1
|
Koehn S, Jones CA, Barber C, Jasper L, Pham A, Lindeman C, Drummond N. Candidacy 2.0 (CC) - an enhanced theory of access to healthcare for chronic conditions: lessons from a critical interpretive synthesis on access to rheumatoid arthritis care. BMC Health Serv Res 2024; 24:986. [PMID: 39187885 PMCID: PMC11348652 DOI: 10.1186/s12913-024-11438-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 08/14/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND The Dixon-Woods et al. Candidacy Framework, a valuable tool since its 2006 introduction, has been widely utilized to analyze access to various services in diverse contexts, including healthcare. This social constructionist approach examines micro, meso, and macro influences on access, offering concrete explanations for access challenges rooted in socially patterned influences. This study employed the Candidacy Framework to explore the experiences of individuals living with rheumatoid arthritis (RA) and their formal care providers. The investigation extended to assessing supports and innovations in RA diagnosis and management, particularly in primary care. METHODS This systematic review is a Critical Interpretive Synthesis (CIS) of qualitative and mixed methods literature. The CIS aimed to generate theory from identified constructs across the reviewed literature. The study found alignment between the seven dimensions of the Candidacy Framework and key themes emerging from the data. Notably absent from the framework was an eighth dimension, identified as the "embodied relational self." This dimension, central to the model, prompted the proposal of a revised framework specific to healthcare for chronic conditions. RESULTS The CIS revealed that the eight dimensions, including the embodied relational self, provided a comprehensive understanding of the experiences and perspectives of individuals with RA and their care providers. The proposed Candidacy 2.0 (Chronic Condition (CC)) model demonstrated how integrating approaches like Intersectionality, concordance, and recursivity enhanced the framework when the embodied self was central. CONCLUSIONS The study concludes that while the original Candidacy Framework serves as a robust foundation, a revised version, Candidacy 2.0 (CC), is warranted for chronic conditions. The addition of the embodied relational self dimension enriches the model, accommodating the complexities of accessing healthcare for chronic conditions. TRIAL REGISTRATION This study did not involve a health care intervention on human participants, and as such, trial registration is not applicable. However, our review is registered with the Open Science Framework at https://doi.org/10.17605/OSF.IO/ASX5C .
Collapse
Affiliation(s)
- Sharon Koehn
- Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - C Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Claire Barber
- Division of Rheumatology, Cumming School of Medicine, Health Sciences Center, University of Calgary, Room #B130Z 3300, Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Lisa Jasper
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
| | - Anh Pham
- Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Cliff Lindeman
- Prescribing, Analytics & Tracked Prescription Program Alberta, College of Physicians & Surgeons, 2700 - 10020 100 Street NW, Edmonton, AB, T5J 0N3, Canada
| | - Neil Drummond
- Faculty of Medicine and Dentistry - Family Medicine Department, University of Alberta, 6- 10L4 University Terrace, 8303 - 112 Street NW, Edmonton, AB, T6G 2T4, Canada
| |
Collapse
|
2
|
Stolt M, Hyytiä S, Suhonen R. Perceptions of foot health services from the perspective of patients with rheumatoid arthritis in Finland. J Foot Ankle Res 2024; 17:e12004. [PMID: 38567744 PMCID: PMC11080684 DOI: 10.1002/jfa2.12004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/19/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Foot health services for people with rheumatoid arthritis (RA) are an important part of their comprehensive care. However, little is known about the perceptions of people with RA have about foot health services. This study aimed to explore how people with RA perceive foot health services. METHODS A descriptive cross-sectional survey design was applied. The electronic survey data were collected in April 2023 from people with RA through a national patients' association (N = 2400, response rate 24%, n = 565). The statistical data were analysed using descriptive statistics and textual data with thematic analysis. RESULTS Most of the respondents (n = 322, 59%) had used foot health services provided by chiropodist or podiatrist. Those who had used services were mostly satisfied but considered patient education about foot health insufficient. One third reported no visits to foot health services at all because of personal and health service system-related factors. CONCLUSIONS Those people with RA who have access to foot health services value and appreciate the services. However, many people with RA do not use foot health services because they perceive availability of such services limited and thus unequal and hard to access. There is a need to develop foot health services for people with RA so that they are easy to access, correspond to their foot health needs and have seamless care paths at different levels of the health care system.
Collapse
Affiliation(s)
- Minna Stolt
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
- Wellbeing Services County of SatakuntaPoriFinland
| | - Sasu Hyytiä
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
| | - Riitta Suhonen
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
- Turku University HospitalWellbeing Services County of Southwest FinlandTurkuFinland
| |
Collapse
|
3
|
Damgaard AJ, Primdahl J, Esbensen BA, Latocha KM, Bremander A. Self-management support needs of patients with inflammatory arthritis and the content of self-management interventions: a scoping review. Semin Arthritis Rheum 2023; 60:152203. [PMID: 37068398 DOI: 10.1016/j.semarthrit.2023.152203] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Self-management skills can empower a person to manage the physical, psychological, and social impact of a health condition. However, the components of self-management interventions differ widely between studies and interventions. By performing a scoping review, we aimed to describe patients' self-management needs and how health professionals (HPs) can provide effective self-management support to patients with inflammatory arthritis (IA). OBJECTIVES 1) to identify the evidence for self-management support needs of patients with IA, and 2) to identify the content (theory/theoretical approach, mode of delivery, duration and frequency) of self-management interventions that target patients with IA. METHODS In May 2021, we performed a systematic literature search (from 2000 onward) in five databases (CINAHL (Ebsco), Cochrane Library, Embase (Ovid), Medline (Ovid) and PsycINFO (Ovid)) regarding self-management in patients with IA. RESULTS Out of 11,748 records identified, we included 31 articles describing patients' support needs and 33 articles describing the content of self-management interventions. Patients' support needs were sorted into six topics: 1) disease impact and the pharmacological treatment, 2) care continuity and relations with HPs, 3) the importance of non-pharmacological treatment, 4) the need for support from family and friends, 5) support needs related to work issues, and 6) contextual preferences for self-management support. The theory/theoretical approach, mode of delivery, duration and frequency varied widely and were often unclearly or insufficiently described. In addition, the self-management concept was scarcely - or not - defined in the included articles. The identified topics for support needs were compared with the described content in the included articles. Only a few self-management interventions focused on patients' need for support in relation to work, and to family and friends. CONCLUSION HPs provided self-management support to patients with IA in various ways, but there were gaps between the patients' support needs and the identified interventions. In developing self-management interventions, the self-management concept needs to be defined and a clear theory is required to support the development of the intervention. Future studies should seek to investigate various modes of delivery, frequency and duration, to develop effective interventions that meet patients' support needs.
Collapse
|
4
|
Laitinen AM, Pasanen M, Wasenius E, Stolt M. Foot self-care competence reported by patients with rheumatoid arthritis: a cross-sectional study. J Foot Ankle Res 2022; 15:93. [PMID: 36527154 PMCID: PMC9758871 DOI: 10.1186/s13047-022-00599-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Foot self-care is important for preventing foot problems and maintaining one's foot health. Foot self-care requires competence to identify foot problems, knowledge and skills to care for those problems, and a willing attitude to care for one's foot health. However, there is major gap in the research evidence of foot self-care competence among patients with rheumatoid arthritis. This study aimed to analyse self-reported levels of competence in foot self-care among patients with rheumatoid arthritis. METHODS A cross-sectional study design was used. Data were collected using a survey consisting of a self-reported competence in foot self-care competence scale (response options on 5-point Likert scale, higher values indicate higher competence) and background questions. The data were analysed with descriptive and inferential statistics and the psychometric properties of the scale using Rasch analysis. RESULTS The participants' (n = 251) self-reported level of competence in foot self-care was moderate (mean 3.50, standard deviation [SD], 0.66). On the sum variable level, the highest mean score was for attitude towards foot self-care (3.98; SD, 0.69), followed by foot self-care knowledge (3.45; SD, 0.67) and experience providing foot self-care (3.38; SD, 0.69). Higher self-reported foot self-care knowledge and female sex were associated with higher self-reported competence in every sum variable. CONCLUSIONS Patients with rheumatoid arthritis evaluated their level of competence in foot self-care as moderate and some deficiencies were identified. These results indicate the importance of educating patients with rheumatoid arthritis about how to advance their foot self-care skills and knowledge. In the future, patients with rheumatoid arthritis could benefit from interventions that increase their knowledge of foot self-care together with practical examples, such as online videos, that demonstrate the practical conduct of foot self-care skills in daily life.
Collapse
Affiliation(s)
- Anne-Marie Laitinen
- grid.1374.10000 0001 2097 1371Department of Nursing Science, University of Turku, Turku, 20014 Finland ,grid.410552.70000 0004 0628 215XTurku University Hospital, Turku, Finland
| | - Miko Pasanen
- grid.1374.10000 0001 2097 1371Department of Nursing Science, University of Turku, Turku, 20014 Finland
| | - Elina Wasenius
- grid.425628.f0000 0001 1913 4955Podiatry, Metropolia University of Applied Sciences, Helsinki, Finland
| | - Minna Stolt
- grid.1374.10000 0001 2097 1371Department of Nursing Science, University of Turku, Turku, 20014 Finland ,grid.9668.10000 0001 0726 2490Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
5
|
Chapman LS, Backhouse M, Bearne L, Cherry L, Cleary G, Davey J, Ferguson R, Grieve A, Helliwell P, Lomax A, McKeeman H, Rawlings A, Rees R, Rooney R, Ryan S, Sanders L, Siddle HJ, Varley S, Warburton L, Woodburn J, Roddy E. Management of foot health in people with inflammatory arthritis: British Society for Rheumatology guideline scope. Rheumatology (Oxford) 2022; 61:3907-3911. [PMID: 35772746 PMCID: PMC9536780 DOI: 10.1093/rheumatology/keac340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/06/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Lara S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Michael Backhouse
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Warwick
| | - Lindsay Bearne
- Centre for Applied Health & Social Care Research, Kingston University and St George's, University of London, London
| | - Lindsey Cherry
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton
| | - Gavin Cleary
- Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool
| | | | | | | | - Philip Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Adam Lomax
- Department of Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds
| | | | | | | | | | | | - Lucy Sanders
- University Hospitals Dorset NHS Foundation Trust
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | | | | | - Jim Woodburn
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Edward Roddy
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent
| | | |
Collapse
|
6
|
Stolt M, Kilkki M, Katajisto J, Suhonen R. Self-assessed foot health in older people with rheumatoid arthritis-A cross-sectional study. Int J Older People Nurs 2021; 16:e12380. [PMID: 34008331 DOI: 10.1111/opn.12380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/17/2021] [Accepted: 03/16/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Foot and ankle problems are especially common in patients with RA, causing significant disability and limitation in daily activities. Previous studies have mainly focussed on foot problems in the adult population whilst the evidence of foot health in the older population is scarce. OBJECTIVES The aim of the study was to analyse self-assessed foot health and associated factors in older people with rheumatoid arthritis (RA). METHODS The study applied a descriptive cross-sectional survey design and recruited older people with RA from the member register of one patient association. We collected the data in January 2019 with the Self-administered Foot Health Assessment Instrument, and sociodemographic and foot-related background questions and analysed the data with descriptive and inferential statistics. RESULTS Older people with RA had many self-reported foot problems. The most common problems were foot pain, dry skin and thickened toenails. In addition, structural deformities of the foot were prevalent. The level of foot health associated with the amount of daily walking or standing, and using walking or running shoes outdoors. Individuals who had consulted a physician due to their foot problems had more structural deformities in the foot. Foot problems limited their ability to perform daily activities. CONCLUSIONS This study demonstrates that older people with RA not only live with a long-term health condition, but they also live with complex foot problems. Older people with RA need healthcare services due to their foot problems. There is a need to develop and implement care practices to alleviate foot pain and support and promote foot health and functional ability in older people with RA. IMPLICATION FOR PRACTICE Understanding the nature and consequences of foot problems in older people with RA allows healthcare professionals to perform more accurate clinical foot evaluations and develop effective interventions to prevent further foot problems.
Collapse
Affiliation(s)
- Minna Stolt
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Mia Kilkki
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Jouko Katajisto
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland.,Welfare Division, City of Turku, Turku, Finland
| |
Collapse
|
7
|
Ramos-Petersen L, Nester CJ, Ortega-Avila AB, Skidmore S, Gijon-Nogueron G. A qualitative study exploring the experiences and perceptions of patients with rheumatoid arthritis before and after wearing foot orthoses for 6 months. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:829-836. [PMID: 33560583 DOI: 10.1111/hsc.13316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/09/2021] [Accepted: 01/15/2021] [Indexed: 06/12/2023]
Abstract
Foot pathology in people with rheumatoid arthritis (RA) can have a psychosocial impact, but interventions such as foot orthoses can reduce foot pain, improving physical activity and quality of life. A previous meta-analysis concluded that foot orthoses can relieve pain and disability and enhance patient's well-being. The aim of this study was to explore the experiences of people with RA, before and after wearing foot orthoses for 6 months. Data were collected through digital recordings of semi-structured interviews carried out before and after wearing foot orthoses for 6 months. A thematic analysis of the transcripts was used to identify themes. Six female participants with RA wore foot orthoses for 6 months in Spain. The mean disease duration was more than 10 years. The findings showed three key themes emerged from the data: (1) improvement in physical activity; (2) footwear… a tricky situation and (3) social implications of RA feet. It is concluded that patients reported that wearing foot orthoses can have a positive impact on physical activity and improve general wellness and quality of life. However, to achieve the potential positive benefits, people with RA also needed to wear suitable footwear (defined as footwear which accommodates both the foot and the insole while maintaining the fit and function of the shoe). Despite the positive impact of wearing orthoses, participants stated that complexities of finding suitable footwear acted as a blocker.
Collapse
Affiliation(s)
- Laura Ramos-Petersen
- Department of Podiatry, Faculty of Health Sciences, Universidad Catolica San Antonio de Murcia, Murcia, Spain
- ABIDOR, Research Group "Avances en Biomecánica Deportiva y Ortopodología", Universidad Catolica San Antonio de Murcia, Murcia, Spain
| | | | - Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Malaga, Spain
- Biomedical Research Institute (IBIMA), Malaga, Spain
| | - Sue Skidmore
- School of Health & Society, University of Salford, Salford, UK
| | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Malaga, Spain
- Biomedical Research Institute (IBIMA), Malaga, Spain
| |
Collapse
|
8
|
Reina-Bueno M, González-López JR, López-López D, Calvo-Lobo C, Ballesteros-Mora M, Rodríguez-Moreno I, Munuera-Martínez PV. Development and Validation of the Overall Foot Health Questionnaire for Patients with Rheumatoid Arthritis: A Cross-Sectional Descriptive Analysis. ACTA ACUST UNITED AC 2019; 55:medicina55060290. [PMID: 31248227 PMCID: PMC6630793 DOI: 10.3390/medicina55060290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 11/21/2022]
Abstract
Background and Objectives: In general, patients with rheumatoid arthritis (RA) are ignorant of the physician’s role and of RA-related feet problems. The aim of our study was to validate a questionnaire on the knowledge of different aspects of overall foot health in patients with RA. Materials and Methods: A cross-sectional descriptive analysis was carried out between March 2017 and April 2017. A questionnaire was designed and validated through the Delphi method to evaluate the knowledge about the illness, the repercussions on feet, medical podiatry care, and the role of the medical podiatrist. Results: After being checked by a panel of experts, all the items obtained a Cronbach’s alpha over 0.70. Conclusions: The content of this questionnaire about the knowledge of different aspects of medical podiatry health in patients with RA has internal consistency.
Collapse
Affiliation(s)
- María Reina-Bueno
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain.
| | - José Rafael González-López
- Departament of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain.
| | - Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, University of A Coruña, 15403 Ferrol, Spain.
| | - César Calvo-Lobo
- Nursing and Physical Therapy Department, Faculty of Health Sciences, University of León, 24401 Ponferrada, Spain.
| | - Marina Ballesteros-Mora
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain.
| | - Inmaculada Rodríguez-Moreno
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain.
| | - Pedro V Munuera-Martínez
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain.
| |
Collapse
|
9
|
UK podiatrists' experiences of podiatry services for people living with arthritis: a qualitative investigation. J Foot Ankle Res 2018; 11:27. [PMID: 29928316 PMCID: PMC5989380 DOI: 10.1186/s13047-018-0262-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/06/2018] [Indexed: 11/28/2022] Open
Abstract
Background Provision of podiatry services, like other therapies in the UK, is an area that lacks guidance by the National Institute for Health and Care Excellence. Many individuals living with arthritis in the UK are not eligible to access NHS podiatry services. The primary aim of this investigation was to understand the views of podiatry clinicians on their experiences of referral, access, provision and treatment for foot problems for patients who have arthritis. Methods Focus groups were undertaken to explore, in-depth, individual views of podiatrists working in the UK to gain feedback on experiences of barriers and facilitators to referral, access, provision and treatment for foot problems for individuals living with arthritis. A purposive sampling strategy was adopted and two, semi-structured, focus group interviews conducted, involving 12 podiatrists from both NHS and independent sectors. To account for geographical variations one focus group took place in each of 2 predetermined ‘zones’ of the UK; Yorkshire and Hampshire. Thematic analysis was employed to identify key meanings and report patterns within the data. Results The key themes derived from the podiatry clinician focus groups suggest a variety of factors influencing demand for, and burden of, foot pain within the UK. Participants expressed frustration on having a service that accepts and treats patients according to their condition, rather than their complaint. Additionally, concern was conveyed over variations in the understanding of stakeholders’ views of what podiatry is and what podiatrists aim to achieve for patients. Conclusion Podiatrists interviewed believed that many individuals living with arthritis in the UK are not eligible to access NHS podiatry services and that this may be, in part, due to confusion over what is known about podiatry and access criteria. Essentially, podiatrists interviewed called for a timely renaissance of current systems, to newer models of care that meet the foot care needs of individual patients’ circumstances and incorporate national multi-disciplinary guidance. Through this project, we have formulated key recommendations that are directed towards improving what other stakeholders (including GPs, commissioners and users of podiatry services) know about the effectiveness of podiatry and also to futureproof the profession of podiatry.
Collapse
|
10
|
Williams AE, Blake A, Cherry L, Alcacer-Pitarch B, Edwards CJ, Hopkinson N, Vital EMJ, Teh LS. Patients’ experiences of lupus-related foot problems: a qualitative investigation. Lupus 2017; 26:1174-1181. [DOI: 10.1177/0961203317696590] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background Systemic lupus erythematosus (SLE) can present with a variety of symptoms. Previous research has shown there is a high prevalence of lower limb and foot problems in patients with SLE associated with the musculoskeletal, vascular and neurological changes. Furthermore, there is a high prevalence of infections affecting the feet and a range of common skin and nail problems. However, it is not known how these foot problems impact upon people’s lives. Therefore, we aimed to explore this using a qualitative approach. Method Following ethical approval, 12 participants were recruited who had a diagnosis of SLE, current and/or past experience of foot problems and were over 18 years in age. Following consent, interviews were carried out with an interpretivist phenomenological approach to both data collection and analysis. Results Seven themes provide insight into: foot problems and symptoms; the impact of these foot problems and symptoms on activities; disclosure and diagnosis of foot problems; treatment of foot problems and symptoms; perceived barriers to professional footcare; unanswered questions about feet and footcare; and identification of the need for professional footcare and footcare advice. Conclusion These participants tend to “self-treat” rather than disclose that they may need professional footcare. A lack of focus upon foot health within a medical consultation is attributed to the participant’s belief that it is not within the doctor’s role, even though it is noted to contribute to reduced daily activity. There is a need for feet to be included as a part of patient monitoring and for foot health management to be made accessible for people with SLE.
Collapse
Affiliation(s)
- A E Williams
- School of Health Sciences, University of Salford, UK
| | - A Blake
- Private podiatrist, Dorset, UK
| | - L Cherry
- Faculty of Health Sciences, University of Southampton, UK
- Department of Podiatry, Solent NHS Trust, UK
| | - B Alcacer-Pitarch
- NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
| | - C J Edwards
- NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, UK
| | - N Hopkinson
- Department of Rheumatology, Royal Bournemouth/Christchurch Hospitals NHS Foundation Trust, UK
| | - E M J Vital
- NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
| | - L S Teh
- Department of Rheumatology, Royal Blackburn Hospital, UK
| |
Collapse
|
11
|
Sanders L, Donovan-Hall M, Borthwick A, Bowen CJ. Experiences of mobility for people living with rheumatoid arthritis who are receiving biologic drug therapy: implications for podiatry services. J Foot Ankle Res 2017; 10:14. [PMID: 28331550 PMCID: PMC5356260 DOI: 10.1186/s13047-017-0195-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/06/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite significant advancements in new treatment modalities for rheumatoid arthritis with biological therapies, foot complications remain a disabling and common feature of the disease. In this study the aim was to explore and describe the personal experiences of people with rheumatoid arthritis in receipt of biologic treatments in a bid to understand the impact of this form of medication on their mobility. METHODS An interpretative phenomenological analysis (IPA) was undertaken to explore in depth the individual experience of rheumatoid disease through personal accounts of the patient journey spanning both 'before' and 'after' the instigation of biologic therapy. A purposive sampling strategy was adopted and in-depth semi structured interviews used to facilitate rich, detailed interview data exploring the lived experiences of individuals undertaking biological therapy and the changes to mobility experienced as a result. Thematic analysis was employed with an IPA framework to identify key meanings, and report patterns within the data. RESULTS Five people with rheumatoid arthritis participated in the study. The mean disease duration was 20.2 years (range: 6 -32) and all were being treated with biologic therapies. Four key themes emerged from the data: 1) Life before biologic treatment, depicted in accounts as a negative experience characterised by painful and disabling symptoms and feelings of hopelessness. 2) Life with biologic treatment, often experienced as a life changing transition, restoring function and mobility and offering renewed hope. 3) Sense of self, in which the impact of rheumatoid disease and the subsequent changes arising from biologic therapy reveal a profound impact on feelings of personal identity both pre and post biologic therapy; an effect of footwear on self-image emerges as a dominant sub theme; 4) Unmet footcare needs were evident in the patient narrative, where the unrelenting if diminished impact of foot pain on mobility was viewed in the context of problematic access to foot health services. CONCLUSION Whilst the findings from this study mirror those within the existing literature, which report improvements in physical function related to biological therapy, foot problems clearly remained an unremitting feature of life for patients with rheumatoid disease, even when in receipt of biologics.
Collapse
Affiliation(s)
- Lucy Sanders
- Faculty of Health Sciences, University of Southampton, Highfield Campus Building 45, University Road, Southampton, Hampshire SO17 1BJ UK
| | - Margaret Donovan-Hall
- Faculty of Health Sciences, University of Southampton, Highfield Campus Building 45, University Road, Southampton, Hampshire SO17 1BJ UK
| | - Alan Borthwick
- Faculty of Health Sciences, University of Southampton, Highfield Campus Building 45, University Road, Southampton, Hampshire SO17 1BJ UK
| | - Catherine J Bowen
- Faculty of Health Sciences, University of Southampton, Highfield Campus Building 45, University Road, Southampton, Hampshire SO17 1BJ UK.,NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| |
Collapse
|
12
|
Graham AS, Stephenson J, Williams AE. A survey of people with foot problems related to rheumatoid arthritis and their educational needs. J Foot Ankle Res 2017; 10:12. [PMID: 28286569 PMCID: PMC5340002 DOI: 10.1186/s13047-017-0193-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/28/2017] [Indexed: 11/23/2022] Open
Abstract
Background Up to 50% of people with rheumatoid arthritis (RA) have foot symptoms at diagnosis, hence early foot health intervention is recommended and this should include patient education. This study identifies, for the first time, the foot health education (FHE) needs of people with RA. Methods An online survey of people with RA (n = 543) captured quantitative data in relation to the aims, methods of delivery, content, timing and accessibility of FHE. Results The majority concurred about the aims of FHE. Verbal delivery and websites were the most common methods. Written and verbal FHE were perceived to be the most effective methods. The point of diagnosis was the preferred time to receive it. Lack of access to FHE included minimal focus on foot health during consultations by both health practitioners and patients with RA. Participant gender, age, disease duration and living situation had a statistically significant influence on the results. Conclusion Foot health education is rarely considered within the medical consultation. There is a lack of patient and/or health professional awareness of this need with a detrimental impact on foot health. Patients require health professionals to identify their foot education health needs. Tailored foot health education should begin at initial diagnosis. Electronic supplementary material The online version of this article (doi:10.1186/s13047-017-0193-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Andrea S Graham
- Centre for Health Science Research, University of Salford, Frederick Road, Salford, UK.,Directorate of Prosthetics, Orthotics and Podiatry, University of Salford, Frederick Road, Salford, UK
| | - John Stephenson
- School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield UK
| | - Anita E Williams
- Centre for Health Science Research, University of Salford, Frederick Road, Salford, UK.,Directorate of Prosthetics, Orthotics and Podiatry, University of Salford, Frederick Road, Salford, UK
| |
Collapse
|
13
|
Graham AS, Williams AE. Foot health education provision for people with rheumatoid arthritis-an online survey of UK podiatrists' perceptions. J Foot Ankle Res 2016; 9:13. [PMID: 27118995 PMCID: PMC4845353 DOI: 10.1186/s13047-016-0145-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 04/20/2016] [Indexed: 11/25/2022] Open
Abstract
Background Patient education supports general disease self-management and in relation to foot problems, it is recommended as a key intervention for people with rheumatoid arthritis (RA). Further, it is known what the foot health educational (FHE) needs are in relation to their experiences of foot problems. Podiatrists are the key health professionals who provide the management of RA-related foot pathology and this includes the delivery of FHE. However, we do not know what is currently provided and what podiatrists’ perceptions are of this intervention. It is possible that there is a difference between what is provided and what patients need in order to maximise their foot health benefits and hence this may contribute to the persistence of foot problems and symptoms. This study primarily aims to define what UK podiatrists’ perceptions of FHE are in relation to; what is delivered, how it is delivered, and the timing of its delivery, in the context of its’ accessibility. The secondary aim is to identify any influence of the participants’ gender, age and duration of professional qualification on their responses. Method An online survey of UK HCPC registered podiatrists was used to capture quantitative data in relation to the perceived; aims, content, methods and effectiveness, timing and barriers to FHE provision to people with RA. Data was analysed to assess significant associations between the participant responses and their gender, age and duration of professional qualification. Free text comments were analysed using thematic analysis. Results 43 podiatrists across the UK completed the survey. The majority of participants stated that, they provided FHE and agreed with its overall aims. The most common methods of delivery that were perceived to be most effective were: verbal, written and website based information. The best times at which to deliver FHE were thought to be at the point of diagnosis of RA and at any available opportunity of health care delivery. The majority of participants thought they had enough knowledge and access to information resources to effectively deliver FHE, but half of the participants felt that consultation duration limited their ability to do so. Gender and duration of professional qualification influenced participants’ perceptions of FHE. Conclusion The importance and content of FHE for people with RA has been defined, but time limitations are seen to restrict its delivery. The development of an education needs analysis tool to facilitate efficient identification of patients FHE needs could enable timely and tailored delivery of FHE to people with RA. Electronic supplementary material The online version of this article (doi:10.1186/s13047-016-0145-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Andrea S Graham
- Centre for Health Sciences Research, University of Salford, Frederick Road, Salford, UK ; Directorate of Prosthetics, Orthotics and Podiatry, University of Salford, Frederick Road, Salford, UK
| | - Anita E Williams
- Centre for Health Sciences Research, University of Salford, Frederick Road, Salford, UK ; Directorate of Prosthetics, Orthotics and Podiatry, University of Salford, Frederick Road, Salford, UK
| |
Collapse
|
14
|
Patient and clinician views on the quality of foot health care for rheumatoid arthritis outpatients: a mixed methods service evaluation. J Foot Ankle Res 2016; 9:1. [PMID: 26740821 PMCID: PMC4702354 DOI: 10.1186/s13047-015-0133-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background Feet are often the first site of joint involvement in rheumatoid arthritis (RA) and get progressively worse if unmanaged, leading to permanent disability and negatively impacting patients’ quality of life. Podiatrists are specialists in the assessment, diagnosis and management of foot and ankle problems, however, RA outpatients often rely on referral from rheumatology clinicians to gain access to musculoskeletal podiatry services on the UK National Health Service (NHS). Therefore, the aim of this evaluation was to identify the foot health needs of rheumatoid arthritis patients and if they are being met by rheumatology clinicians. Methods A mixed methods approach was used: collecting qualitative data from patients and quantitative data from clinicians. Two focus groups were conducted with nine RA patients from a tertiary rheumatology outpatient clinic in the UK and the data were thematically analysed to inform a clinician survey. Thirteen rheumatology clinicians, from the same centre, completed the online survey. Resultant data were analysed to produce descriptive statistics. Results Patient focus group data generated four main themes: (1) need for foot health information, (2) feet ignored during routine consultations, (3) frequency of foot examination and (4) access to podiatry. Survey data highlighted that (i) 69–85 % of clinicians provided patients with foot health information sometimes, (ii) feet were examined in 47 % of routine consultations, (iii) 54 % of clinicians did not examine feet routinely because they are not included in the disease activity score with 28 joints (DAS-28), (iv) 31 % of clinicians referred patients to podiatry upon RA diagnosis, (v) 0 % of clinicians referred patients to podiatry for periodic review, (vi) 54 % of clinicians believed patients will self-report foot problems and (vii) 62 % of clinicians felt competent in foot examination. Conclusions RA patients’ foot health needs were not being fully met by rheumatology clinicians. Patients want foot health information and easy access to podiatry services. Rheumatology outpatient consultations need to have a wider focus than the DAS-28 and incorporate foot examination as standard. Clinicians need to ensure they have sufficient training and follow current national foot health guidance to provide optimal foot health care and outcomes for their RA patients. Electronic supplementary material The online version of this article (doi:10.1186/s13047-015-0133-2) contains supplementary material, which is available to authorized users.
Collapse
|