Swipe om te navigeren naar een ander artikel
The authors declare that they have no competing interests.
AW conceived of the study and led the development of the survey, AG contributed to the development of the survey and qualitative data analysis, SD contributed to the development of the survey and CB participated in its dissemination and helped to draft the manuscript. All authors read and approved the final manuscript.
In the last decade there has been a significant expansion in the body of knowledge on the effects of rheumatoid arthritis (RA) on the foot and the management of these problems. Aligned with this has been the development of specialist clinical roles for podiatrists. However, despite being recommended by national guidelines, specialist podiatrists are scarce. In order to inform non-specialist podiatrists of the appropriate interventions for these foot problems, management guidelines have been developed and disseminated by a group of specialist podiatrists. The aim of this survey was to investigate the use of these guidelines in clinical practice.
Following ethical approval an online questionnaire survey was carried out. The questions were formulated from a focus group and comprised fixed response and open response questions. The survey underwent cognitive testing with two podiatrists before being finalised. An inductive approach using thematic analysis was used with the qualitative data.
245 questionnaires were completed (128–non-specialist working in the private sector, 101 non–specialists working in the NHS and 16 specialist podiatrists). Overall, 97% of the non-specialists (n = 222) had not heard of the guidelines. The non-specialists identified other influences on their management of people with RA, such as their undergraduate training and professional body branch meetings. Three main themes emerged from the qualitative data: (i) the benefits of the foot health management guidelines, (ii) the barriers to the use of guidelines generally and (iii) the features of useable clinical guidelines.
This study has revealed some crucial information about podiatrists’ level of engagement with the foot health management guidelines and the use of guidelines in general. Specifically, the non-specialist podiatrists were less likely to use the foot health management guidelines than the specialist podiatrists. The positive aspects were that for the specialist practitioners, the guidelines helped them to identify their professional development needs and for the few non-specialists that did use them, they enabled appropriate referral to the rheumatology team for foot health management. The barriers to their use included a lack of understanding of the risk associated with managing people with RA and that guidelines can be too long and detailed for use in clinical practice. Suggestions are made for improving the implementation of foot health guidelines.
Bowen CJ, Hooper L, Culliford D, Dewbury K, Sampson M, Burridge J, et al: Assessment of the natural history of forefoot bursae using ultrasonography in patients with rheumatoid arthritis: a twelve-month investigation. Arthritis Care Res (Hoboken). 2010, 62 (12): 1756-1762. 10.1002/acr.20326. CrossRef
Barn R, Turner DE, Rafferty D, Sturrock RD, Woodburn J: Tibialis posterior tenosynovitis and associated pes plano valgus in rheumatoid arthritis: EMG, multi-segment foot kinematics and ultrasound features. Arthritis Care Res (Hoboken). 2013, 65 (4): 495-502. 10.1002/acr.21859. CrossRef
Turner DE, Helliwell PS, Siegel KL, Woodburn J: Biomechanics of the foot in rheumatoid arthritis: identifying abnormal function and the factors associated with localised disease ‘impact’. Clin Biomech (Bristol, Avon). 2008, 23 (1): 93-100. 10.1016/j.clinbiomech.2007.08.009. CrossRef
Turner DE, Helliwell PS, Emery P, Woodburn J: The impact of rheumatoid arthritis on foot function in the early stages of disease: a clinical case series. BMC Musculoskelet Disord. 2006, 21 (7): 102- CrossRef
Hooper L, Bowen CJ, Gates L, Culliford DJ, Ball C, Edwards CJ, et al: Prognostic indicators of foot-related disability in patients with rheumatoid arthritis: results of a prospective three-year study. Arthritis Care Res (Hoboken). 2012, 64 (8): 1116-1124.
Wechalekar MD, Lester S, Proudman SM, Cleland LG, Whittle SL, Rischmueller M, et al: Active foot synovitis in patients with rheumatoid arthritis: applying clinical criteria for disease activity and remission may result in underestimation of foot joint involvement. Arthritis Rheum. 2012, 64 (5): 1316-1322. 10.1002/art.33506. CrossRefPubMed
Hennessy K, Woodburn J, Steultjens MP: Custom foot orthoses for rheumatoid arthritis: A systematic review. Arthritis Care Res (Hoboken). 2012, 64 (3): 311-320. 10.1002/acr.21559. CrossRef
Woodburn J, Hennessy K, Steultjens MP, McInnes IB, Turner DE: Looking through the ‘window of opportunity’: is there a new paradigm of podiatry care on the horizon in early rheumatoid arthritis?. J Foot Ankle Res. 2010, 17 (3): 8- CrossRef
ARMA: Arthritis and Musculoskeletal Alliance - Standards of Care for people with Inflammatory Arthritis. 2004, cited; Available from: http://www.arma.uk.net
NICE: Guidance for the management of rheumatoid arthritis in adults. 2009, cited; Available from: http://www.nice.org.uk/nicemedia/pdf/CG79NICEGuideline.pdf
Podiatry Rheumatic Care Association: Standards of Care for People with Musculoskeletal Foot Health Problems. 2010, cited; Available from: http://www.prcassoc.org.uk/standards-project
Bowen CJ, Dewbury K, Sampson M, Sawyer S, Burridge J, Edwards CJ, et al: Musculoskeletal ultrasound imaging of the plantar forefoot in patients with rheumatoid arthritis: inter-observer agreement between a podiatrist and a radiologist. J Foot Ankle Res. 2008, 1 (1): 5-10.1186/1757-1146-1-5. CrossRefPubMedPubMedCentral
National Audit Office: Services for People with Rheumatoid Arthritis. 2009, London: The Stationary Office
Redmond AC, Waxman R, Helliwell PS: Provision of foot health services in rheumatology in the UK. Rheumatology (Oxford). 2006, 45 (5): 571-576. 10.1093/rheumatology/kei205. CrossRef
Rheumatology Futures Group: Perceptions of patients and professionals on rheumatoid arthritis care. 2009, London: The Kings Fund
Bacon D, Borthwick AM: Charismatic authority in modern healthcare: the case of the ‘diabetes specialist podiatrist’. Sociol Health Illn. 2012, 10.1111/1467-9566.12024.
Dixon WG, Watson K, Lunt M, Hyrich KL, Silman AJ, Symmons DP, et al: Rates of serious infection, including site-specific and bacterial intracellular infection, in rheumatoid arthritis patients receiving anti-tumor necrosis factor therapy: results from the British Society for Rheumatology Biologics Register. Arthritis Rheum. 2006, 54 (8): 2368-2376. 10.1002/art.21978. CrossRefPubMed
Primary Care Rheumatology Society: Expert Opinions in Rheumatology: Issue 2. The PCR Society Guide to Commissioning Musculoskeletal Services. 2011, Hertfordshire: AC Publications
Williams AE, Bowden AP: Meeting the challenge for foot health in rheumatic diseases. Foot. 2004, 14 (3): 154-158. 10.1016/j.foot.2004.03.006. CrossRef
Colaizzi PF: Psychological research as a Phenomenologist Views It. Existential Phenomenological Alternatives for Psychology. Edited by: Valle RS, King M. 1978, New York: Oxford University Press, 48-71.
Dodek P, Cahill NE, Heyland DK: The relationship between organizational culture and implementation of clinical practice guidelines: a narrative review. J Parenter Enteral Nutr. 2010, 34 (6): 669-674. 10.1177/0148607110361905. CrossRef
Piper H, Hassell AB, Rowe IF, Delamere J: Committee WMRSaT. Experience of six years of a regional peer review scheme in rheumatology. Rheumatology (Oxford). 2006, 45 (9): 1110-1115. 10.1093/rheumatology/kel042. CrossRef
Hetthen J, Helliwell PS: A comparison between primary care-led rheumatology services and secondary care provision. Rheumatology (Oxford). 1999, 38 (12): 1294-1295. 10.1093/rheumatology/38.12.1294. CrossRef
- Guidelines for the management of people with foot health problems related to rheumatoid arthritis: a survey of their use in podiatry practice
Anita E Williams
Andrea S Graham
Catherine J Bowen
- BioMed Central