Swipe om te navigeren naar een ander artikel
The online version of this article (doi:10.1186/s13047-016-0153-6) contains supplementary material, which is available to authorized users.
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.
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.
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.
Additional file 1: Table S1. Evolution of codes used in thematic analysis. (DOC 80 kb)13047_2016_153_MOESM1_ESM.doc
Yano K, Ikari K, Takatsuki Y, Taniguchi A, Yamanaka H, Momohara S. Longer operative time is the risk for delayed wound healing after forefoot surgery in patients with rheumatoid arthritis. Modern rheumatology/the Japan Rheumatism Association. 2016;26(2):211–5.
Darzi A. High Quality Care For All. London: Department of Health; 2008.
Lord D. The first year of high quality care for all. Health Serv J. 2009;119(6162):17.
Miles MB, Huberman AM. Qualitative data analysis: an expanded source book. Thousand Oaks: Sage Publications; 1994.
Aronsen J. A pragmatic view of thematic analysis. The Qualitative Report. 1 994;2(1):1–3.
Patton MQ. Qualitative Evaluation and Research Methods. 2nd ed. London: Sage; 1990.
Frith H, Gleeson K. Clothing and embodiment: Men managing body image and appearance. Psychol Men Masculin. 2004;5(1):40–8. CrossRef
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. CrossRef
van der Heijden KW, Rasker JJ, Jacobs JW, Dey K. Kates forefoot arthroplasty in rheumatoid arthritis. A 5-year followup study. J Rheumatol. 1992;19(10):1545–50. PubMed
Woolhead G, Donovan J, Dieppe P. Patient expectations and total joint arthroplasty. J Rheumatol. 2003;30(7):1656–7. author reply 7. PubMed
Woolhead GM, Donovan JL, Dieppe PA. Outcomes of total knee replacement: a qualitative study. Rheumatology (Oxford). 2005;44(8):1032–7. CrossRef
Ogden J. Health Psychology: a textbook. 4th ed. Oxford: Oxford University Press; 2007.
Borthwick AM, Boyce RA, Nancarrow SA. Symbolic power and professional titles: the case of "podiatric surgeon". Health Sociol Rev. 2015;24(3):310–22. CrossRef
Goodacre LJ, Candy FJ. 'If I didn't have RA I wouldn't give them house room': the relationship between RA, footwear and clothing choices. Rheumatology (Oxford). 2011;50(3):513–7. CrossRef
Naidoo S, Anderson S, Mills J, Parson S, Breeden S, Bevan E, et al. I could cry, the amount of shoes I can't get into": A qualitative exploration of the factors that influence retail footwear selection in women with rheumatoid arthritis. J Foot Ankle Res. 2011;4(21).
Bogoch ER, Escort BG, Ronald K. Hand appearance as a patient motivation for surgery and a determinant of satisfaction with metacarpophalangeal joint arthroplasty for rheumatoid arthritis. J Hand Surg-Am. 2011;36A(6):1007–14. CrossRef
Bogoch ER, Judd MG. The hand: a second face? J Rheumatol. 2002;29(12):2477–83. PubMed
Backhouse MR, Keenan A-M, Hensor EMA, Young A, James D, Dixey J, et al. Use of conservative and surgical foot care in an inception cohort of patients with rheumatoid arthritis. Rheumatology. 2011;50(9):1586-95.
- Interpreting outcome following foot surgery in people with rheumatoid arthritis
Michael R. Backhouse
Karen A. Vinall-Collier
Anthony C. Redmond
Philip S. Helliwell
- BioMed Central