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Title: Challenging current perceptions : an exploration of the nature and extent of foot complaints in rheumatoid arthritis
Author: Otter, Simon
ISNI:       0000 0001 2422 4840
Awarding Body: University of Brighton
Current Institution: University of Brighton
Date of Award: 2008
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The extent and nature of the impact of rheumatoid arthritis (RA) in the feet from the point of view of those with the disease is unknown. Most epidemiological studies of foot involvement in RA have been based upon radiological scoring or the findings of clinicians' examination of feet in clinically based populations. This thesis aimed to explore foot involvement in RA from the perspective of people with the disease integrated with the perceptions of rheumatologists and podiatrists. Three questionnaires were developed de novo through an iterative process of integrating information gained from focus groups, illness narratives and literature reviews. Following piloting, questionnaires sent to participants enquired about symptoms in the feet, the anatomical distribution of those symptoms, and their impact on quality of life from the perspectives of 1040 people with RA, 78 podiatrists and 414 rheumatologists throughout the UK. Additionally, the availability of podiatric services and the usefulness of interventions for foot symptoms and foot function were triangulated from participants. Quantitative data were analysed using SPSS and a process of thematic analysis was used to interpret qualitative data. Results from participants indicated that symptoms due to RA were prevalent in all parts of the foot and ankle but the metatarsophalangeal and ankle joints were most commonly and severely affected. Most people with RA (79%) reported suffering recurrent, moderate or severe foot pain every day. Other symptoms (stiffness, numbness and swelling) were also common. Overall, these findings were greater than those that have been reported previously. Foot complaints were noted to have a profound effect on quality of life, with loss of mobility due to symptoms in the feet, and difficulties finding comfortable footwear, leading to loss of independence, anger, frustration and depression; findings that have not been previously reported in detail. A gap between the need for specialist foot care and receiving such care was highlighted, with a total 82% of respondents having discussed their foot symptoms with their rheumatologist. Amongst these patients 64% had been referred to a podiatrist. Clinicians' assessment practices varied widely both within and between professions. Patients reported that on average rheumatologists examined their hands every 6.2 months, whereas their feet were only examined every 16.5 months; this led some patients to feel that rheumatologists were disinterested in their foot complaints. Additionally, the type of assessment undertaken by clinicians did not fully take account of the issues people with RA were reporting. Issues that were key to patients were quality of life and the ability to participate in valued life activities. Difficulties with obtaining adequate foot health care were noted by those with the disease and clinicians alike. Symptoms in the feet in RA are common, severe and tend to be under-reported by clinicians. Involvement of the metatarsophalangeal joints and ankles is especially troublesome. Motion in these joints is vital for normal propulsive gait. Severe involvement causes reduced mobility and impedes independence with considerable consequences for social integration. Outcome measures that exclude the feet discourage foot examination and thus do not fully account for domains of importance to those with RA. Rheumatologists and podiatrists need to work more closely in order for a more patient-centred service to be developed, where a biopsychosocial approach to foot care would more fully address the needs of people with RA.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: B000 Health Professions ; B960 Podiatry