The impact, frequency and care of foot problems in people with rheumatoid arthritis
Although foot problems are common in rheumatoid arthritis (RA) their prevalence and importance to patients, the barriers patients face accessing foot care, and the types of care received have not been adequately established. Previous studies were hospital based and/or sampled selected groups of patients and did not adequately capture the patient perspective regarding foot problems and the benefits of foot care. Further, the accuracy of the patient self-report, the basis of previous studies, is not known.
To overcome these limitations and address the question of how to improve access to foot care a mixed methods approach employed three interlinked studies: a qualitative analysis of interviews with patients to identify relevant outcome measures; a population survey using these measures to establish prevalence and impact of foot problems and factors influencing access to foot care; and a clinical assessment of the accuracy of self-report which also provided a detailed description of current foot problems.
Semi-structured interviews with patients with RA confirmed that foot problems are common and revealed how they impact on many aspects of patients’ lives such as ability to work. Patients adopt a variety of self-management strategies to manage foot problems and can recognise common foot pathologies. Patients’ decisions to access foot care or not were complex. Some considered access to foot care unnecessary but for others limited awareness of treatment options, lack of knowledge of how to access care and feet being ignored in rheumatology clinical practice emerged as barriers to accessing foot care. Patients who had accessed foot care prioritised their foot problems as an important health care need and provided a broad description of foot care interventions received. Positive experience of foot care received encouraged continued utilisation of foot care services, while negative experiences contributed to patients’ decisions to discontinue interacting with foot care services. Important outcomes and issues raised by patients have not been previously investigated or quantified and therefore informed the content of the subsequent survey.
The survey in a random population sample of RA patients demonstrated that foot problems were prevalent and caused substantial impact. Many reported that their foot problems were severe, important and that they were not coping well with them. However, patients reported examination of their feet to be inconsistent and discussions during clinical consultations in relation to foot problems were often initiated by patients rather than the doctor or nurse. Although the literature suggests health resources are poorly accessed by men and people from socially deprived areas, in this survey two thirds of respondents had accessed foot care (often outside the NHS), including over half of the men and many from deprived areas. The survey also provides a description of the general and RA characteristics, prevalence of additional health problems in a large sample of the RA population.
Clinical assessment of a selected sub-sample of responders to the survey provided a detailed description of the nature and type of current foot problems. Additionally, the study demonstrates that self-report of most common foot problems is reliable and can be utilised with a high degree of confidence. However, there is a clear indication that a direct examination of patients’ feet is required to detect numbness, pes planus and joint swelling. The number of patients with foot care needs was high and nearly half required immediate clinical intervention. Patient satisfaction and perceived benefits differed between foot care services.
Foot problems are common, important issues for patients with RA. Access to foot care was more prevalent than anticipated but many patients had serious current problems, questioning the appropriateness and effectiveness of current foot care which is provided by non-specialist clinicians. Further work should investigate how specialist foot care services could support non-specialist clinicians and improve outcomes.
Wilson, O. The impact, frequency and care of foot problems in people with rheumatoid arthritis. (Thesis). University of the West of England
|Publicly Available Date||May 26, 2016|
|Keywords||foot problem, rheumatoid arthritis, access foot care, mixed methods|
160525 THESIS FINAL - repository.pdf