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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

Chapman, Lara S.; Flurey, Caroline A.; Redmond, Anthony C.; Richards, Pamela; Hofstetter, Catherine; Tapster, Bethany; Emmel, Jenny; Helliwell, Philip S.; Menz, Hylton B.; Hannan, Marian T.; Shea, Beverley; Siddle, Heidi J.

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 Thumbnail


Lara S. Chapman

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Caroline Flurey
Associate Professor in Men's Health and Long-term Conditions

Anthony C. Redmond

Pamela Richards

Catherine Hofstetter

Bethany Tapster

Jenny Emmel

Philip S. Helliwell

Hylton B. Menz

Marian T. Hannan

Beverley Shea

Heidi J. Siddle


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.

Journal Article Type Article
Acceptance Date May 10, 2023
Online Publication Date May 11, 2023
Publication Date Aug 1, 2023
Deposit Date May 22, 2023
Publicly Available Date May 22, 2023
Journal Seminars in Arthritis and Rheumatism
Print ISSN 0049-0172
Electronic ISSN 1532-866X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 61
Article Number 152212
Keywords Foot; Ankle; Rheumatic; Musculoskeletal; Qualitative; Systematic review; Thematic synthesis; Outcomes; OMERACT
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