of important outcome domains through literature reviews, qualitative interviews and focus groups with patients and (ii) prioritisation of domains through an online, modified Delphi consensus study and subsequent consensus meeting with representation from all stakeholder groups. Findings will be disseminated widely to enhance uptake. CONCLUSIONS This protocol details the development process and methodology to identify and prioritise domains for a COS in the novel area of foot and ankle disorders in RMDs. Future use of this standardised set of outcome domains, developed with all key stakeholders, will help address issues with outcome variability. This will facilitate comparing and combining study findings, thus improving the evidence base for treatments of these conditions. Future work will identify suitable outcome measurement instruments for each of the core domains. TRIAL REGISTRATION This study is registered with the Core Outcome Measures in Effectiveness Trials (COMET) database, as of June 2022: https://www.comet-initiative.org/Studies/Details/2081.
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Affiliation(s)
- Lara S. Chapman
- grid.9909.90000 0004 1936 8403Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK ,grid.507369.eCentre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Nottingham, UK
| | - Anthony C. Redmond
- grid.9909.90000 0004 1936 8403Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK ,grid.507369.eCentre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Nottingham, UK ,grid.454370.10000 0004 0439 7412National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK
| | - Caroline A. Flurey
- grid.6518.a0000 0001 2034 5266Department of Health and Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | | | - Toby O. Smith
- grid.7372.10000 0000 8809 1613Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - John B. Arnold
- grid.1026.50000 0000 8994 5086IIMPACT in Health, Allied Health & Human Performance Unit, University of South Australia, Adelaide, Australia
| | - Dorcas Beaton
- grid.17063.330000 0001 2157 2938Institute for Work and Health, and Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON Canada
| | - Philip G. Conaghan
- grid.9909.90000 0004 1936 8403Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK ,grid.507369.eCentre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Nottingham, UK ,grid.454370.10000 0004 0439 7412National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK
| | - Yvonne M. Golightly
- grid.10698.360000000122483208Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA ,grid.266813.80000 0001 0666 4105College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE USA
| | - Marian T. Hannan
- grid.239395.70000 0000 9011 8547Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | | | - Lara J. Maxwell
- grid.28046.380000 0001 2182 2255Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Hylton B. Menz
- grid.1018.80000 0001 2342 0938School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Beverley Shea
- grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Peter Tugwell
- grid.28046.380000 0001 2182 2255Department of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Philip Helliwell
- grid.9909.90000 0004 1936 8403Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Heidi J. Siddle
- grid.9909.90000 0004 1936 8403Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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14
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Gong Q, Halstead J, Keenan AM, Milanese S, Redmond AC, Arnold JB. Intrinsic foot muscle size and associations with strength, pain and foot-related disability in people with midfoot osteoarthritis. Clin Biomech (Bristol, Avon) 2023; 101:105865. [PMID: 36565560 DOI: 10.1016/j.clinbiomech.2022.105865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/29/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND To compare intrinsic foot muscle size between people with and without symptomatic midfoot osteoarthritis, and examine the association between muscle size and strength, pain and foot-related disability. METHODS Twenty-three participants with symptomatic midfoot osteoarthritis and 23 age, sex and BMI matched controls were included. Intrinsic foot muscle cross-sectional area was measured using MRI. Hand-held dynamometry was used to assess foot and ankle muscle strength, and foot-related pain and disability was measured using Manchester Foot Pain & Disability Index. FINDINGS Small and non-statistically significant differences were found in intrinsic foot muscle cross-sectional area between the two groups (effect sizes 0.15-0.26, p > 0.05). Muscle strength was reduced in the midfoot osteoarthritis group, with differences of 12-33% (effect sizes 0.47-1.2). In the control group, moderate positive associations) existed between foot muscle cross-sectional area and lesser digits flexor strength (r = 0.5 to 0.7, p < 0.05). Conversely, in the midfoot osteoarthritis group, negligible positive associations were found (r < 0.3, p > 0.05). Associations between foot muscle cross-sectional with and pain and disability scores in the midfoot osteoarthritis group were negligible (r < -0.3, p > 0.05). INTERPRETATION Despite reductions in maximal isometric muscle strength, midfoot osteoarthritis does not appear to be associated with reduced intrinsic foot muscle cross-sectional area measured by MRI. Muscle compositional or neural factors may explain the reductions in muscle strength and variation in symptoms in people with midfoot osteoarthritis and should be investigated.
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Affiliation(s)
- Qun Gong
- IIMPACT in Health, Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - Jill Halstead
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK; Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Anne-Maree Keenan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, UK; School of Healthcare, Faculty of Medicine and Health, University of Leeds, UK
| | - Steve Milanese
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, SA 5000, Australia
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, UK
| | - John B Arnold
- IIMPACT in Health, Allied Health & Human Performance, University of South Australia, Adelaide, Australia; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, UK.
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15
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Keene DJ, Costa ML, Peckham N, Tutton E, Barber VS, Dutton SJ, Hopewell S, Redmond AC, Willett K, Lamb SE. Progressive exercise versus best practice advice for adults aged 50 years or over after ankle fracture: the AFTER pilot randomised controlled trial. BMJ Open 2022; 12:e059235. [PMID: 36424115 PMCID: PMC9693648 DOI: 10.1136/bmjopen-2021-059235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE The aim of the Ankle Fracture Treatment: Enhancing Rehabilitation (AFTER) study, a multicentre external pilot parallel-group randomised controlled trial (RCT), was to assess feasibility of a definitive trial comparing rehabilitation approaches after ankle fracture. SETTING Five UK National Health Service hospitals. PARTICIPANTS Participants were aged 50 years and over with an ankle fracture requiring immobilisation for at least 4 weeks. INTERVENTIONS Participants were allocated 1:1 via a central web-based randomisation system to: (1) best practice advice (one session of physiotherapy, up to two optional additional advice sessions) or (2) progressive exercise (up to six sessions of physiotherapy). PRIMARY OUTCOME MEASURES Feasibility: (1) participation rate, (2) intervention adherence and (3) retention. RESULTS Sixty-one of 112 (54%) eligible participants participated, exceeding progression criteria for participation of 25%. Recruitment progression criteria was 1.5 participants per site per month and 1.4 was observed. At least one intervention session was delivered for 28/30 (93%) of best practice advice and 28/31 (90%) of progressive exercise participants, exceeding the 85% progression criteria. For those providing follow-up data, the proportion of participants reporting performance of home exercises in the best practice advice and the progressive exercise groups at 3 months was 20/23 (87%) and 21/25 (84%), respectively. Mean time from injury to starting physiotherapy was 74.1 days (95% CI 53.9 to 94.1 days) for the best practice advice and 72.7 days (95% CI 54.7 to 88.9) for the progressive exercise group. Follow-up rate (6-month Olerud and Molander Ankle Score) was 28/30 (93%) for the best practice advice group and 26/31 (84%) in the progressive exercise group with an overall follow-up rate of 89%. CONCLUSIONS This pilot RCT demonstrated that a definitive trial would be feasible. The main issues to address for a definitive trial are intervention modifications to enable earlier provision of rehabilitation and ensuring similar rates of follow-up in each group. TRIAL REGISTRATION NUMBER ISRCTN16612336.
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Affiliation(s)
- David J Keene
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Matthew L Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nicholas Peckham
- Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Elizabeth Tutton
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Kadoorie Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Vicki S Barber
- Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Susan J Dutton
- Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Keith Willett
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
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16
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Anderson AM, Drew BT, Antcliff D, Redmond AC, Comer C, Smith TO, McHugh GA. Content and delivery of pre-operative interventions for patients undergoing total knee replacement: a rapid review. Syst Rev 2022; 11:184. [PMID: 36050795 PMCID: PMC9436722 DOI: 10.1186/s13643-022-02019-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/07/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Total knee replacement (TKR) is a common operation typically performed for end-stage knee osteoarthritis. Patients awaiting TKR often have poor health-related quality of life. Approximately 20% of patients experience persistent pain post-TKR. Pre-operative TKR interventions could improve pre- and post-operative outcomes, but future research is required to inform their design. This review aimed to identify and synthesize recent literature on the content and delivery of pre-operative TKR interventions to help guide future research and clinical practice. METHODS This rapid review included randomized trials of pre-operative TKR interventions ("outcomes studies") and primary studies exploring patients' and/or health professionals' views of pre-operative TKR interventions ("views studies"). Medline, Embase, PsycINFO, CINAHL and the Cochrane Central Register of Controlled Trials were searched for English language studies published between January 2009 and December 2020. Eligible studies' reference lists were screened. Studies were appraised using the Mixed Methods Appraisal Tool. The findings were narratively synthesized using a convergent segregated approach. RESULTS From 3263 records identified, 52 studies were included (29 outcomes studies, 21 views studies, two outcomes/views studies). The studies' methodological quality varied but was generally highest in qualitative studies. The outcomes studies investigated education (n=5), exercise (n=20), psychological (n=2), lifestyle (n=1), and/or other interventions (n=5). The views studies addressed education (n=20), exercise (n=3), psychological (n=1), lifestyle (n=4), and/or other interventions (n=1). Only three outcomes studies (two randomized controlled trials (RCTs) and a pilot study) compared the effectiveness of intervention components/delivery approaches. The two RCTs' results suggest that pre-operative TKR exercise interventions are equally effective regardless of whether they include strength or strength plus balance training and whether they are hospital- or home-based. Personal tailoring and using more than one delivery format were associated with improved outcomes and/or perceived as beneficial for multiple intervention types. CONCLUSIONS Definitive evidence on the optimal design of pre-operative TKR interventions is lacking. Personal tailoring and employing multiple delivery formats appear to be valuable design elements. Preliminary evidence suggests that including balance training and hospital versus home delivery may not be critical design elements for pre-operative TKR exercise interventions. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019143248 FUNDER: National Institute for Health and Care Research (ICA-CDRF-2018-04-ST2-006).
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Affiliation(s)
- Anna M Anderson
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK. .,NIHR Leeds Biomedical Research Centre, Leeds, UK.
| | - Benjamin T Drew
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Deborah Antcliff
- School of Healthcare, University of Leeds, Leeds, UK.,Physiotherapy Department, Bury Care Organisation, Northern Care Alliance NHS Group, Bury, UK.,School of Medicine, Keele University, Keele, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Christine Comer
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Leeds Community Healthcare NHS Trust Musculoskeletal and Rehabilitation Services, Leeds, UK
| | - Toby O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Wilkins RA, Siddle HJ, Chapman GJ, Horn E, Walwyn R, Redmond AC. UK haemophilia consultant access to foot and ankle services and concurrent patient impact questionnaire responses to foot and ankle interventions. Haemophilia 2022; 28:e136-e140. [PMID: 35830681 PMCID: PMC9540863 DOI: 10.1111/hae.14625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Richard A Wilkins
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,Leeds Haemophilia Comprehensive Care Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
| | - Graham J Chapman
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Elizabeth Horn
- Leeds Haemophilia Comprehensive Care Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rebecca Walwyn
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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18
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Stratton‐Powell AA, Williams S, Tipper JL, Redmond AC, Brockett CL. Mixed material wear particle isolation from periprosthetic tissue surrounding total joint replacements. J Biomed Mater Res B Appl Biomater 2022; 110:2276-2289. [PMID: 35532138 PMCID: PMC9540445 DOI: 10.1002/jbm.b.35076] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 11/05/2021] [Accepted: 04/18/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Ashley A. Stratton‐Powell
- Institute of Medical and Biological Engineering, School of Mechanical Engineering University of Leeds Leeds UK
| | - Sophie Williams
- Institute of Medical and Biological Engineering, School of Mechanical Engineering University of Leeds Leeds UK
| | - Joanne L. Tipper
- Institute of Medical and Biological Engineering, School of Mechanical Engineering University of Leeds Leeds UK
- School of Biomedical Engineering University of Technology Sydney Ultimo New South Wales Australia
| | - Anthony C. Redmond
- NIHR Leeds Biomedical Research Centre Leeds Teaching Hospitals NHS Trust Leeds UK
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, School of Medicine University of Leeds Leeds UK
| | - Claire L. Brockett
- Institute of Medical and Biological Engineering, School of Mechanical Engineering University of Leeds Leeds UK
- NIHR Leeds Biomedical Research Centre Leeds Teaching Hospitals NHS Trust Leeds UK
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19
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Schaper M, Sharrock M, Wilkins RA, Redmond AC. P129 Quantification of longitudinal joint and cartilaginous changes within ankles with haemophilia joint degeneration using MRI imaging. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Aims
Haemophilia is an X-linked recessive genetic disorder characterised by episodes of spontaneous and traumatic intra-articular bleeding. 90% of bleeds are of musculoskeletal origin, with the ankle being most affected joint. Recurrent bleeding results in haemosiderin accumulation, linked to progressive, end-stage ankle haemarthropathy in adolescent and adult patients. Magnetic Resonance Imaging (MRI) is gold-standard for the evaluation of early soft tissue and cartilage changes in ankles with haemarthropathy. This study utilised MRI sequences to quantify longitudinal changes within the ankle joint, via changes in cartilage thickness (CT), subchondral thickness (ST) and joint space width (JS) over time.
Methods
Clinical T1 Sagittal MRI scans of HJD ankles were selected (N = 5). Each patient had a minimum of two MRI scans available, at least one year apart, to allow for comparison of longitudinal changes. All images were identity coded but fully anonymised. The earliest available and most recent MRI scan were measured in three slices (medial, lateral and middle slice) and at different points along the joint space (anterior, middle and posterior). Measurements taken were cartilage thickness on the talar dome (CT) and the distance between the subchondral bone of the tibial plafond and talar dome (ST). The joint space width (JS) was then determined by subtracting CT from ST.
Results
Chondral thickness measurements showed most reduction, particularly at the antero-lateral aspect (-0.4mm) compared to the antero-medial and middle sections, with -0.24mm and -0.34mm (Table 1). ST and JS reduction was predominantly seen in the anterior joint, with most reduction in antero-lateral joint (-1.13mm). The posterior joint showed minimal reduction in the postero-medial and middle sections, with the posterior-lateral joint space width increasing (0.2mm). Subchondral thickness and joint space measurements were variable and did not demonstrate linear change over time.
Conclusion
A systematic longitudinal decrease in cartilage thickness was seen in the antero-lateral and antero-medial aspect of the ankle joint. The antero-lateral aspect of the ankle showed the greatest reduction in joint space and cartilage thickness. This suggests that this area of the joint is likely to provide the best early indications of haemarthropathy when using MRI as a diagnostic tool.
Disclosure
M. Schaper: None. M. Sharrock: None. R.A. Wilkins: None. A.C. Redmond: None.
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Affiliation(s)
- Madeleine Schaper
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UNITED KINGDOM
| | - Megan Sharrock
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UNITED KINGDOM
| | - Richard A Wilkins
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UNITED KINGDOM
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UNITED KINGDOM
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20
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Wilkins RA, Chapman LS, Emmel JC, Flannery T, Chapman GJ, Walwyn REA, Redmond AC, Siddle HJ. A systematic review and narrative synthesis of footwear and orthotic devices used in the management of ankle haemarthrosis and haemarthropathy in haemophilia. Haemophilia 2022; 28:422-436. [PMID: 35245413 PMCID: PMC9310701 DOI: 10.1111/hae.14521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
Introduction Haemarthrosis is a clinical feature of haemophilia leading to haemarthropathy. The ankle joint is most commonly affected, resulting in significant pain, disability and a reduction in health‐related quality of life. Footwear and orthotic devices are effective in other diseases that affect the foot and ankle, such as rheumatoid arthritis, but little is known about their effect in haemophilia. Aims To review the efficacy and effectiveness of footwear and orthotic devices in the management of ankle joint haemarthrosis and haemarthropathy in haemophilia. Methods A systematic literature review was conducted. Two review authors independently screened studies for inclusion and appraised methodological quality using Joanna Briggs Institute Critical Appraisal checklists. A narrative analysis was undertaken. Results Ten studies involving 271 male participants were eligible for inclusion. All studies were quasi‐experimental; three employed a within‐subject design. Two studies included an independent comparison or control group. A range of footwear and orthotic devices were investigated. Limited evidence from non‐randomised studies suggested that footwear and orthotic devices improve the number of ankle joint bleeding episodes, gait parameters and patient‐reported pain. Conclusion This review demonstrates a lack of robust evidence regarding the efficacy and effectiveness of footwear and orthotic devices in the management of ankle joint haemarthrosis and haemarthropathy in haemophilia. Methodological heterogeneities and limitations with the study designs, small sample sizes and limited follow‐up of participants exist. Future studies utilising randomised designs, larger sample sizes, long‐term follow‐up and validated patient‐reported outcome measures are needed to inform the clinical management of ankle joint haemarthrosis and haemarthropathy.
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Affiliation(s)
- Richard A Wilkins
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Leeds Haemophilia Comprehensive Care Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Lara S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Jenny C Emmel
- Medical Education, Library & Evidence Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Thuvia Flannery
- Leeds Haemophilia Comprehensive Care Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Graham J Chapman
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Rebecca E A Walwyn
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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21
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Kocher A, Ndosi M, Denhaerynck K, Simon M, Dwyer AA, Distler O, Hoeper K, Künzler-Heule P, Redmond AC, Villiger PM, Walker UA, Nicca D. A rare disease patient-reported outcome measure: revision and validation of the German version of the Systemic Sclerosis Quality of Life Questionnaire (SScQoL) using the Rasch model. Orphanet J Rare Dis 2021; 16:356. [PMID: 34372892 PMCID: PMC8351336 DOI: 10.1186/s13023-021-01944-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Rare disease patient-reported outcome measures (PROMs) require linguistic adaptation to overcome the challenge of geographically dispersed patient populations. Importantly, PROMs such as health-related quality of life (HRQoL) should accurately capture responses to patient-identified concerns. The Systemic Sclerosis Quality of Life Questionnaire (SScQoL) is a 29-item tool validated in six languages. Previous evaluation of the German version revealed problems with dichotomous responses. This study aimed to revise the German SScQoL, extend the response structure, and evaluate content and construct validity, reliability and unidimensionality. Methods The instrument validation study involved revising the German SScQoL response structure, cognitive debriefing with patients and validation using Rasch analysis. The revised SScQoL was completed by Swiss-German-speaking patients with SSc within the Swiss MANagement Of Systemic Sclerosis (MANOSS) study. Rasch analysis was employed to test the validity, reliability and unidimensionality of the revised instrument. Results Based on cognitive debriefing with patients (n = 6) dichotomous items were extended to a polytomous 4-point response structure. A total of 78 patients completed the revised SScQoL. Initial analysis of the 29 items suggested the scale lacked fit to the model (χ2 = 51.224, df = 29, p = 0.007). Grouping items into five domains resulted in an adequate fit to the Rasch model (χ2 = 5.343, df = 5, p = 0.376) and unidimensionality (proportion of significant independent t tests: 0.045, 95% CI 0.016–0.114). Overall, the scale was well targeted, had high internal consistency (Person Separation Index, PSI = 0.931) and worked consistently in patients with different demographic and clinical characteristics. Conclusions The revised German SScQoL has a 4-point response structure and is a valid, reliable measure. Rasch analysis is useful for validating continuous response structure of quality of life measures. Further evaluation of measurement equivalence with other German-speaking cultures is required for multinational comparisons and data pooling. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01944-9.
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Affiliation(s)
- Agnes Kocher
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Kris Denhaerynck
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Michael Simon
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,Nursing Research Unit, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew A Dwyer
- Boston College, Connell School of Nursing, Chestnut Hill, MA, USA
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kirsten Hoeper
- Hannover Medical School, Department, Rheumatology and Immunology, Hannover, Germany
| | - Patrizia Künzler-Heule
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Gastroenterology/Hepatology and Department of Nursing, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Peter M Villiger
- Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Dunja Nicca
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland. .,Department of Global and Public Health, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland.
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22
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Kearney R, McKeown R, Parsons H, Haque A, Parsons N, Nwankwo H, Mason J, Underwood M, Redmond AC, Brown J, Kefford S, Costa M. Use of cast immobilisation versus removable brace in adults with an ankle fracture: multicentre randomised controlled trial. BMJ 2021; 374:n1506. [PMID: 34226192 PMCID: PMC8256800 DOI: 10.1136/bmj.n1506] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To assess function, quality of life, resource use, and complications in adults treated with plaster cast immobilisation versus a removable brace for ankle fracture. DESIGN Multicentre randomised controlled trial. SETTING 20 trauma units in the UK National Health Service. PARTICIPANTS 669 adults aged 18 years and older with an acute ankle fracture suitable for cast immobilisation: 334 were randomised to a plaster cast and 335 to a removable brace. INTERVENTIONS A below the knee cast was applied and ankle range of movement exercises started on cast removal. The removable brace was fitted, and ankle range of movement exercises were started immediately. MAIN OUTCOME MEASURES Primary outcome was the Olerud Molander ankle score at 16 weeks, analysed by intention to treat. Secondary outcomes were Manchester-Oxford foot questionnaire, disability rating index, quality of life, and complications at 6, 10, and 16 weeks. RESULTS The mean age of participants was 46 years (SD 17 years) and 381 (57%) were women. 502 (75%) participants completed the study. No statistically significant difference was found in the Olerud Molander ankle score between the cast and removable brace groups at 16 weeks (favours brace: 1.8, 95% confidence interval -2.0 to 5.6). No clinically significant differences were found in the Olerud Molander ankle scores at other time points, in the secondary unadjusted, imputed, or per protocol analyses. CONCLUSIONS Traditional plaster casting was not found to be superior to functional bracing in adults with an ankle fracture. No statistically difference was found in the Olerud Molander ankle score between the trial arms at 16 weeks. TRIAL REGISTRATION ISRCTN registry ISRCTN15537280.
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Affiliation(s)
- Rebecca Kearney
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Rebecca McKeown
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Helen Parsons
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Aminul Haque
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Nick Parsons
- Warwick Medical School, University of Warwick, Warwick, UK
| | - Henry Nwankwo
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - James Mason
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | | | - Anthony C Redmond
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Jaclyn Brown
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Siobhan Kefford
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Matthew Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Rheumatology, Musculoskeletal and Orthopaedic Sciences, University of Oxford, Oxford, UK
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23
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Talbott HG, Wilkins RA, Redmond AC, Brockett CL, Mengoni M. Morphological variation of the hemophilic talus. Clin Anat 2021; 34:941-947. [PMID: 33998061 DOI: 10.1002/ca.23757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/30/2021] [Accepted: 05/14/2021] [Indexed: 11/12/2022]
Abstract
Flattening of the trochlear tali is clinically observed as structural and functional changes advance in patients with hemarthropathy of the ankle. However, the degree of this flattening has not yet been quantified, and distribution of the morphological changes across the talus not yet defined. Chronologically sequential MR images of both a hemophilic patient group (N = 5) and a single scan from a nondiseased, sex-matched, control group (N = 11) were used to take four measurements of the trochlear talus morphology at three locations (medial, central and lateral) along the sagittal plane. Three ratios of interest were defined from these to assess whether the talar dome flattens with disease. The control group MRI measurements were validated against literature data obtained from CT scans or planar X-Rays. The influence of disease on talar morphology was assessed by direct comparison of the hemophilic cases with the control group. The values for all three ratios, in all locations, differed between the control and the hemophilic group. Flattening was indicated in the hemophilic group in the medial and lateral talus, but differences in the central talus were not statistically significant. This work demonstrates that morphological assessment of the talus from MR images is similar to that from CT scans or planar X-Rays. Talar flattening does occur with hemarthropathy, especially at the medial and lateral edges of the joint surface. General flattening of the trochlear talus was confirmed in this small patient sample, however the degree and rate of change is unique to each ankle.
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Affiliation(s)
- Harriet G Talbott
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Richard A Wilkins
- Leeds Institute of Rheumatology & Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK.,Leeds Haemophilia Comprehensive Care Centre, Leeds Teaching Hospitals NHS trust, Leeds, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatology & Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK.,Centre for Sports, Exercise and Osteoarthritis Versus Arthritis, Nottingham, Oxford, Loughborough, Leeds, UK
| | - Claire L Brockett
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK.,Leeds Institute of Rheumatology & Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK.,Centre for Sports, Exercise and Osteoarthritis Versus Arthritis, Nottingham, Oxford, Loughborough, Leeds, UK
| | - Marlène Mengoni
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
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24
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Anderson AM, Comer C, Smith TO, Drew BT, Pandit H, Antcliff D, Redmond AC, McHugh GA. Consensus on pre-operative total knee replacement education and prehabilitation recommendations: a UK-based modified Delphi study. BMC Musculoskelet Disord 2021; 22:352. [PMID: 33853564 PMCID: PMC8044503 DOI: 10.1186/s12891-021-04160-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Over 90,000 total knee replacement (TKR) procedures are performed annually in the United Kingdom (UK). Patients awaiting TKR face long delays whilst enduring severe pain and functional limitations. Almost 20% of patients who undergo TKR are not satisfied post-operatively. Optimising pre-operative TKR education and prehabilitation could help improve patient outcomes pre- and post-operatively; however, current pre-operative TKR care varies widely. Definitive evidence on the optimal content and delivery of pre-operative TKR care is lacking. This study aimed to develop evidence- and consensus-based recommendations on pre-operative TKR education and prehabilitation. METHODS A UK-based, three-round, online modified Delphi study was conducted with a 60-member expert panel. All panellists had experience of TKR services as patients (n = 30) or professionals (n = 30). Round 1 included initial recommendations developed from a mixed methods rapid review. Panellists rated the importance of each item on a five-point Likert scale. Panellists could also suggest additional items in Round 1. Rounds 2 and 3 included all items from Round 1, new items suggested in Round 1 and charts summarising panellists' importance ratings from the preceding round. Free-text responses were analysed using content analysis. Quantitative data were analysed descriptively. All items rated as 'Important' or 'Very important' by at least 70% of all respondents in Round 3 were included in the final set of recommendations. RESULTS Fifty-five panellists (92%) (patients n = 26; professionals n = 29) completed Round 3. Eighty-six recommendation items were included in Round 1. Fifteen new items were added in Round 2. Rounds 2 and 3 therefore included 101 items. Seventy-seven of these reached consensus in Round 3. Six items reached consensus amongst patient or professional panellists only in Round 3. The final set of recommendations comprises 34 education topics, 18 education delivery approaches, 10 exercise types, 13 exercise delivery approaches and two other treatments. CONCLUSIONS This modified Delphi study developed a comprehensive set of recommendations that represent a useful resource for guiding decision-making on the content and delivery of pre-operative TKR education and prehabilitation. The recommendations will need to be interpreted and reviewed periodically in light of emerging evidence.
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Affiliation(s)
- Anna M Anderson
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK.
- NIHR Leeds Biomedical Research Centre, Leeds, UK.
| | - Christine Comer
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds Community Healthcare NHS Trust Musculoskeletal and Rehabilitation Services, Leeds, UK
| | - Toby O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Benjamin T Drew
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Hemant Pandit
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Deborah Antcliff
- School of Healthcare, University of Leeds, Leeds, UK
- Physiotherapy Department, Bury Care Organisation, Northern Care Alliance NHS Group, Bury, England, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
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25
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Palmer JL, Siddle HJ, Redmond AC, Alcacer-Pitarch B. Implementation of podiatry telephone appointments for people with rheumatic and musculoskeletal diseases. J Foot Ankle Res 2021; 14:4. [PMID: 33413562 PMCID: PMC7790049 DOI: 10.1186/s13047-020-00441-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Foot health problems are common in the general population, and particularly so in people with rheumatic and musculoskeletal disorders (RMD). Several clinical guidelines state that people with RMDs should have access to foot health services, although service capacity is often limited. The current COVID-19 pandemic has increased the need for alternative ways to provide patient care. The aim of this clinical audit was to review a newly implemented telephone follow-up appointment service conducted within the Rheumatology Podiatry Department in Leeds, UK. METHODS Fifty-eight patients attending the Rheumatology Podiatry Department at Leeds Teaching Hospitals NHS Trust were contacted by telephone approximately 6-8 weeks following initial intervention. During the telephone consultation, all patients were asked pre-defined questions relating to their symptoms, intervention efficacy, the need for further appointments and their preference for the type of consultation. To assess the cost of the telephone consultation the number of attempts needed in order to make successful contact, the duration of the call and the number of telephone follow-up appointments completed in a working day were also recorded. RESULTS Twenty-five patients (43%) were successfully contacted within the 6-8 weeks stipulated time frame and were included in the analysis. Of the 25 contacted, twelve (48%) patients were successfully contacted on the first attempt. Ten (40%) were successfully contacted on the second attempt. The remaining three patients (12%) required 3 or more attempts to make successful contact. Telephone consultations were estimated not to last longer than 10 min, including notes screening and documentation. Eleven patients (44%) reported an improvement in their symptoms, thirteen (52%) reported no change and one patient (4%) reported their symptoms to be worse. CONCLUSION Telephone follow-up consultations may be a potentially cost-effective alternative to face-to-face appointments when implemented in a Rheumatology Podiatry Department, and provide an alternative way of providing care, especially when capacity for face-to-face contact is limited. The potential cost saving and efficiency benefits of this service are likely to be enhanced when telephone consultations are pre-arranged with patients.
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Affiliation(s)
- J L Palmer
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK.,First Contact Physiotherapy Practitioner, Primary Care Sheffield, Darnall Primary Care Centre, Sheffield, UK
| | - H J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Leeds, LS7 4SA, UK.,Podiatry Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Leeds, LS7 4SA, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - B Alcacer-Pitarch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Leeds, LS7 4SA, UK. .,Podiatry Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK. .,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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26
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Filippou V, Redmond AC, Bennion J, Backhouse MR, Wong D. Capturing accelerometer outputs in healthy volunteers under normal and simulated-pathological conditions using ML classifiers .. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:4604-4607. [PMID: 33019019 DOI: 10.1109/embc44109.2020.9176201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Wearable devices offer a possible solution for acquiring objective measurements of physical activity. Most current algorithms are derived using data from healthy volunteers. It is unclear whether such algorithms are suitable in specific clinical scenarios, such as when an individual has altered gait. We hypothesized that algorithms trained on healthy population will result in less accurate results when tested in individuals with altered gait. We further hypothesized that algorithms trained on simulated-pathological gait would prove better at classifying abnormal activity. We studied healthy volunteers to assess whether activity classification accuracy differed for those with healthy and simulated-pathological conditions. Healthy participants (n=30) were recruited from the University of Leeds to perform nine predefined activities under healthy and simulated-pathological conditions. Activities were captured using a wrist-worn MOX accelerometer (Maastricht Instruments, NL). Data were analyzed based on the Activity-Recognition-Chain process. We trained a Neural-Network, Random-Forests, k-Nearest-Neighbors (k-NN), Support-Vector-Machines (SVM) and Naive Bayes models to classify activity. Algorithms were trained four times; once with `healthy' data, and once with `simulated-pathological data' for each of activity-type and activity-task classification. In activity-type instances, the SVM provided the best results; the accuracy was 98.4% when the algorithm was trained and then tested with unseen data from the same group of healthy individuals. Accuracy dropped to 52.8% when tested on simulated-pathological data. When the model was retrained with simulated-pathological data, prediction accuracy for the corresponding test set was 96.7%. Algorithms developed on healthy data are less accurate for pathological conditions. When evaluating pathological conditions, classifier algorithms developed using data from a target sub-population can restore accuracy to above 95%.
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Arnold JB, Halstead J, Grainger AJ, Keenan AM, Hill CL, Redmond AC. Foot and Leg Muscle Weakness in People With Midfoot Osteoarthritis. Arthritis Care Res (Hoboken) 2020; 73:772-780. [PMID: 32170831 DOI: 10.1002/acr.24182] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/03/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To compare foot and leg muscle strength in people with symptomatic midfoot osteoarthritis (OA) with asymptomatic controls, and to determine the association between muscle strength, foot pain, and disability. METHODS Participants with symptomatic midfoot OA and asymptomatic controls were recruited for this cross-sectional study from general practices and community health clinics. The maximum isometric muscle strength of the ankle plantarflexors, dorsiflexors, invertors and evertors, and the hallux and lesser toe plantarflexors was measured using hand-held dynamometry. Self-reported foot pain and foot-related disability were assessed with the Manchester Foot Pain and Disability Index. Differences in muscle strength were compared between groups. Multivariable regression was used to determine the association between muscle strength, foot pain, and disability after adjusting for covariates. RESULTS People with midfoot OA (n = 52) exhibited strength deficits in all muscle groups, ranging from 19% (dorsiflexors) to 30% (invertors) relative to the control group (n = 36), with effect sizes of 0.6-1.1 (P < 0.001). In those with midfoot OA, ankle invertor muscle strength was negatively and independently associated with foot pain (β = -0.026 [95% confidence interval (95% CI) -0.051, -0.001]; P = 0.045). Invertor muscle strength was negatively associated with foot-related disability, although not after adjustment for depressive symptoms (β = -0.023 [95% CI -0.063, 0.017]; P = 0.250). CONCLUSION People with symptomatic midfoot OA demonstrate weakness in the foot and leg muscles compared to asymptomatic controls. Preliminary indications from this study suggest that strengthening of the foot and leg muscles may offer potential to reduce pain and improve function in people with midfoot OA.
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Affiliation(s)
- John B Arnold
- University of Leeds, NIHR Leeds Biomedical Research Centre, Leeds, UK, University of South Australia, Adelaide, South Australia
| | - Jill Halstead
- University of Leeds, NIHR Leeds Biomedical Research Centre, and Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Andrew J Grainger
- University of Leeds, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Anne-Maree Keenan
- University of Leeds, NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Catherine L Hill
- The Queen Elizabeth Hospital and University of Adelaide, Adelaide, South Australia
| | - Anthony C Redmond
- University of Leeds, NIHR Leeds Biomedical Research Centre, Leeds, UK
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Alcacer-Pitarch B, Backhouse MR, Gijon-Nogeron G, Biscontini D, Bonafede S, Ferreira A, Gatt A, Lescure Y, Nava T, Redmond AC. Provision of foot and ankle care services for people with rheumatic and musculoskeletal disease across Europe. Musculoskeletal Care 2019; 18:12-19. [PMID: 31802611 DOI: 10.1002/msc.1431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND The aim of the present study was to explore the variation in the provision of care for people with rheumatic and musculoskeletal diseases (RMDs), and foot and ankle problems between European healthcare systems. METHODS An electronic questionnaire was developed and piloted in seven countries prior to being distributed to the presidents of all 22 national health professionals in rheumatology associations within the European League Against Rheumatism (EULAR). Summary data were obtained using SPSS V22. Ethical approval was sought from the Medical Research Ethics Committee of University of Malaga (CEUMA-91-2015-H). RESULTS Sixteen questionnaires (73% response rate) were completed (Austria, Belgium, Czech Republic, Denmark, France, Hungary, Ireland, Italy, Malta, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the UK). All 16 respondents indicated that foot and ankle healthcare services were provided in their country, but only three countries had services specializing in RMD-related foot and ankle problems (the Netherlands, the UK and Malta). The professions providing care varied, depending on the pathology and the country. Foot and ankle pain was mostly treated by rheumatologists and physiotherapists; foot and ankle deformities by orthopaedic surgeons and orthotist/prosthetists; and foot and ankle ulcers by nurses. Services were predominantly delivered through the public sector, and in secondary care (hospital) settings. CONCLUSIONS Only three countries reported having specialist foot and ankle services addressing the needs of people with RMDs. Variation was seen in the professions which provided care between countries, and also between the foot and ankle pathologies cared for. There is a lack of clinical pathways and guidelines for the management of patients with RMD-related foot and ankle problems.
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Affiliation(s)
- Begonya Alcacer-Pitarch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Michael Ross Backhouse
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Gabriel Gijon-Nogeron
- Podiatry Department, Faculty of Health Sciences, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Malaga, Malaga,, Spain
| | - Devid Biscontini
- Rheumatology Unit, Azienda Ospedaliera Di Perugia, Umbria, Italy
| | | | - Andre Ferreira
- Department of Medicine and Surgery, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | | | - Tiziana Nava
- Department of Translational Medicine and Surgery Program in Physical Therapy, Università Bicocca, Milan, Italy
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Keene DJ, Costa ML, Tutton E, Hopewell S, Barber VS, Dutton SJ, Redmond AC, Willett K, Lamb SE. Progressive functional exercise versus best practice advice for adults aged 50 years or over after ankle fracture: protocol for a pilot randomised controlled trial in the UK - the Ankle Fracture Treatment: Enhancing Rehabilitation (AFTER) study. BMJ Open 2019; 9:e030877. [PMID: 31678945 PMCID: PMC6830709 DOI: 10.1136/bmjopen-2019-030877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Ankle fractures result in significant morbidity in adults, with prognosis worsening with increasing age. Previous trials have not found evidence supporting supervised physiotherapy sessions, but these studies have not focused on older adults or tailored the exercise interventions to the complex needs of this patient group. The Ankle Fracture Treatment: Enhancing Rehabilitation study is a pilot randomised controlled trial to assess feasibility of a later definitive trial comparing best-practice advice with progressive functional exercise for adults aged 50 years and over after ankle fracture.The main objectives are to assess: (i) patient engagement with the trial, measured by the participation rate of those eligible; (ii) establish whether the interventions are acceptable to participants and therapists, assessed by intervention adherence levels, participant interviews and a therapist focus group; (iii) participant retention in the trial, measured by the proportion of participants providing outcome data at 6 months; (iv) acceptability of measuring outcomes at 3 and 6 month follow-up. METHODS AND ANALYSIS A multicentre pilot randomised controlled trial with an embedded qualitative study. At least 48 patients aged 50 years and over with an ankle fracture requiring surgical management, or non-operative management by immobilisation for at least 4 weeks, will be recruited from a minimum of three National Health Service hospitals in the UK. Participants will be allocated 1:1 via a central web-based randomisation system to: (i) best-practice advice (one session of face-to-face self-management advice delivered by a physiotherapist and up to two optional additional sessions) or (ii) progressive functional exercise (up to six sessions of individual face-to-face physiotherapy). An embedded qualitative study will include one-to-one interviews with up to 20 participants and a therapist focus group. ETHICS AND DISSEMINATION Hampshire B Research Ethics Committee (18/SC/0281) gave approval on 2nd July 2018. TRIAL REGISTRATION NUMBER ISRCTN16612336.
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Affiliation(s)
- David J Keene
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Matthew L Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Elizabeth Tutton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Vicki S Barber
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Susan J Dutton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Keith Willett
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
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De Pieri E, Lunn DE, Chapman GJ, Rasmussen KP, Ferguson SJ, Redmond AC. Patient characteristics affect hip contact forces during gait. Osteoarthritis Cartilage 2019; 27:895-905. [PMID: 30772383 DOI: 10.1016/j.joca.2019.01.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/08/2019] [Accepted: 01/15/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine hip contact force (HCF), calculated through multibody modelling, in a large total hip replacement (THR) cohort stratified by patient characteristics such as body mass index (BMI), age and function. METHOD 132 THR patients undertook one motion capture session of gait analysis at a self-selected walking speed. HCFs were then calculated using the AnyBody Modelling System. Patients were stratified into three BMI groups, five age groups, and finally three functional groups determined by their self-selected gait speed. By means of statistical parametric mapping (SPM), statistical analyses of the 1-dimensional time series were performed to separately evaluate the influence of age, BMI and functionality on HCF. RESULTS The mean predicted HCFs were comparable to HCFs measured with instrumented prostheses reported in the literature. The SPM analysis revealed a statistically significant positive linear correlation between BMI and HCF, indicating that obese patients are more likely to experience higher HCF during most of the stance phase, while a statistically significant negative correlation with age was found only during the late swing-phase. Patients with higher functional ability exhibited significantly increased peak HCF, while patients with lower functional ability demonstrated lower HCFs overall and a pathological flattening of the typical double hump force profile. CONCLUSION HCFs experienced at the bearing surface are highly dependent on patient characteristics. BMI and functional ability were determined to have the biggest influence on contact forces. Current preclinical testing standards do not reflect this.
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Affiliation(s)
- E De Pieri
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.
| | - D E Lunn
- Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds, UK.
| | - G J Chapman
- Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds, UK.
| | | | - S J Ferguson
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.
| | - A C Redmond
- Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds, UK.
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Arnold JB, Marshall M, Thomas MJ, Redmond AC, Menz HB, Roddy E. Midfoot osteoarthritis: potential phenotypes and their associations with demographic, symptomatic and clinical characteristics. Osteoarthritis Cartilage 2019; 27:659-666. [PMID: 30660723 DOI: 10.1016/j.joca.2018.12.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/20/2018] [Accepted: 12/23/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the demographic, symptomatic, clinical and structural foot characteristics associated with potential phenotypes of midfoot osteoarthritis (OA). DESIGN Cross-sectional study of 533 community-dwelling adults aged ≥50 years with foot pain in the past year. Health questionnaires and clinical assessments of symptoms, foot structure and function were undertaken. Potential midfoot OA phenotypes were defined by the pattern of radiographic joint involvement affecting either the medial midfoot (talonavicular, navicular-1st cuneiform, or cuneiform-1st metatarsal joint), central midfoot (2nd cuneiform-metatarsal joint), or both medial and central midfoot joints. Multivariable regression models with generalised estimating equations were used to investigate the associations between patterns of midfoot joint involvement and symptomatic, clinical and structural characteristics compared to those with no or minimal midfoot OA. RESULTS Of 879 eligible feet, 168 had medial midfoot OA, 103 central midfoot OA, 76 both medial and central midfoot OA and 532 no/minimal OA. Having both medial and central midfoot OA was associated with higher pain scores, dorsally-located midfoot pain (OR 2.54, 95%CI 1.45, 4.45), hallux valgus (OR 1.76, 95%CI 1.02, 3.05), flatter foot posture (β 0.44, 95%CI 0.12, 0.77), lower medial arch height (β 0.02, 95%CI 0.01, 0.03) and less subtalar inversion and 1st MTPJ dorsiflexion. Isolated medial midfoot OA and central midfoot OA had few distinguishing clinical characteristics. CONCLUSIONS Distinct phenotypes of midfoot OA appear challenging to identify, with substantial overlap in symptoms and clinical characteristics. Phenotypic differences in symptoms, foot posture and function were apparent in this study only when both the medial and central midfoot were involved.
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Affiliation(s)
- J B Arnold
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; National Institute for Health Research (NIHR), Leeds Biomedical Research Centre, Leeds, UK; Alliance for Research in Exericse, Nutrition & Activity (ARENA) and School of Health Sciences, University of South Australia, Adelaide, Australia.
| | - M Marshall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - M J Thomas
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK; Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Staffordshire, UK
| | - A C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; National Institute for Health Research (NIHR), Leeds Biomedical Research Centre, Leeds, UK
| | - H B Menz
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK; Discipline of Podiatry and La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
| | - E Roddy
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK; Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Staffordshire, UK
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Lunn DE, Chapman GJ, Redmond AC. Hip kinematics and kinetics in total hip replacement patients stratified by age and functional capacity. J Biomech 2019; 87:19-27. [DOI: 10.1016/j.jbiomech.2019.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/29/2019] [Accepted: 02/09/2019] [Indexed: 01/14/2023]
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Chapman LS, Redmond AC, Landorf KB, Rome K, Keenan AM, Waxman R, Alcacer-Pitarch B, Siddle HJ, Backhouse MR. Foot orthoses for people with rheumatoid arthritis: a survey of prescription habits among podiatrists. J Foot Ankle Res 2019; 12:7. [PMID: 30700994 PMCID: PMC6347791 DOI: 10.1186/s13047-019-0314-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/14/2019] [Indexed: 11/29/2022] Open
Abstract
Background Guidelines recommend foot orthoses for people with both early (< 2 years) and established rheumatoid arthritis (RA). While prefabricated foot orthoses are cheaper and can exhibit comparable effects to customised devices, the available evidence for their effectiveness is inconsistent. Little is known about what types of foot orthoses clinicians prescribe. This study describes the foot orthoses prescription habits of podiatrists for people with rheumatoid arthritis. Methods One hundred and eighty-three podiatrists from the United Kingdom (UK) (n = 88), Australia (n = 68) and New Zealand (n = 27) completed a self-administered, online survey regarding the types of foot orthoses prescribed in clinical practice for people with RA. This study forms part of a wider international survey exploring foot orthosis prescription habits. Results UK respondents were more likely to prescribe prefabricated orthoses for early RA (n = 47, 53%) and customised orthoses for established RA (n = 47, 53%). Respondents in Australia were more likely to prescribe customised orthoses for both early (n = 32, 47%) and established (n = 46, 68%) RA, whilst respondents in New Zealand were more likely to prescribe prefabricated orthoses for both early (n = 16, 59%) and established (n = 10, 37%) disease. Irrespective of disease stage, the use of foam impression boxes was more prevalent in the UK and New Zealand when capturing a model of the feet prior to manufacturing customised orthoses. In contrast, electronic scanning and plaster of Paris were more common in Australia. Computer aided manufacture was utilised more frequently among respondents in Australia than in the UK and New Zealand. Respondents in all three countries specified more flexible shell materials for established RA, compared to early disease. Cushioning top covers (e.g. PORON® or polyurethane) were most frequently specified in all countries for both disease stages. Conclusions Considerable variation was seen in the self-reported foot orthoses prescription habits of respondents for people with RA. Variation between countries and disease stage was seen in type of orthoses, specific brands, manufacturing methods, and materials prescribed. The results allow podiatrists and broader health service providers to compare their practice against reported national and international patterns. Electronic supplementary material The online version of this article (10.1186/s13047-019-0314-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lara S Chapman
- 1Department of Podiatry, Harrogate and District NHS Foundation Trust, Harrogate District Hospital, Lancaster Park Road, Harrogate, UK.,2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Anthony C Redmond
- 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Karl B Landorf
- 4Discipline of Podiatry, School of Allied Health, La Trobe University, Melbourne, Australia.,5La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Keith Rome
- 6Health and Rehabilitation Research Institute and School of Podiatry, Auckland University of Technology, Auckland, New Zealand
| | - Anne-Maree Keenan
- 3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,7School of Healthcare, University of Leeds, Leeds, UK
| | - Robin Waxman
- 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Begonya Alcacer-Pitarch
- 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Heidi J Siddle
- 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Michael R Backhouse
- 8York Trials Unit, Department of Health Sciences, University of York, York, UK
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Abstract
BACKGROUND: This study reports the results of 2 separate surveys of British Hip Society (BHS) members relating to leg length inequality (LLI) after primary total hip replacement (THR). SURVEY 1: Investigates the members' opinions on the effect of LLI on the outcome of THR and explores the acceptable limits of LLI. SURVEY 2: Reports on the intraoperative techniques currently used by BHS members to minimise LLI after THR. RESULTS - SURVEY 1: 97% of all surgeons completing the survey believed that LLI can affect the outcome of THR. RESULTS - SURVEY 2: All surgeons reported using at least 1 intraoperative technique for assessing leg length with a median of 5 techniques. Over 50% of surgeons use 2 or more tests. CONCLUSION - SURVEY 1: 89% of surgeons agreed that 15 mm of LLI after primary uncomplicated THR was always acceptable. 90% of surgeons felt that LLI more than 22.74 mm was never acceptable. CONCLUSION - SURVEY 2: Despite the multiple published papers on various methods of assessing leg length intraoperatively, the problem of LLI post THR persists. This study highlights the need for further research to develop a simple intraoperative technique with high accuracy and reproducibility.
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Affiliation(s)
- Faye A Loughenbury
- 1 NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Anthony B McWilliams
- 1 NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.,2 Barnsley Hospitals NHS Trust, Barnsley, UK
| | - Todd D Stewart
- 1 NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.,3 Leeds Institute for Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Anthony C Redmond
- 1 NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.,3 Leeds Institute for Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Martin H Stone
- 1 NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.,3 Leeds Institute for Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds, UK
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Chapman LS, Redmond AC, Landorf KB, Rome K, Keenan AM, Waxman R, Alcacer-Pitarch B, Siddle HJ, Backhouse MR. A survey of foot orthoses prescription habits amongst podiatrists in the UK, Australia and New Zealand. J Foot Ankle Res 2018; 11:64. [PMID: 30505351 PMCID: PMC6258496 DOI: 10.1186/s13047-018-0304-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/31/2018] [Indexed: 11/29/2022] Open
Abstract
Background Foot orthoses are frequently used but little is known about which types are used in contemporary practice. This study aimed to explore the types of foot orthoses currently used by podiatrists and the prescription variations in a range of conditions. Methods A web-based, cross-sectional survey was distributed through professional bodies in the United Kingdom (UK), Australia, and New Zealand. Questions focussed on foot orthosis prescription habits in relation to 26 conditions affecting the back and lower limb. Results Two hundred and sixty-four podiatrists practising in 19 different countries completed the survey; the majority practised in the UK (47%, n = 124), Australia (30%, n = 79) and New Zealand (12%, n = 32). Respondents qualified between 1968 and 2016, and 147 (56%) were female. Respondents worked in different healthcare sectors and this varied between countries: 42 (34%) respondents in the UK worked solely in the public sector, compared to 3 (4%) in Australia and 2 (6%) in New Zealand. Forty-four (35%) respondents in the UK worked solely in private practice, compared to 64 (81%) in Australia and 14 (44%) in New Zealand. UK respondents prescribed more prefabricated orthoses per week (mean 5.5 pairs) than simple insole-type devices (±2.7) and customised devices (±2.9). Similarly, respondents in New Zealand prescribed more prefabricated orthoses per week (±7.7) than simple (±1.4) and customised (±2.8) devices. In contrast, those in Australia prescribed more customised orthoses per week (±4.4) than simple (±0.8) and prefabricated (±1.9) orthoses. Differences in the types of orthoses prescribed were observed between country of practice, working sector, and the condition targeted. Generally, prefabricated orthoses were commonly prescribed for the 26 highlighted conditions in the UK and New Zealand. Australian podiatrists prescribed far fewer devices overall, but when they did prescribe, they were more likely to prescribe custom devices. Respondents in all three countries were more likely to prescribe customised orthoses for people with diabetes complicated by peripheral neuropathy than for diabetes without this complication. Conclusions Foot orthosis prescription habits vary between countries. Prefabricated orthoses were frequently prescribed in the UK and New Zealand, and customised orthoses in Australia. Prescriptions for people with diabetes differed depending on the presence of neuropathy, despite a lack of robust evidence supporting these decisions. This study provides new insight into contemporary practice. Electronic supplementary material The online version of this article (10.1186/s13047-018-0304-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lara S Chapman
- 1Department of Podiatry, Harrogate and District NHS Foundation Trust, Harrogate District Hospital, Lancaster Park Road, Harrogate, UK.,2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Anthony C Redmond
- 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Karl B Landorf
- 4Discipline of Podiatry, School of Allied Health, La Trobe University, Melbourne, Australia.,5La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Keith Rome
- 6Health and Rehabilitation Research Institute and School of Podiatry, Auckland University of Technology, Auckland, New Zealand
| | - Anne-Maree Keenan
- 3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,7School of Healthcare, University of Leeds, Leeds, UK
| | - Robin Waxman
- 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Begonya Alcacer-Pitarch
- 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Heidi J Siddle
- 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Michael R Backhouse
- 8York Trials Unit, Department of Health Sciences, University of York, York, UK
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Peeters G, Edwards KL, Brown WJ, Barker AL, Arden N, Redmond AC, Conaghan PG, Cicuttini F, Mishra GD. Potential Effect Modifiers of the Association Between Physical Activity Patterns and Joint Symptoms in Middle-Aged Women. Arthritis Care Res (Hoboken) 2018; 70:1012-1021. [PMID: 29210208 PMCID: PMC6033095 DOI: 10.1002/acr.23430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/26/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine whether body mass index (BMI), menopausal status, and hormone therapy (HT) use modify the association between physical activity (PA) patterns throughout middle age and the incidence and prevalence of joint symptoms in women in later middle age. METHODS Data were from 6,661 participants (born 1946-1951) in the Australian Longitudinal Study on Women's Health. Surveys, with questions on joint pain and stiffness, PA, height and weight, menopausal symptoms, and HT use, were completed every 3 years from 1998 to 2010. PA patterns were defined as none or low, low or meeting guidelines, fluctuating, or meeting guidelines at all times (reference pattern). Logistic regression was used to examine the association between PA patterns and prevalent (in 2010) and cumulative incident (1998-2010) joint symptoms and effect modification by patterns in BMI, menopausal status, and HT. RESULTS The groups representing fluctuating PA (odds ratio [OR] 1.34 [99% confidence interval (99% CI) 1.04-1.72]) and no or low PA (OR 1.60 [99% CI 1.08-2.35]) had higher odds of incident joint symptoms than those described as meeting guidelines at all times. Stratification by BMI showed that this association was statistically significant in the obese group only. No evidence for effect modification by menopausal status or HT use was found. The findings were similar for prevalent joint symptoms. CONCLUSION Maintaining at least low levels of PA throughout middle age was associated with a lower prevalence and incidence of joint symptoms later in life. This apparent protective effect of PA on joint symptoms was stronger in obese women than in under- or normal-weight women, and not related to menopause or HT status.
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Affiliation(s)
- Geeske Peeters
- University of California, San Francisco, Trinity College Dublin, Dublin, Ireland, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia, University of Queensland School of Public Health, Brisbane, Queensland, Australia, and Arthritis Research UK Centre for Sport Exercise and OsteoarthritisNottinghamUK
| | - Kimberley L. Edwards
- Arthritis Research UK Centre for Sport Exercise and Osteoarthritis and the University of Nottingham School of MedicineNottinghamUK
| | - Wendy J. Brown
- University of Queensland School of Human Movement and Nutrition SciencesBrisbaneQueenslandAustralia
| | - Anna L. Barker
- Monash University School of Public Health and Preventive MedicineMelbourneVictoriaAustralia
| | - Nigel Arden
- Oxford University Arthritis Research UK Centre for Sport, Exercise, and OsteoarthritisOxfordUK
| | - Anthony C. Redmond
- Arthritis Research UK Centre for Sport Exercise and Osteoarthritis, Nottingham, UK, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research CentreLeedsUK
| | - Philip G. Conaghan
- Arthritis Research UK Centre for Sport Exercise and Osteoarthritis, Nottingham, UK, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research CentreLeedsUK
| | - Flavia Cicuttini
- Monash University School of Public Health and Preventive MedicineMelbourneVictoriaAustralia
| | - Gita D. Mishra
- University of Queensland School of Public HealthBrisbaneQueenslandAustralia
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Corbacho B, Cockayne S, Fairhurst C, Hewitt CE, Hicks K, Kenan AM, Lamb SE, MacIntosh C, Menz HB, Redmond AC, Rodgers S, Scantlebury A, Watson J, Torgerson DJ. Cost-Effectiveness of a Multifaceted Podiatry Intervention for the Prevention of Falls in Older People: The REducing Falls with Orthoses and a Multifaceted Podiatry Intervention Trial Findings. Gerontology 2018; 64:503-512. [PMID: 29945150 DOI: 10.1159/000489171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 04/12/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Falls are a major cause of morbidity among older people. Multifaceted interventions may be effective in preventing falls and related fractures. OBJECTIVE To evaluate the cost-effectiveness alongside the REducing Falls with Orthoses and a Multifaceted podiatry intervention (REFORM) trial. METHODS REFORM was a pragmatic multicentre cohort randomised controlled trial in England and Ireland; 1,010 participants (> 65 years) were randomised to receive either a podiatry intervention (n = 493), including foot and ankle strengthening exercises, foot orthoses, new footwear if required, and a falls prevention leaflet, or usual podiatry treatment plus a falls prevention leaflet (n = 517). PRIMARY OUTCOME incidence of falls per participant in the 12 months following randomisation. SECONDARY OUTCOMES proportion of fallers and quality of life (EQ-5D-3L) which was converted into quality-adjusted life years (QALYs) for each participant. Differences in mean costs and QALYs at 12 months were used to assess the cost-effectiveness of the intervention relative to usual care. Cost-effectiveness analyses were conducted in accordance with National Institute for Health and Clinical Excellence reference case standards, using a regression-based approach with costs expressed in GBP (2015 price). The base case analysis used an intention-to-treat approach on the imputed data set using multiple imputation. RESULTS There was a small, non-statistically significant reduction in the incidence rate of falls in the intervention group (adjusted incidence rate ratio 0.88, 95% CI 0.73-1.05, p = 0.16). Participants allocated to the intervention group accumulated on average marginally higher QALYs than the usual care participants (mean difference 0.0129, 95% CI -0.0050 to 0.0314). The intervention costs were on average GBP 252 more per participant compared to the usual care participants (95% CI GBP -69 to GBP 589). Incremental cost-effectiveness ratios ranged between GBP 19,494 and GBP 20,593 per QALY gained, below the conventional National Health Service cost-effectiveness thresholds of GBP 20,000 to GBP 30,000 per additional QALY. The probability that the podiatry intervention is cost-effective at a threshold of GBP 30,000 per QALY gained was 0.65. The results were robust to sensitivity analyses. CONCLUSION The benefits of the intervention justified the moderate cost. The intervention could be a cost-effective option for falls prevention when compared with usual care in the UK.
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Affiliation(s)
- Belen Corbacho
- Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom
| | - Sarah Cockayne
- Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom
| | - Caroline Fairhurst
- Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom
| | - Catherine E Hewitt
- Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom
| | - Kate Hicks
- Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom
| | - Anne-Maree Kenan
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Critical Care Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | | | - Hylton B Menz
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Anthony C Redmond
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Sara Rodgers
- Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom
| | - Arabella Scantlebury
- Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom
| | - Judith Watson
- Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom
| | - David J Torgerson
- Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom
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38
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Drew BT, Bowes MA, Redmond AC, Dube B, Kingsbury SR, Conaghan PG. Patellofemoral morphology is not related to pain using three-dimensional quantitative analysis in an older population: data from the Osteoarthritis Initiative. Rheumatology (Oxford) 2017; 56:2135-2144. [PMID: 28968747 PMCID: PMC5850212 DOI: 10.1093/rheumatology/kex329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Indexed: 11/25/2022] Open
Abstract
Objectives Current structural associations of patellofemoral pain (PFP) are based on 2D imaging methodology with inherent measurement uncertainty due to positioning and rotation. This study employed novel technology to create 3D measures of commonly described patellofemoral joint imaging features and compared these features in people with and without PFP in a large cohort. Methods We compared two groups from the Osteoarthritis Initiative: one with localized PFP and pain on stairs, and a control group with no knee pain; both groups had no radiographic OA. MRI bone surfaces were automatically segmented and aligned using active appearance models. We applied t-tests, logistic regression and linear discriminant analysis to compare 13 imaging features (including patella position, trochlear morphology, facet area and tilt) converted into 3D equivalents, and a measure of overall 3D shape. Results One hundred and fifteen knees with PFP (mean age 59.7, BMI 27.5 kg/m2, female 58.2%) and 438 without PFP (mean age 63.6, BMI 26.9 kg/m2, female 52.9%) were included. After correction for multiple testing, no statistically significant differences were found between groups for any of the 3D imaging features or their combinations. A statistically significant discrimination was noted for overall 3D shape between genders, confirming the validity of the 3D measures. Conclusion Challenging current perceptions, no differences in patellofemoral morphology were found between older people with and without PFP using 3D quantitative imaging analysis. Further work is needed to see if these findings are replicated in a younger PFP population.
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Affiliation(s)
- Benjamin T Drew
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds.,NIHR Leeds Biomedical Research Centre, Leeds
| | | | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds.,NIHR Leeds Biomedical Research Centre, Leeds
| | - Bright Dube
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds.,NIHR Leeds Biomedical Research Centre, Leeds
| | - Sarah R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds.,NIHR Leeds Biomedical Research Centre, Leeds
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds.,NIHR Leeds Biomedical Research Centre, Leeds
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39
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Drew BT, Conaghan PG, Smith TO, Selfe J, Redmond AC. The effect of targeted treatment on people with patellofemoral pain: a pragmatic, randomised controlled feasibility study. BMC Musculoskelet Disord 2017; 18:338. [PMID: 28778218 PMCID: PMC5545020 DOI: 10.1186/s12891-017-1698-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/24/2017] [Indexed: 12/30/2022] Open
Abstract
Background Targeted treatment, matched according to specific clinical criteria e.g. hip muscle weakness, may result in better outcomes for people with patellofemoral pain (PFP). However, to ensure the success of future trials, a number of questions on the feasibility of a targeted treatment need clarification. The aim of the study was to explore the feasibility of matched treatment (MT) compared to usual care (UC) management for a subgroup of people with PFP determined to have hip weakness and to explore the mechanism of effect for hip strengthening. Methods In a pragmatic, randomised controlled feasibility study, 24 participants with PFP (58% female; mean age 29 years) were randomly allocated to receive either MT aimed specifically at hip strengthening, or UC over an eight-week period. The primary outcomes were feasibility outcomes, which included rates of adherence, attrition, eligibility, missing data and treatment efficacy. Secondary outcomes focused on the mechanistic outcomes of the intervention, which included hip kinematics. Results Conversion to consent (100%), missing data (0%), attrition rate (8%) and adherence to both treatment and appointments (>90%) were deemed successful endpoints. The analysis of treatment efficacy showed that the MT group reported a greater improvement for the Global Rating of Change Scale (62% vs. 9%) and the Anterior Knee Pain Scale (−5.23 vs. 1.18) but no between-group differences for either average or worst pain. Mechanistic outcomes showed a greatest reduction in peak hip internal rotation angle for the MT group (13.1% vs. −2.7%). Conclusion This feasibility study indicates that a definitive randomised controlled trial investigating a targeted treatment approach is achievable. Findings suggest the mechanism of effect of hip strengthening may be to influence kinematic changes in hip function in the transverse plane. Trial registration This study was registered retrospectively. 10.1186/ISRCTN74560952. Registration date: 2017–02-06. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1698-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benjamin T Drew
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Chapeltown Rd, Leeds, LS7 4SA, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | | | - Toby O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Chapeltown Rd, Leeds, LS7 4SA, UK. .,NIHR Leeds Biomedical Research Centre, Leeds, UK.
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40
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Siddle HJ, Hodgson RJ, Hensor EMA, Grainger AJ, Redmond AC, Wakefield RJ, Helliwell PS. Plantar plate pathology is associated with erosive disease in the painful forefoot of patients with rheumatoid arthritis. BMC Musculoskelet Disord 2017; 18:308. [PMID: 28720138 PMCID: PMC5516379 DOI: 10.1186/s12891-017-1668-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 07/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Disease-related foot pathology is recognised to have a significant impact on mobility and functional capacity in the majority of patients with rheumatoid arthritis (RA). The forefoot is widely affected and the metatarsophalangeal (MTP) joints are the most common site of symptoms. The plantar plates are the fibrocartilaginous distal attachments of the plantar fascia inserting into the five proximal phalanges. Together with the transverse metatarsal ligament they prevent splaying of the forefoot and subluxation of the MTP joints. Damage to the plantar plates is a plausible mechanism therefore, through which the forefoot presentation, commonly described as ‘walking on pebbles’, may develop in patients with RA. The aims of this study were to investigate the relationship between plantar plate pathology and clinical, biomechanical and plain radiography findings in the painful forefoot of patients with RA. Secondly, to compare plantar plate pathology at the symptomatic lesser (2nd-5th) MTP joints in patients with RA, with a group of healthy age and gender matched control subjects without foot pain. Methods In 41 patients with RA and ten control subjects the forefoot was imaged using 3T MRI. Intermediate weighted fat-suppressed sagittal and short axis sequences were acquired through the lesser MTP joints. Images were read prospectively by two radiologists and consensus reached. Plantar plate pathology in patients with RA was compared with control subjects. Multivariable multilevel modelling was used to assess the association between plantar plate pathology and the clinical, biomechanical and plain radiography findings. Results There were significant differences between control subjects and patients with RA in the presence of plantar plate pathology at the lesser MTP joints. No substantive or statistically significant associations were found between plantar plate pathology and clinical and biomechanical findings. The presence of plantar plate pathology was independently associated with an increase in the odds of erosion (OR = 52.50 [8.38–326.97], p < 0.001). Conclusion The distribution of plantar plate pathology at the lesser MTP joints in healthy control subjects differs to that seen in patients with RA who have the consequence of inflammatory disease in the forefoot. Longitudinal follow-up is required to determine the mechanism and presentation of plantar plate pathology in the painful forefoot of patients with RA. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1668-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK. .,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.
| | - Richard J Hodgson
- Centre for Imaging Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Elizabeth M A Hensor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK
| | - Andrew J Grainger
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.,Department of Radiology, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK
| | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK
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41
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Halstead J, Martín-Hervás C, Hensor EMA, McGonagle D, Keenan AM, Redmond AC, Conaghan PG. Development and Reliability of a Preliminary Foot Osteoarthritis Magnetic Resonance Imaging Score. J Rheumatol 2017; 44:1257-1264. [PMID: 28572462 DOI: 10.3899/jrheum.160617] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Foot osteoarthritis (OA) is very common but underinvestigated musculoskeletal condition and there is little consensus as to common magnetic resonance imaging (MRI) features. The aim of this study was to develop a preliminary foot OA MRI score (FOAMRIS) and evaluate its reliability. METHODS This preliminary semiquantitative score included the hindfoot, midfoot, and metatarsophalangeal joints. Joints were scored for joint space narrowing (JSN; 0-3), osteophytes (0-3), joint effusion/synovitis, and bone cysts (present/absent). Erosions and bone marrow lesions (BML) were scored (0-3) and BML were evaluated adjacent to entheses and at sub-tendon sites (present/absent). Additionally, tenosynovitis (0-3) and midfoot ligament pathology (present/absent) were scored. Reliability was evaluated in 15 people with foot pain and MRI-detected OA using 3.0T MRI multi-sequence protocols, and assessed using ICC as an overall score and per anatomical site. RESULTS Intrareader agreement (ICC) was generally good to excellent across the foot in joint features (JSN 0.90, osteophytes 0.90, effusion/synovitis 0.46, cysts 0.87), bone features (BML 0.83, erosion 0.66, BML entheses 0.66, BML sub-tendon 0.60) and soft tissue features (tenosynovitis 0.83, ligaments 0.77). Interreader agreement was lower for joint features (JSN 0.43, osteophytes 0.27, effusion/synovitis 0.02, cysts 0.48), bone features (BML 0.68, erosion 0.00, BML entheses 0.34, BML sub-tendon 0.13), and soft tissue features (tenosynovitis 0.35, ligaments 0.33). CONCLUSION This preliminary FOAMRIS demonstrated good intrareader reliability and fair interreader reliability when assessing the total feature scores. Further development is required in cohorts with a range of pathologies and to assess the psychometric measurement properties.
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Affiliation(s)
- Jill Halstead
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the School of Healthcare, University of Leeds; UK National Institute for Health Research (NIHR) Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds; Arthritis Research UK Experimental Osteoarthritis Treatment Centre, Leeds; Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Nottingham/Leeds; Salford Royal Hospital UK National Health Service (NHS) Foundation Trust, Manchester, UK; Department of Musculoskeletal Radiology, La Paz University Hospital, Autonomous University of Madrid; Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain.,J. Halstead, PhD, Visiting Research Fellow, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Principal Podiatrist, Salford Royal Hospital NHS Foundation Trust; C. Martín-Hervás, PhD, MD, Consultant Radiologist, Department of Musculoskeletal Radiology, La Paz University Hospital, and Associate Professor of Radiology, School of Medicine, Autonomous University of Madrid, and Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine; E.M. Hensor, PhD, Biostatistician, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust; D. McGonagle, PhD, Professor of Investigative Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust; A.M. Keenan, PhD, Professor of Allied Health Research, School of Healthcare, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre; A.C. Redmond, PhD, Professor of Clinical Biomechanics, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre, and Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis; P.G. Conaghan, PhD, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre, and Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis. P.G. Conaghan and A.C. Redmond contributed equally to this study
| | - Carmen Martín-Hervás
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the School of Healthcare, University of Leeds; UK National Institute for Health Research (NIHR) Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds; Arthritis Research UK Experimental Osteoarthritis Treatment Centre, Leeds; Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Nottingham/Leeds; Salford Royal Hospital UK National Health Service (NHS) Foundation Trust, Manchester, UK; Department of Musculoskeletal Radiology, La Paz University Hospital, Autonomous University of Madrid; Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain.,J. Halstead, PhD, Visiting Research Fellow, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Principal Podiatrist, Salford Royal Hospital NHS Foundation Trust; C. Martín-Hervás, PhD, MD, Consultant Radiologist, Department of Musculoskeletal Radiology, La Paz University Hospital, and Associate Professor of Radiology, School of Medicine, Autonomous University of Madrid, and Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine; E.M. Hensor, PhD, Biostatistician, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust; D. McGonagle, PhD, Professor of Investigative Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust; A.M. Keenan, PhD, Professor of Allied Health Research, School of Healthcare, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre; A.C. Redmond, PhD, Professor of Clinical Biomechanics, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre, and Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis; P.G. Conaghan, PhD, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre, and Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis. P.G. Conaghan and A.C. Redmond contributed equally to this study
| | - Elizabeth M A Hensor
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the School of Healthcare, University of Leeds; UK National Institute for Health Research (NIHR) Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds; Arthritis Research UK Experimental Osteoarthritis Treatment Centre, Leeds; Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Nottingham/Leeds; Salford Royal Hospital UK National Health Service (NHS) Foundation Trust, Manchester, UK; Department of Musculoskeletal Radiology, La Paz University Hospital, Autonomous University of Madrid; Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain.,J. Halstead, PhD, Visiting Research Fellow, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Principal Podiatrist, Salford Royal Hospital NHS Foundation Trust; C. Martín-Hervás, PhD, MD, Consultant Radiologist, Department of Musculoskeletal Radiology, La Paz University Hospital, and Associate Professor of Radiology, School of Medicine, Autonomous University of Madrid, and Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine; E.M. Hensor, PhD, Biostatistician, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust; D. McGonagle, PhD, Professor of Investigative Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust; A.M. Keenan, PhD, Professor of Allied Health Research, School of Healthcare, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre; A.C. Redmond, PhD, Professor of Clinical Biomechanics, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre, and Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis; P.G. Conaghan, PhD, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre, and Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis. P.G. Conaghan and A.C. Redmond contributed equally to this study
| | - Dennis McGonagle
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the School of Healthcare, University of Leeds; UK National Institute for Health Research (NIHR) Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds; Arthritis Research UK Experimental Osteoarthritis Treatment Centre, Leeds; Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Nottingham/Leeds; Salford Royal Hospital UK National Health Service (NHS) Foundation Trust, Manchester, UK; Department of Musculoskeletal Radiology, La Paz University Hospital, Autonomous University of Madrid; Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain.,J. Halstead, PhD, Visiting Research Fellow, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Principal Podiatrist, Salford Royal Hospital NHS Foundation Trust; C. Martín-Hervás, PhD, MD, Consultant Radiologist, Department of Musculoskeletal Radiology, La Paz University Hospital, and Associate Professor of Radiology, School of Medicine, Autonomous University of Madrid, and Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine; E.M. Hensor, PhD, Biostatistician, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust; D. McGonagle, PhD, Professor of Investigative Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust; A.M. Keenan, PhD, Professor of Allied Health Research, School of Healthcare, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre; A.C. Redmond, PhD, Professor of Clinical Biomechanics, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre, and Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis; P.G. Conaghan, PhD, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre, and Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis. P.G. Conaghan and A.C. Redmond contributed equally to this study
| | - Anne-Maree Keenan
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the School of Healthcare, University of Leeds; UK National Institute for Health Research (NIHR) Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds; Arthritis Research UK Experimental Osteoarthritis Treatment Centre, Leeds; Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Nottingham/Leeds; Salford Royal Hospital UK National Health Service (NHS) Foundation Trust, Manchester, UK; Department of Musculoskeletal Radiology, La Paz University Hospital, Autonomous University of Madrid; Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain.,J. Halstead, PhD, Visiting Research Fellow, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Principal Podiatrist, Salford Royal Hospital NHS Foundation Trust; C. Martín-Hervás, PhD, MD, Consultant Radiologist, Department of Musculoskeletal Radiology, La Paz University Hospital, and Associate Professor of Radiology, School of Medicine, Autonomous University of Madrid, and Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine; E.M. Hensor, PhD, Biostatistician, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust; D. McGonagle, PhD, Professor of Investigative Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust; A.M. Keenan, PhD, Professor of Allied Health Research, School of Healthcare, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre; A.C. Redmond, PhD, Professor of Clinical Biomechanics, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre, and Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis; P.G. Conaghan, PhD, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre, and Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis. P.G. Conaghan and A.C. Redmond contributed equally to this study
| | - Anthony C Redmond
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the School of Healthcare, University of Leeds; UK National Institute for Health Research (NIHR) Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds; Arthritis Research UK Experimental Osteoarthritis Treatment Centre, Leeds; Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Nottingham/Leeds; Salford Royal Hospital UK National Health Service (NHS) Foundation Trust, Manchester, UK; Department of Musculoskeletal Radiology, La Paz University Hospital, Autonomous University of Madrid; Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain. .,J. Halstead, PhD, Visiting Research Fellow, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Principal Podiatrist, Salford Royal Hospital NHS Foundation Trust; C. Martín-Hervás, PhD, MD, Consultant Radiologist, Department of Musculoskeletal Radiology, La Paz University Hospital, and Associate Professor of Radiology, School of Medicine, Autonomous University of Madrid, and Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine; E.M. Hensor, PhD, Biostatistician, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust; D. McGonagle, PhD, Professor of Investigative Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust; A.M. Keenan, PhD, Professor of Allied Health Research, School of Healthcare, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre; A.C. Redmond, PhD, Professor of Clinical Biomechanics, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre, and Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis; P.G. Conaghan, PhD, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre, and Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis. P.G. Conaghan and A.C. Redmond contributed equally to this study.
| | - Philip G Conaghan
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the School of Healthcare, University of Leeds; UK National Institute for Health Research (NIHR) Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds; Arthritis Research UK Experimental Osteoarthritis Treatment Centre, Leeds; Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Nottingham/Leeds; Salford Royal Hospital UK National Health Service (NHS) Foundation Trust, Manchester, UK; Department of Musculoskeletal Radiology, La Paz University Hospital, Autonomous University of Madrid; Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain.,J. Halstead, PhD, Visiting Research Fellow, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Principal Podiatrist, Salford Royal Hospital NHS Foundation Trust; C. Martín-Hervás, PhD, MD, Consultant Radiologist, Department of Musculoskeletal Radiology, La Paz University Hospital, and Associate Professor of Radiology, School of Medicine, Autonomous University of Madrid, and Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine; E.M. Hensor, PhD, Biostatistician, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust; D. McGonagle, PhD, Professor of Investigative Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust; A.M. Keenan, PhD, Professor of Allied Health Research, School of Healthcare, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre; A.C. Redmond, PhD, Professor of Clinical Biomechanics, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre, and Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis; P.G. Conaghan, PhD, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Arthritis Research UK Experimental Osteoarthritis Treatment Centre, and Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis. P.G. Conaghan and A.C. Redmond contributed equally to this study
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Cockayne S, Fairhurst C, Adamson J, Hewitt C, Hull R, Hicks K, Keenan AM, Lamb SE, Green L, McIntosh C, Menz HB, Redmond AC, Rodgers S, Torgerson DJ, Vernon W, Watson J, Knapp P, Rick J, Bower P, Eldridge S, Madurasinghe VW, Graffy J. An optimised patient information sheet did not significantly increase recruitment or retention in a falls prevention study: an embedded randomised recruitment trial. Trials 2017; 18:144. [PMID: 28351376 PMCID: PMC5370466 DOI: 10.1186/s13063-017-1797-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 01/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background Randomised controlled trials are generally regarded as the ‘gold standard’ experimental design to determine the effectiveness of an intervention. Unfortunately, many trials either fail to recruit sufficient numbers of participants, or recruitment takes longer than anticipated. The current embedded trial evaluates the effectiveness of optimised patient information sheets on recruitment of participants in a falls prevention trial. Methods A three-arm, embedded randomised methodology trial was conducted within the National Institute for Health Research-funded REducing Falls with ORthoses and a Multifaceted podiatry intervention (REFORM) cohort randomised controlled trial. Routine National Health Service podiatry patients over the age of 65 were randomised to receive either the control patient information sheet (PIS) for the host trial or one of two optimised versions, a bespoke user-tested PIS or a template-developed PIS. The primary outcome was the proportion of patients in each group who went on to be randomised to the host trial. Results Six thousand and nine hundred patients were randomised 1:1:1 into the embedded trial. A total of 193 (2.8%) went on to be randomised into the main REFORM trial (control n = 62, template-developed n = 68; bespoke user-tested n = 63). Information sheet allocation did not improve recruitment to the trial (odds ratios for the three pairwise comparisons: template vs control 1.10 (95% CI 0.77–1.56, p = 0.60); user-tested vs control 1.01 (95% CI 0.71–1.45, p = 0.94); and user-tested vs template 0.92 (95% CI 0.65–1.31, p = 0.65)). Conclusions This embedded methodology trial has demonstrated limited evidence as to the benefit of using optimised information materials on recruitment and retention rates in the REFORM study. Trial registration International Standard Randomised Controlled Trials Number registry, ISRCTN68240461. Registered on 01 July 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1797-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Cockayne
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Caroline Fairhurst
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Joy Adamson
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Catherine Hewitt
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Robin Hull
- Podiatry Services, Harrogate and District NHS Foundation Trust, Harrogate District Hospital, Lancaster Park Road, Harrogate, UK
| | - Kate Hicks
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Anne-Maree Keenan
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.,Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Critical Care Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Lorraine Green
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.,Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Caroline McIntosh
- School of Health Sciences, Áras Moyola, National University of Ireland, Galway, Ireland
| | - Hylton B Menz
- Lower Extremity and Gait Studies Program, Faculty of Health Sciences, La Trobe University, Bundoora, 3086, Victoria, Australia
| | - Anthony C Redmond
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.,Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Sara Rodgers
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - David J Torgerson
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Wesley Vernon
- The School of Human & Health Sciences, Division of Podiatry, University of Huddersfield, Huddersfield, UK
| | - Judith Watson
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Peter Knapp
- Department of Health Sciences and the Hull York Medical School, University of York, York, YO10 5DD, UK
| | - Jo Rick
- Medical Research Council North West Hub for Trials Methodology Research, National Institute of Health Research (NIHR) School for Primary Care Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Peter Bower
- Medical Research Council North West Hub for Trials Methodology Research, National Institute of Health Research (NIHR) School for Primary Care Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Sandra Eldridge
- Pragmatic Clinical Trials Unit (PCTU), Centre for Primary Care and Public Health, Blizard Institute, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Vichithranie W Madurasinghe
- Pragmatic Clinical Trials Unit (PCTU), Centre for Primary Care and Public Health, Blizard Institute, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Jonathan Graffy
- Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
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Cockayne S, Adamson J, Clarke A, Corbacho B, Fairhurst C, Green L, Hewitt CE, Hicks K, Kenan AM, Lamb SE, McIntosh C, Menz HB, Redmond AC, Richardson Z, Rodgers S, Vernon W, Watson J, Torgerson DJ. Cohort Randomised Controlled Trial of a Multifaceted Podiatry Intervention for the Prevention of Falls in Older People (The REFORM Trial). PLoS One 2017; 12:e0168712. [PMID: 28107372 PMCID: PMC5249075 DOI: 10.1371/journal.pone.0168712] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/03/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Falls are a major cause of morbidity among older people. A multifaceted podiatry intervention may reduce the risk of falling. This study evaluated such an intervention. DESIGN Pragmatic cohort randomised controlled trial in England and Ireland. 1010 participants were randomised (493 to the Intervention group and 517 to Usual Care) to either: a podiatry intervention, including foot and ankle exercises, foot orthoses and, if required, new footwear, and a falls prevention leaflet or usual podiatry treatment plus a falls prevention leaflet. The primary outcome was the incidence rate of self-reported falls per participant in the 12 months following randomisation. Secondary outcomes included: proportion of fallers and those reporting multiple falls, time to first fall, fear of falling, Frenchay Activities Index, Geriatric Depression Scale, foot pain, health related quality of life, and cost-effectiveness. RESULTS In the primary analysis were 484 (98.2%) intervention and 507 (98.1%) control participants. There was a small, non statistically significant reduction in the incidence rate of falls in the intervention group (adjusted incidence rate ratio 0.88, 95% CI 0.73 to 1.05, p = 0.16). The proportion of participants experiencing a fall was lower (49.7 vs 54.9%, adjusted odds ratio 0.78, 95% CI 0.60 to 1.00, p = 0.05) as was the proportion experiencing two or more falls (27.6% vs 34.6%, adjusted odds ratio 0.69, 95% CI 0.52 to 0.90, p = 0.01). There was an increase (p = 0.02) in foot pain for the intervention group. There were no statistically significant differences in other outcomes. The intervention was more costly but marginally more beneficial in terms of health-related quality of life (mean quality adjusted life year (QALY) difference 0.0129, 95% CI -0.0050 to 0.0314) and had a 65% probability of being cost-effective at a threshold of £30,000 per QALY gained. CONCLUSION There was a small reduction in falls. The intervention may be cost-effective. TRIAL REGISTRATION ISRCTN ISRCTN68240461.
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Affiliation(s)
- Sarah Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
- * E-mail:
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Arabella Clarke
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Belen Corbacho
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Lorraine Green
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Catherine E. Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Kate Hicks
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Anne-Maree Kenan
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Sarah E. Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Critical Care Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | | | - Hylton B. Menz
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Anthony C. Redmond
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Zoe Richardson
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Wesley Vernon
- Podiatry Services, Sheffield Teaching Hospitals NHS Foundation Trust, Jordanthorpe Health Centre, Sheffield, United Kingdom
| | - Judith Watson
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - David J. Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
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44
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Siddle HJ, Mandl P, Aletaha D, Vliet Vlieland TP, Backhaus M, Cornell P, D'Agostino MA, Ellegaard K, Iagnocco A, Jakobsen B, Jasinski T, Kildal NH, Lehner M, Möller I, Supp GM, O'Connor P, Redmond AC, Naredo E, Wakefield RJ. The EULAR points to consider for health professionals undertaking musculoskeletal ultrasound for rheumatic and musculoskeletal diseases. Ann Rheum Dis 2016; 77:311-313. [PMID: 27941130 DOI: 10.1136/annrheumdis-2016-210741] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 11/22/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds, UK
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Thea P Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marina Backhaus
- Department of Internal Medicine, Rheumatology and Clinical Immunology, Academic Hospital of the Charité Berlin, Berlin, Germany
| | - Patricia Cornell
- Department of Rheumatology, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Maria-Antonietta D'Agostino
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Laboratoire d'Excellence INFLAMEX, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France
| | - Karen Ellegaard
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Annamaria Iagnocco
- Rheumatology Unit-Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - Bente Jakobsen
- National Advisory Unit on Pregnancy and Rheumatic Diseases, St. Olavs Hospital, Trondheim, Norway
| | - Tiina Jasinski
- Patient Research Partner, Estonian Rheumatism Association, Tallinn, Estonia
| | - Nina H Kildal
- Faculty of Health and Social Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Michaela Lehner
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | | | - Gabriela M Supp
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Philip O'Connor
- NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds, UK.,Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds, UK
| | - Esperanza Naredo
- Department of Rheumatology, Hospital GU Gregorio Marañón, Madrid, Spain
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds, UK
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45
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Chapman GJ, Halstead J, Redmond AC. Comparability of off the shelf foot orthoses in the redistribution of forces in midfoot osteoarthritis patients. Gait Posture 2016; 49:235-240. [PMID: 27459418 PMCID: PMC5038933 DOI: 10.1016/j.gaitpost.2016.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/08/2016] [Accepted: 07/13/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Midfoot osteoarthritis (OA) is more prevalent and strongly associated with pain than previously thought. Excessive mechanical loading of the midfoot structures may contribute to midfoot OA and studies suggest that functional foot orthoses (FFO) may relieve pain through improving function. This exploratory study aimed to evaluate the mechanical effect of two off-the-shelf FFOs, compared to a sham orthosis in people with midfoot OA. METHODS Thirty-three participants with radiographically confirmed symptomatic midfoot OA were randomly assigned to wear either a commercially available FFO or a sham orthosis. After wearing their assigned orthoses for 12 weeks, plantar pressure measurements were obtained under shoe-only and assigned orthoses conditions. Participants assigned to the sham, were additionally tested wearing a second type of FFO at the end of trial. Descriptive mean change (±95% confidence intervals) in plantar pressure for each orthoses condition, versus a shoe only baseline condition are presented. FINDINGS Compared to the shoe only conditions, both FFOs decreased hindfoot and forefoot maximum force and peak pressure, whilst increasing maximum force and contact area under the midfoot. The sham orthosis yielded plantar pressures similar to the shoe-only condition. INTERPRETATION Findings suggest that both types of off-the-shelf FFO may provide mechanical benefit, whilst the sham orthoses produced similar findings to the shoe only condition, indicating appropriate sham properties. This paper provides insight into the mechanisms of action underpinning the use of FFOs and sham orthoses, which can inform future definitive RCTs examining the effect of orthoses on midfoot OA.
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Affiliation(s)
- Graham J. Chapman
- Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK,NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK,Arthritis Research UK, Experimental Osteoarthritis Treatment Centre, UK,Corresponding author at: Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Road, Leeds, LS7 4SA, UK.
| | - Jill Halstead
- Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK,Arthritis Research UK, Experimental Osteoarthritis Treatment Centre, UK
| | - Anthony C. Redmond
- Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK,NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK,Arthritis Research UK, Experimental Osteoarthritis Treatment Centre, UK,Arthritis Research UK, Sports, Exercise and Osteoarthritis Centre, UK
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46
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Santiago T, Alcacer-Pitarch B, Salvador MJ, Del Galdo F, Redmond AC, da Silva JAP. A preliminary study using virtual touch imaging and quantification for the assessment of skin stiffness in systemic sclerosis. Clin Exp Rheumatol 2016; 34 Suppl 100:137-141. [PMID: 26939859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 01/18/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To evaluate ultrasound Virtual Touch Imaging and Quantification (VTIQ) as a method for determining absolute skin stiffness in patients with systemic sclerosis (SSc). METHODS Skin thickness, assessed by the modified Rodnan Skin Score (mRSS) and absolute skin stiffness, using VTIQ, were measured at all mRSS anatomical sites to quantify the shear wave velocity (in m/s) in 26 SSc patients and in 17 age- and gender-matched controls. Correlations between mRSS and absolute skin stiffness, and comparisons between patients and controls were analysed statistically using Mann-Whitney U tests and correlations between variables using Pearson's. P values <0.05 were considered significant. RESULTS Shear wave velocity as a measure of skin stiffness was significantly higher in SSc than in controls in 11 out of 16 mRSS sites investigated. Shear-wave velocity was strongly correlated with the local mRSS in the following anatomical sites: forearm, hand, phalanx, and thigh. In the patient group, clinically unaffected skin could also be differentiated from healthy skin using shear-wave velocity. CONCLUSIONS VTIQ represents an innovative and promising technique that provides, for the first time, a non-invasive, absolute quantification of skin stiffness. Further studies of VTIQ are required, but this early study supports the clinical and scientific potential of this new measure of skin involvement in SSc.
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Affiliation(s)
- Tânia Santiago
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Begonya Alcacer-Pitarch
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds; and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Maria João Salvador
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Francesco Del Galdo
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds; and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Anthony C Redmond
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds; and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospital NHS Trust, Leeds, UK
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47
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Backhouse MR, Vinall-Collier KA, Redmond AC, Helliwell PS, Keenan AM. Interpreting outcome following foot surgery in people with rheumatoid arthritis. J Foot Ankle Res 2016; 9:20. [PMID: 27398097 PMCID: PMC4938997 DOI: 10.1186/s13047-016-0153-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/22/2016] [Indexed: 11/16/2022] Open
Abstract
Background Foot surgery is common in RA but the current lack of understanding of how patients interpret outcomes inhibits evaluation of procedures in clinical and research settings. This study aimed to explore which factors are important to people with RA when they evaluate the outcome of foot and ankle surgery. Methods and Results Semi structured interviews with 11 RA participants who had mixed experiences of foot surgery were conducted and analysed using thematic analysis. Responses showed that while participants interpreted surgical outcome in respect to a multitude of factors, five major themes emerged: functional ability, participation, appearance of feet and footwear, surgeons’ opinion, and pain. Participants interpreted levels of physical function in light of other aspects of their disease, reflecting on relative change from their preoperative state more than absolute levels of ability. Appearance was important to almost all participants: physical appearance, foot shape, and footwear were closely interlinked, yet participants saw these as distinct concepts and frequently entered into a defensive repertoire, feeling the need to justify that their perception of outcome was not about cosmesis. Surgeons’ post-operative evaluation of the procedure was highly influential and made a lasting impression, irrespective of how the outcome compared to the participants’ initial goals. Whilst pain was important to almost all participants, it had the greatest impact upon them when it interfered with their ability to undertake valued activities. Conclusions People with RA interpret the outcome of foot surgery using multiple interrelated factors, particularly functional ability, appearance and surgeons’ appraisal of the procedure. While pain was often noted, this appeared less important than anticipated. These factors can help clinicians in discussing surgical options in patients. Electronic supplementary material The online version of this article (doi:10.1186/s13047-016-0153-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael R Backhouse
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA UK ; NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Karen A Vinall-Collier
- Dental Public Health, University of Leeds, Leeds, UK ; Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA UK ; NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA UK ; Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Anne-Maree Keenan
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK ; School of Healthcare, University of Leeds, Leeds, UK
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48
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Wilkins RA, Siddle HJ, Redmond AC, Helliwell PS. Plantar forefoot pressures in psoriatic arthritis-related dactylitis: an exploratory study. Clin Rheumatol 2016; 35:2333-8. [PMID: 27225246 PMCID: PMC4989019 DOI: 10.1007/s10067-016-3304-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 05/04/2016] [Accepted: 05/07/2016] [Indexed: 12/14/2022]
Abstract
Dactylitis is a common feature of psoriatic arthritis (PsA); local physical trauma has been identified as a possible contributing factor. The aim of this study was to explore differences in forefoot plantar pressures in patients with PsA with and without dactylitis and compare to healthy controls. Thirty-six participants were recruited into three groups: group A PsA plus a history of dactylitis; group B PsA, no dactylitis; group C control participants. Forefoot plantar pressures were measured barefoot and in-shoe at the left second and fourth toes and corresponding metatarsophalangeal joints. Temporal and spatial parameters were measured and data from the foot impact scale for rheumatoid arthritis (FIS-RA), EQ5D and health assessment questionnaire (HAQ) were collected. Pressure time integral peak plantar pressure, and contact time barefoot and in-shoe were not significantly different between groups. Temporal and spatial parameters reported no significant differences between groups. ANOVA analysis and subsequent post hoc testing using Games-Howell test yielded significance in FIS-RA scores between both PsA groups versus controls, A p ≤ 0.0001 and PsA group B p < 0.0001 in the FIS-RA impairment and footwear domain, PsA group A p < 0.03 and PsA group B p ≤ 0.05 in the FIS-RA activity and participation domain compared to controls. This is the first exploratory study to investigate forefoot plantar pressures in patients with and without historical dactylitis in PsA. FIS-RA scores indicate PsA patients have significant limitations compared to controls, although a history of dactylitis does not appear to worsen patient reported outcomes.
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Affiliation(s)
- Richard A Wilkins
- Section of Clinical Biomechanics and Physical Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK. .,Foot Health Department, Leeds Teaching Hospitals NHS Trust, Lower Ground Floor, Chancellor Wing, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK.
| | - Heidi J Siddle
- Section of Clinical Biomechanics and Physical Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.,Foot Health Department, Leeds Teaching Hospitals NHS Trust, Lower Ground Floor, Chancellor Wing, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Anthony C Redmond
- Section of Clinical Biomechanics and Physical Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK
| | - Philip S Helliwell
- Section of Clinical Biomechanics and Physical Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.,Rheumatology Department, Bradford Teaching Hospitals NHS foundation Trust, St Luke's Hospital, Little Horton Lane, Bradford, BD5 0NA, UK
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Halstead J, Keenan AM, Chapman GJ, Redmond AC. The feasibility of a modified shoe for multi-segment foot motion analysis: a preliminary study. J Foot Ankle Res 2016; 9:7. [PMID: 26913080 PMCID: PMC4765151 DOI: 10.1186/s13047-016-0138-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 02/16/2016] [Indexed: 11/12/2022] Open
Abstract
Background The majority of multi-segment kinematic foot studies have been limited to barefoot conditions, because shod conditions have the potential for confounding surface-mounted markers. The aim of this study was to investigate whether a shoe modified with a webbed upper can accommodate multi-segment foot marker sets without compromising kinematic measurements under barefoot and shod conditions. Methods Thirty participants (15 controls and 15 participants with midfoot pain) underwent gait analysis in two conditions; barefoot and wearing a shoe (shod) in a random order. The shod condition employed a modified shoe (rubber plimsoll) with a webbed upper, allowing skin mounted reflective markers to be visualised through slits in the webbed material. Three dimensional foot kinematics were captured using the Oxford multi-segment foot model whilst participants walked at a self-selected speed. Results The foot pain group showed greater hindfoot eversion and less hindfoot dorsiflexion than controls in the barefoot condition and these differences were maintained when measured in the shod condition. Differences between the foot pain and control participants were also observed for walking speed in the barefoot and in the shod conditions. No significant differences between foot pain and control groups were demonstrated at the forefoot in either condition. Conclusions Subtle differences between pain and control groups, which were found during barefoot walking are retained when wearing the modified shoe. The novel properties of the modified shoe offers a potential solution for the use of passive infrared based motion analysis for shod applications, for instance to investigate the kinematic effect of foot orthoses.
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Affiliation(s)
- J Halstead
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA UK
| | - A M Keenan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA UK ; NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK ; Arthritis Research UK Experimental Arthritis Centre, Leeds, UK
| | - G J Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA UK ; NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK ; Arthritis Research UK Experimental Arthritis Centre, Leeds, UK
| | - A C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA UK ; NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK ; Arthritis Research UK Experimental Arthritis Centre, Leeds, UK ; Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Nottingham, UK ; Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Oxford, UK ; Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Loughborough, UK ; Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Leeds, UK
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Drew BT, Redmond AC, Smith TO, Penny F, Conaghan PG. Which patellofemoral joint imaging features are associated with patellofemoral pain? Systematic review and meta-analysis. Osteoarthritis Cartilage 2016; 24:224-36. [PMID: 26471209 DOI: 10.1016/j.joca.2015.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/06/2015] [Accepted: 09/09/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To review the association between patellofemoral joint (PFJ) imaging features and patellofemoral pain (PFP). DESIGN A systematic review of the literature from AMED, CiNAHL, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PEDro, EMBASE and SPORTDiscus was undertaken from their inception to September 2014. Studies were eligible if they used magnetic resonance imaging (MRI), computed tomography (CT), ultrasound (US) or X-ray (XR) to compare PFJ features between a PFP group and an asymptomatic control group in people <45 years of age. A pooled meta-analysis was conducted and data was interpreted using a best evidence synthesis. RESULTS Forty studies (all moderate to high quality) describing 1043 people with PFP and 839 controls were included. Two features were deemed to have a large standardised mean difference (SMD) based on meta-analysis: an increased MRI bisect offset at 0° knee flexion under load (0.99; 95% CI: 0.49, 1.49) and an increased CT congruence angle at 15° knee flexion, both under load (1.40 95% CI: 0.04, 2.76) and without load (1.24; 95% CI: 0.37, 2.12). A medium SMD was identified for MRI patella tilt and patellofemoral contact area. Limited evidence was found to support the association of other imaging features with PFP. A sensitivity analysis showed an increase in the SMD for patella bisect offset at 0° knee flexion (1.91; 95% CI: 1.31, 2.52) and patella tilt at 0° knee flexion (0.99; 95% CI: 0.47, 1.52) under full weight bearing. CONCLUSION Certain PFJ imaging features were associated with PFP. Future interventional strategies may be targeted at these features. PROSPERO REGISTRATION NUMBER CRD 42014009503.
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Affiliation(s)
- B T Drew
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK; NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - A C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK; NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - T O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - F Penny
- Physiotherapy Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - P G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK; NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
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