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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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Chapman LS, Kelly A, Balay-Dustrude E, Bekker C, Berthelsen DB, Ghosh N, Gordon RA, Haas R, Jones C, Luquini A, Weinbrecht-Mischkewitz M, Pickles T, Saygin D, Nielsen W, Webers C, Grosskleg S, Tugwell P, D'Agostino MA, Guillemin F, March L. Evolving and evaluating the OMERACT fellows program: insights and implications from OMERACT 2023 fellows. Semin Arthritis Rheum 2024; 65:152391. [PMID: 38340612 DOI: 10.1016/j.semarthrit.2024.152391] [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: 11/10/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To describe the evolution of the OMERACT Fellows Program (OM FP) and to evaluate the innovative changes implemented in the 2023 program. METHODS The OM FP, the first of its kind in global rheumatology, was developed in 2000 to mentor early career researchers in methods and processes for reaching evidence-driven consensus for outcome measures in clinical studies. The OM FP has evolved through continuing iterations of face to face and online feedback. Key new features delivered in 2023 included e-learning modules, virtual introductory pre-meetings, increased networking with Patient Research Partners (PRPs), learning opportunities to give and receive personal feedback, ongoing performance feedback during the meeting from Fellow peers, PRPs, senior OMERACTers (members of the OMERACT community) and Emerging Leader mentors, involvement in pitching promotions, two-minute Lightning Talks in a plenary session and an embedded poster tour. An online survey was distributed after the meeting to evaluate the program. RESULTS OM FP has included 208 fellows from 16 countries across 4 continents covering 47 different aspects of rheumatology outcomes since its inception. Over 50 % have remained engaged with OMERACT work. In 2023, 18 Fellows attended and 15 (83 %) completed the post-meeting survey. A dedicated OM FP was deemed important by all respondents, and 93 % would attend the meeting in future. The PRP/Fellow Connection Carousel and Lightning Talks were rated exceptional by 93 %. Key components to improve included clarification of expectations, overall workload, the Emerging Leaders Mentoring Program, and the content and duration of daily summary sessions. CONCLUSION The innovations in the 2023 OM FP were well received by the majority of participants and supports early career rheumatology researchers to develop collaborations, skills and expertise in outcome measurement. Implementation of feedback from Fellows will enhance the program for future meetings, continuing to facilitate learning and succession planning within OMERACT.
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Affiliation(s)
- Lara S Chapman
- HEE/NIHR Clinical Doctoral Research Fellow, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK.
| | - Ayano Kelly
- PhD student, Canberra Rheumatology, Department of Rheumatology, Canberra Hospital, and College of Health and Medicine, Australian National University, Australia
| | - Erin Balay-Dustrude
- Pediatric Rheumatology Fellow, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Charlotte Bekker
- Assistant Professor, Department of Pharmacy, Radboudumc university medical center, the Netherlands
| | - Dorthe B Berthelsen
- PhD student, Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark; Department of Rehabilitation, Municipality of Guldborgsund, Nykoebing F, Denmark
| | - Nilasha Ghosh
- Assistant Professor, Hospital for Special Surgery/Weill Cornell Medical College, Cornell University, New York, USA
| | - Rachael A Gordon
- Rheumatology Fellow, University of Pittsburgh, Department of Medicine, Division of Rheumatology and Clinical Immunology, Pittsburgh, USA
| | - Romi Haas
- Research Fellow, Musculoskeletal Health and Wiser Health Care Units, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Caitlin Jones
- Postdoctoral Research Associate, Sydney Musculoskeletal Health, Sydney School of Public Health & The Institute for Musculoskeletal Health, Sydney Local Health District and University of Sydney, Australia
| | - Andre Luquini
- PhD student, Department of Experimental Medicine, Faculty of Medicine, University of British Columbia, Canada
| | - Max Weinbrecht-Mischkewitz
- Research Fellow, Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Internal Medicine, Rheumatology, Clinical Immunology and Osteology, Schlosspark-Klinik, University Medicine Berlin, Germany
| | - Tim Pickles
- Health and Care Research Wales NIHR Doctoral Fellow, Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Didem Saygin
- Assistant Professor, University of Pittsburgh Medical Center, Department of Medicine, Division of Rheumatology and Clinical Immunology, Pittsburgh, USA
| | - Wils Nielsen
- PhD student, University of Toronto Lupus Clinic, Centre for Prognosis Studies, Rheumatic Diseases, Toronto Western Hospital, Toronto, ON, Canada
| | - Casper Webers
- Postdoctoral Researcher, Department of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Shawna Grosskleg
- Secretariat, Outcome Measures in Rheumatology (OMERACT), Toronto, Canada
| | - Peter Tugwell
- Professor of Medicine and Epidemiology & Community Medicine, University of Ottawa, Ontario, Canada
| | - Maria Antonietta D'Agostino
- Professor of Rheumatology, Università Cattolica del Sacro Cuore; Rheumatology UOC, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | | | - Lyn March
- Professor, Department of Rheumatology, Royal North Shore Hospital and Kolling Institute, The University of Sydney, Australia
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Chapman LS, Siddle HJ, Serban S, Mankia K, Rooney CM, Mustufvi Z, Pini S, Vinall-Collier K. 'What is my risk really?': a qualitative exploration of preventive interventions among individuals at risk of rheumatoid arthritis. Rheumatol Adv Pract 2024; 8:rkae023. [PMID: 38495430 PMCID: PMC10939459 DOI: 10.1093/rap/rkae023] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/05/2024] [Indexed: 03/19/2024] Open
Abstract
Objectives Intervention in the pre-arthritis phase of RA could prevent or delay the onset of disease. The primary aim of this study was to explore perspectives of being at risk and potential preventive interventions among individuals at risk of developing RA and to identify factors influencing their engagement with prevention. A secondary aim, established during the analytical process, was to understand and compare different approaches to health-related behaviours related to prevention of RA. Methods Anti-CCP-positive (CCP+) at-risk individuals with musculoskeletal symptoms but no synovitis participated in semi-structured interviews. Data were analysed using reflexive thematic analysis, followed by a secondary ideal-type analysis. Results Nineteen CCP+ at-risk individuals (10 women; age range 35-70 years) participated. Three overarching themes were identified: being CCP+ at risk; aiming to prevent RA; and influencers of engagement. Participants described distress related to symptoms and uncertainty about disease progression. Many participants had concerns about medication side effects. In contrast, most participants expressed willingness to make lifestyle changes with the aim of preventing RA. Engagement with preventive measures was influenced by symptom severity, personal risk level, co-morbidities, experiences of taking other medications/supplements, knowledge of RA, risk factors and medications, and perceived effort. Three types of participants were identified from the data: proactive preventers, change considerers and fearful avoiders. Overall orientation to health behaviours also impacted the attitude towards preventing RA. Conclusion Findings could inform recruitment and retention in RA prevention research and promote uptake of preventive interventions in clinical practice.
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Affiliation(s)
- Lara S Chapman
- 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, Leeds, UK
| | - Stefan Serban
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Kulveer Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
| | | | | | - Simon Pini
- Leeds Institute of Health Sciences, University of Leeds, Leeds, 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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5
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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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6
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Chapman LS, Vinall-Collier K, Siddle HJ, Mustufvi Z, Mankia K, Serban S. 'It surprised me a lot that there is a link': a qualitative study of the acceptability of periodontal treatment for individuals at risk of rheumatoid arthritis. RMD Open 2023; 9:rmdopen-2023-003099. [PMID: 37156573 PMCID: PMC10174022 DOI: 10.1136/rmdopen-2023-003099] [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: 02/22/2023] [Accepted: 04/06/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES Current evidence suggests that periodontal disease could be a causal risk factor for rheumatoid arthritis (RA) onset and progression. Earlier periodontal intervention in individuals at risk of RA could provide a unique opportunity to prevent or delay the onset of RA. This study aimed to explore the acceptability of periodontal treatment as a measure to potentially prevent RA among at-risk individuals and healthcare professionals. METHODS Semistructured interviews were conducted with anti-CCP positive at-risk individuals (CCP+ at risk) and a range of healthcare professionals. At-risk participant data were analysed using reflexive thematic analysis; subsequent coding of healthcare professional data was deductive, based on a preidentified set of constructs. RESULTS Nineteen CCP+ at-risk and 11 healthcare professionals participated. Three themes (six subthemes) were identified: (1) understanding risk (knowledge of shared at-risk factors; information and communication); (2) oral health perceptions and experiences (personal challenges and opportunities for dental intervention and oral health maintenance; external barriers) and (3) oral health treatment and maintenance (making oral health changes with the aim of preventing RA; acceptability of participation in periodontal research). CONCLUSIONS Periodontal disease is common in individuals at risk of RA, but the impact of poor oral health may not be well understood. Oral health information should be tailored to the individual. CCP+ at-risk participants and healthcare professionals identified seeking dental treatment can be hindered by dental phobia, treatment costs or inability to access dentists. While CCP+ at-risk individuals may be reluctant to take preventive medications, a clinical trial involving preventive periodontal treatment is potentially acceptable.
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Affiliation(s)
- Lara S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Karen Vinall-Collier
- Department of Dental Public Health, School of Dentistry, University of Leeds, Leeds, UK
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Zhain Mustufvi
- Department of Dental Public Health, School of Dentistry, University of Leeds, Leeds, UK
| | - K Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Stefan Serban
- Department of Dental Public Health, School of Dentistry, University of Leeds, Leeds, UK
- Public Health Directorate, NHS England North West Region, Manchester, UK
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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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Anderson AM, Chapman LS, Siddle HJ, Watson S, Klugerman J, Antcliff D, Keenan AM, Brockett CL. "I could have a proper ankle" - a qualitative study of patients' perceptions of total ankle replacement and ankle fusion surgery. J Foot Ankle Res 2022; 15:88. [PMID: 36503504 PMCID: PMC9743489 DOI: 10.1186/s13047-022-00595-8] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND End-stage ankle osteoarthritis typically causes severe pain and impaired function. Surgical treatment involves total ankle replacement (TAR) or ankle fusion. Definitive evidence about which procedure is optimal is lacking. No previous studies have thoroughly explored patients' experiences across the entire TAR/ankle fusion pathway. This study aimed to address this gap by exploring perceptions of surgery, education, rehabilitation and outcomes among patients who had undergone TAR or ankle fusion. METHODS Seven participants were purposively selected from an orthopaedic centre in northern England (3 females, 4 males). Participants had undergone primary TAR without revision (n = 2), TAR requiring revision (n = 3) or ankle fusion (n = 2). Each participant completed a single semi-structured interview. Interviews were digitally recorded, transcribed verbatim and analysed thematically. RESULTS Three themes, each with two subthemes, were identified: decision-making (seeking help; surgical options), perceptions of support (information/education; clinical support) and impact on the individual (personal circumstances and beliefs; post-operative outcomes). Pain affecting participants' valued activities was key to their decision to seek help. Participants' decision between TAR and ankle fusion was influenced by multiple factors. Concerns regarding the lack of joint flexibility following fusion were highlighted, with some participants perceiving TAR as a "proper ankle" that would enable them to avoid limping. Participants obtained information from various sources, with most feeling that the education from their care team was inadequate. Participants' individual circumstances and beliefs influenced their decision-making and perceptions of their post-operative outcomes. Finally, whilst most participants were pleased with their outcomes, some experienced substantial ongoing problems such as difficulty walking and chronic pain. CONCLUSIONS This study demonstrates the importance of providing adequate education about TAR and ankle fusion to enable patients to make informed decisions. Most participants felt that the education and clinical support they received did not fully meet their needs. Participants' personal circumstances and beliefs had a strong influence on their decision-making and perceptions of their post-operative outcomes, highlighting the need to personally tailor education and clinical support. Future work with a larger sample of patients and other key stakeholders is required to develop consensus-based guidelines on pre- and post-operative support for patients undergoing TAR/ankle fusion.
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Affiliation(s)
- Anna M. Anderson
- grid.9909.90000 0004 1936 8403Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK ,grid.9909.90000 0004 1936 8403School of Healthcare, University of Leeds, Leeds, UK ,grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Lara S. Chapman
- grid.9909.90000 0004 1936 8403Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Heidi J. Siddle
- grid.9909.90000 0004 1936 8403Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Sue Watson
- Leeds National Institute for Health and Care Research Biomedical Research Centre, Leeds, UK
| | - Jane Klugerman
- Leeds National Institute for Health and Care Research Biomedical Research Centre, Leeds, UK
| | - Deborah Antcliff
- grid.9909.90000 0004 1936 8403School of Healthcare, University of Leeds, Leeds, UK ,grid.451052.70000 0004 0581 2008Bury Integrated Pain Service, Bury Care Organisation, Northern Care Alliance NHS Foundation Trust, Bury, England, UK ,grid.9757.c0000 0004 0415 6205School of Medicine, Keele University, Keele, UK
| | - Anne-Maree Keenan
- grid.9909.90000 0004 1936 8403School of Healthcare, University of Leeds, Leeds, UK ,Leeds National Institute for Health and Care Research Biomedical Research Centre, Leeds, UK
| | - Claire L. Brockett
- grid.9909.90000 0004 1936 8403Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
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Arnold JB, Bowen CJ, Chapman LS, Gates LS, Golightly YM, Halstead J, Hannan MT, Menz HB, Munteanu SE, Paterson KL, Roddy E, Siddle HJ, Thomas MJ. International Foot and Ankle Osteoarthritis Consortium review and research agenda for diagnosis, epidemiology, burden, outcome assessment and treatment. Osteoarthritis Cartilage 2022; 30:945-955. [PMID: 35176480 PMCID: PMC10464637 DOI: 10.1016/j.joca.2022.02.603] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 11/25/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To summarise the available evidence relating to the diagnosis, epidemiology, burden, outcome assessment and treatment of foot and ankle osteoarthritis (OA) and to develop an agenda to guide future research. METHOD Members of the International Foot and Ankle Osteoarthritis Consortium compiled a narrative summary of the literature which formed the basis of an interactive discussion at the Osteoarthritis Research Society International World Congress in 2021, during which a list of 24 research agenda items were generated. Following the meeting, delegates were asked to rank the research agenda items on a 0 to 100 visual analogue rating scale (0 = not at all important to 100 = extremely important). Items scoring a mean of 70 or above were selected for inclusion. RESULTS Of the 45 delegates who attended the meeting, 31 contributed to the agenda item scoring. Nineteen research agenda items met the required threshold: three related to diagnosis, four to epidemiology, four to burden, three to outcome assessment and five to treatment. CONCLUSIONS Key knowledge gaps related to foot and ankle OA were identified, and a comprehensive agenda to guide future research planning was developed. Implementation of this agenda will assist in improving the understanding and clinical management of this common and disabling, yet relatively overlooked condition.
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Affiliation(s)
- J B Arnold
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, 5000, Australia
| | - C J Bowen
- School of Health Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Southampton, Southampton, SO17 1BJ, UK
| | - L S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - L S Gates
- School of Health Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Southampton, Southampton, SO17 1BJ, UK
| | - Y M Golightly
- Department of Epidemiology, Gillings School of Global Public Health, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3330 Thurston Building, CB 7280, Chapel Hill, NC 27599, USA
| | - J Halstead
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, LS2 9JT, UK; Podiatry Services, Leeds Community Healthcare NHS Trust, Leeds, LS6 1PF, UK
| | - M T Hannan
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, And Harvard Medical School, Boston, MA, 02108, USA
| | - H B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia; Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - S E Munteanu
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - K L Paterson
- Centre for Health, Exercise and Sports Medicine, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - E Roddy
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK; Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire, ST6 7AG, UK
| | - H J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - M J Thomas
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK; Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire, ST6 7AG, UK
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10
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Chapman LS, Backhouse M, Bearne L, Cherry L, Cleary G, Davey J, Ferguson R, Grieve A, Helliwell P, Lomax A, McKeeman H, Rawlings A, Rees R, Rooney R, Ryan S, Sanders L, Siddle HJ, Varley S, Warburton L, Woodburn J, Roddy E. Management of foot health in people with inflammatory arthritis: British Society for Rheumatology guideline scope. Rheumatology (Oxford) 2022; 61:3907-3911. [PMID: 35772746 PMCID: PMC9536780 DOI: 10.1093/rheumatology/keac340] [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: 03/02/2022] [Revised: 06/06/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Lara S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Michael Backhouse
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Warwick
| | - Lindsay Bearne
- Centre for Applied Health & Social Care Research, Kingston University and St George's, University of London, London
| | - Lindsey Cherry
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton
| | - Gavin Cleary
- Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool
| | | | | | | | - Philip Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Adam Lomax
- Department of Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds
| | | | | | | | | | | | - Lucy Sanders
- University Hospitals Dorset NHS Foundation Trust
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | | | | | - Jim Woodburn
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Edward Roddy
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent
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11
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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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12
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Siddle HJ, Chapman LS, Mankia K, Zăbălan C, Kouloumas M, Raza K, Falahee M, Kerry J, Kerschbaumer A, Aletaha D, Emery P, Richards SH. Perceptions and experiences of individuals at-risk of rheumatoid arthritis (RA) knowing about their risk of developing RA and being offered preventive treatment: systematic review and thematic synthesis of qualitative studies. Ann Rheum Dis 2021; 81:159-168. [PMID: 34750103 PMCID: PMC8762008 DOI: 10.1136/annrheumdis-2021-221160] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/07/2021] [Indexed: 11/04/2022]
Abstract
Objectives There is increasing interest in identifying individuals at-risk of rheumatoid arthritis (RA) and initiating early treatment to prevent or delay the onset of arthritis. We aimed to describe the perceptions and experiences of at-risk individuals and to inform the conduct of clinical trials and studies, and clinical practice. Methods A systematic review and thematic synthesis of qualitative studies was conducted. Two review authors independently screened studies for inclusion, appraised their methodological quality using the Critical Appraisal Skills Programme checklist and assessed confidence in the findings using the Grading of Recommendations Assessment, Development and Evaluation–Confidence in Evidence from Reviews of Qualitative Research approach. Results Seven studies involving 115 individuals at-risk of developing RA were included. Three major themes (seven subthemes) were identified: understanding the risk of developing RA (knowledge of RA and identification of potential risk factors); preventive interventions to reduce the risk of developing RA (understanding the value and role of preventive interventions, and engagement with preventive interventions); and perceptions of predictive testing for RA (benefits of predictive testing, decision to undertake predictive testing and concerns about predictive testing). Moderate confidence in most review findings was evident. Conclusion While there are clear benefits in informing individuals at-risk of RA about their risk following predictive testing and offering preventive treatment, there are potential barriers to engagement, intensified by the burden of uncertainty. Identification of the optimum approaches for presenting risk information, including the risks and benefits of engaging with preventive interventions, is urgently needed to support individuals at-risk of RA in their decision making. PROSPERO registration number CRD42021236034.
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Affiliation(s)
- Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Lara S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Kulveer Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | | | | | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Joel Kerry
- Library and Information Service, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Daniel Aletaha
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
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13
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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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14
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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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15
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Chapman LS. Population health management and the role of the case manager. Case Manager 1999; 10:60-3. [PMID: 10890838 DOI: 10.1016/s1061-9259(99)80157-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
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Chapman LS, Nelson L, Sloan B, Plankenhorn R. Primary, secondary, and tertiary prevention capabilities of selected HMOs: findings of an employer survey. Am J Health Promot 1997; 12:102-9. [PMID: 10174661 DOI: 10.4278/0890-1171-12.2.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To survey Health Maintenance Organizations (HMOs) of a major employer regarding the extent of their health promotion and disease prevention capabilities. DESIGN A one-time cross-sectional survey. SETTING The setting involved in this study was managed care organizations. SUBJECTS The subjects were 22 HMOs located in the western part of the United States. MEASURES The study involved completion of a survey grid on a fairly comprehensive range of primary, secondary, and tertiary prevention activities. RESULTS Twenty-two HMOs were surveyed and 20 responded, providing a response rate of 90.9%. Analysis of distribution of responses and simple means were used. If a "perfect score" included addressing all 52 prevention targets across all 13 intervention modalities (minus inappropriate combinations) and that represented a score of 100%, the highest scoring HMO indicated that it provided or addressed 36.8% of all possible modalities and prevention target combinations. The composite average score for all three areas of prevention for all responding HMOs was slightly less than 13%. Additionally, five of the HMO respondents provided approximately 59% of all the prevention activity reported in the survey. Nonrepresentativeness of the HMOs in the sample represents the most significant study limitation. CONCLUSIONS Results suggest that prevention capabilities among the HMOs surveyed are unevenly distributed and somewhat concentrated.
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Affiliation(s)
- L S Chapman
- Summex Corporation, Seattle, Washington 98155, USA
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17
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Chapman LS, Haysom MBC, Saffigna PG. The recovery of 15N from labelled urea fertilizer in crop components of sugarcane and in soil profiles. ACTA ACUST UNITED AC 1994. [DOI: 10.1071/ar9941577] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Trash conservation measures associated with burnt and green harvested cane, and minimum tillage, are being adopted by canegrowers. These new management systems pose questions about how to apply N fertilizers. Experiments were conducted to evaluate the efficiency of fertilizer N uptake by the crop. Urea, labelled with 15N , was either broadcast or buried in three trash management systems: with and without trash after harvesting cane burnt, and with trash after harvesting cane green. The proportion of applied fertilizer-N recovered in a cane crop was 33% when labelled urea was buried, and 18% when broadcast. The presence of trash mulches from burnt or green harvested cane had negligible effects on the uptake of fertilizer-N. Of fertilizer-N applied, 25% was detected in soil 12 months after application, and there was no difference between burying and broadcasting urea. The fate of the lost fertilizer-N was not determined. Leaching did not appear to be a significant loss process in this gleyed podzolic soil, but ammonia volatilization probably occurred when urea was broadcast and it is suspected that denitrification accounted for the majority of the fertilizer-N losses.
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Chapman LS. Labor negotiation strategies for health promotion. Health Cost Manage 1987; 4:20-9. [PMID: 10282130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Both management and labor can appreciate that health care costs are absorbing a fast-growing percentage of total compensation dollars, but they may disagree on what to do about it. The President of Corporate Health Designs suggests some strategies for achieving consensus, focusing on a program that combines aggressive workplace health promotion with financial incentives for employees--"carrots" for those who try to be healthy, "sticks" for those who don't.
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Chapman LS, Gertz NE. A prescription for lower health care costs. Pers J 1985; 64:48-52. [PMID: 10269515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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Abstract
Recent studies have shown that vowels tend to be identified more accurately in consonantal context than in isolation. This contextual advantage is often explained perceptually, e.g., by assuming that the formant transitions associated with the consonants convey significant vowel information. In two experiments with stylized synthetic speech patterns, we were unable to replicate the contextual advantage. These negative results were probably due to certain unnatural stimulus characteristics. In another experiment we used natural speech stimuli to assess whether nonperceptual factors associated with the identification task contribute to the contextual advantage. Subjects responded to the test items either by (a) circling written CVC syllables, (b) circling written isolated vowels, or (c) vocally mimicking the items (a task that we assume imposes minimal memory load on subjects). Of these response conditions, only the first yielded an advantage for vowels in context, suggesting that the effect depends on two factors: Stimulus-response compatibility and memory load.
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