Assistive devices: usage in patients with rheumatoid arthritis

Assistive devices non-use, abandonment, or non-adherence? Toward standard terminology for assistive devices outcomes

For individuals with disabilities, failure to use prescribed assistive technology devices (ATDs) according to professional recommendations can have detrimental health consequences. The literature has employed various terms to describe this phenomenon such as nonuse, abandonment, and non-adherence to characterize this behavior, lacking clear and standardized definitions. Consistent use of a standardized language is critical for advancing research in this area. This study aims to identify and describe the concepts related to the failure to use prescribed ATDs, along with the associated contexts, and proposes a framework for standardizing terminology in this domain. A narrative literature review encompassing studies from inception to June 2023 was conducted to elucidate these concepts. Out of 1029 initially identified articles, 27 were retained for in-depth analysis. The review unveiled a significant inconsistency in the use of terms like nonuse, abandonment, noncompliance, and non-adherence. Some articles even employed these terms interchangeably without clear definitions. Only 10 of the 27 reviewed articles provided definitions for the terminology they used. This highlights the crucial need for adopting valid conceptual models to select appropriate terms. Researchers are strongly encouraged to furnish operational definitions aligned with theoretical models and relevant to their research context to advance this field consistently.

Psychosocial predictors of mobility assistive devices non-adherence among older adults

Background: Mobility assistive devices (MADs) provide support to older adults to improve their quality of life; however, research shows that as many as 75% of older adults are non-adherent to prescribed MADs. This study investigated the psychosocial factors that predict non-adherence to MADs among older adults.Methods: A sample of Canadian older adult MADs users who resided in a long-term care facility was included. The data was collected using the Psychosocial Impact of Assistive Devices Scale (PIADS), and the Medical Outcomes Study Social Support Survey (mMOS-SS). Data analysis was performed using SPSS 28. Descriptive statistics were used to describe the sample and the study variables. Pearson correlation coefficients were used to evaluate the association between the study variables. Variables that were associated with non-adherence in a univariate analysis were subsequently entered into a multiple regression analysis.Results: The sample comprised 48 residents (26 females and 22 males), with a mean age of 86.8. In the univariate analysis, scores from the three PIADS subscales, namely, Competence, Adaptability, and Self-esteem, and the Social Support scale were significantly correlated with non-adherence (p < 0.05). In the multiple regression analyses, only Self-esteem significantly predicted non-adherence (p < 0.05), and this model explained between 43.5 and 54.3% of the variance in non-adherence.Conclusion: This study revealed that the Self-esteem construct, which includes several concepts related to psychological well-being, was the only significant predictor of non-adherence among the studied sample of older adults. The clinical implications of the findings are subsequently discussed.

Patient Compliance With Wearing Lower Limb Assistive Devices: A Scoping Review

OBJECTIVE

The aim of this scoping review was to identify information on compliance with wearing orthoses and other supportive devices, to discuss the barriers to adherence, and to suggest strategies for improvement based on these findings.

METHODS

Online databases of PubMed, Web of Science, and the Cochrane Library were searched for articles about patients' compliance with regard to lower limb assistive devices. In addition, a methodological quality control process was conducted. Studies were included if in the English language and related to compliance and adherence to the lower limb assistive device. Exclusion was based on first reading the abstract and then the full manuscript confirming content was not related to orthotic devices and compliance.

RESULTS

Twelve studies were included. The data revealed between 6% and 80% of patients were not using a prescribed device. Barriers to the use of the orthotic device included medical, functional, device properties and lack of proper fit. Strategies for improved compliance included better communication between patient and clinician, patient education, and improved comfort and device esthetics.

CONCLUSIONS

Individualized orthotic adjustments, rehabilitation, and patient education were promising for increasing adherence. Despite positive aspects of improvements in gait, balance in elderly, and a sense of security produced by using assistive devices, compliance remains less than ideal due to barriers. As compliance in recent studies has not improved, continued work in this area is essential to realize the benefits of technological advances in orthotic and assistive devices.

Societal participation in ehlers-danlos syndromes and hypermobility spectrum disorder, compared to fibromyalgia and healthy controls

Ehlers-Danlos syndrome and hypermobility spectrum disorder affect daily life. There is a lack of research that investigates how the disease affects aspects of participation. This study investigates whether there is a difference in the level of participation in society in persons with vascular EDS (N = 18), hypermobile EDS (N = 20), classical EDS (N = 4) and Hypermobility Spectrum Disorder (N = 27), compared to a healthy control group (N = 69) and fibromyalgia (N = 69). In this retrospective case-control study, the Ghent Participation Scale was completed by all participants. Each patient with EDS and HSD was matched by age and sex to healthy controls. The hEDS and HSD group were compared with the healthy control group and a positive control group (persons with fibromyalgia). The results show that there was a significant lower overall participation score for persons with hEDS/HSD compared to the healthy control group. In addition, significant differences were observed in the subscores self-performed activities and delegated activities in the hEDS/HSD group compared to healthy controls, being HEDS/HSD patients who obtained the lower scores. Further research is needed to obtain representative results of the participation level for the EDS/HSD population. In this way, interventions can be set up for patients with EDS in an evidence-based way and that are appropriate to the patient’s level of participation.

Offloading treatment in people with diabetic foot disease: A systematic scoping review on adherence to foot offloading

BACKGROUND AND AIMS

To identify measurement methods, proportions of adherent participants, factors affecting adherence, and concordance promoting interventions.

METHODS

A systematic scoping review was conducted by searching Medline, CINAHL, PubMed, EMBASE, and EMCARE databases.

RESULTS

Twenty-four trials were identified from 1001 citations. Only 25% of the included studies used objective methods to quantify adherence. The proportion of adherent participants (≥80% of daily steps/time) ranged from 28% to 60%. Psychosocial factors are the most common influencers of adherence. However, interventions for improving compliance are lacking.

CONCLUSION

There is a need to accurately quantify and optimize adherence to foot offloading in people with diabetes.

Technische Alltagshilfen in der Rheumatologie – Was ist sinnvoll, was ist bewiesen, welche Perspektiven gibt es?

Einschränkungen der Alltagsaktivität sind ein relevantes gesundheitliches Problem bei Patienten mit entzündlich-rheumatischen Systemerkrankungen. Technische Alltagshilfen nehmen in der Rehabilitation von diesen Teilhabeeinschränkungen einen hohen Stellenwert ein. Wir erläutern Evidenz für den Einsatz von Alltagshilfen und die neuen Entwicklungen auf diesem Gebiet.

Enabling older adults to carry out paperless falls-risk self-assessments using guidetomeasure-3D: A mixed methods study

BACKGROUND

The home environment falls-risk assessment process (HEFAP) is a widely used falls prevention intervention strategy which involves a clinician using paper-based measurement guidance to ensure that appropriate information and measurements are taken and recorded accurately. Despite the current use of paper-based guidance, over 30% of all assistive devices installed within the home are abandoned by patients. This is in part due to poor fit between the device, the patient, and the environment in which it is installed. Currently HEFAP is a clinician-led process, however, older adult patients are increasingly being expected to collect HEFAP measurements themselves as part of the personalisation agenda. Without appropriate patient-centred guidance, levels of device abandonment to are likely to rise to unprecedented levels. This study presents guidetomeasure-3D, a mobile 3D measurement guidance application designed to support patients in carrying out HEFAP self-assessments.

AIM

The aim of this study is to present guidetomeasure-3D, a web-enabled 3D mobile application that enables older-adult patients to carry out self-assessment measurement tasks, and to carry out a mixed-methods evaluation of its performance, and associated user perceptions of the application, compared with a 2D paper-based equivalent.

METHODS

Thirty-four older adult participants took part in a mixed-methods within-subjects repeated measures study set within a living lab. A series of HEFAP self-assessment tasks were carried out according to two treatment conditions: (1) using the 3D guidetomeasure-3D application; (2) using a 2D paper-based guide. SUS questionnaires and semi-structured interviews were completed at the end of the task. A comparative statistical analysis explored performance with regards to measurement accuracy, accuracy consistency, task efficiency, and system usability. Interview transcripts were analysed using inductive and deductive thematic analysis (informed by UTAUT).

RESULTS

The guidetomeasure-3D application outperformed the 2D paper-based guidance in terms of accuracy (smaller mean error difference in 11 out of 12 items), accuracy consistency (p < 0.05, for 6 out of 12 items), task efficiency (p = 0.003), system usability (p < 0.00625, for two out of 10 SUS items), and clarity of guidance (p < 0.0125, for three out of four items). Three high-level themes emerged from interviews: Performance Expectancy, Effort Expectancy, and Social Influence. Participants reported that guidetomeasure-3D provided improved visual quality, clarity, and more precise guidance overall. Real-time audio instruction was reported as being particularly useful, as was the use of the object rotation and zoom functions which were associated with improving user confidence particularly when carrying out more challenging tasks.

CONCLUSIONS

This study reveals that older adults using guidetomeasure-3D achieved improved levels of accuracy and efficiency along with improved satisfaction and increased levels of confidence compared with the 2D paper-based equivalent. These results are significant and promising for overcoming HEFAP equipment abandonment issue. Furthermore they constitute an important step towards overcoming challenges associated with older adult patients, the digitisation of healthcare, and realising the enablement of patient self-care and management via the innovative use of mobile technologies. Numerous opportunities for the generalisability and transferability of the findings of this research are also proposed. Future research will explore the extent to which mobile 3D visualisation technologies may be utilised to optimise the clinical utility of HEFAP when deployed by clinicians.

The association between having assistive devices and activities of daily living ability and health-related quality of life: An exploratory cross-sectional study among people with advanced cancer

OBJECTIVE

To explore whether people with advanced cancer who had assistive devices had higher or lower ADL ability and/or HRQoL than people with advanced cancer who did not have assistive devices.

METHODS

A cross-sectional study of 164 participants with advanced cancer. Self-reported ADL ability and HRQoL were assessed using the ADL-Interview and the EORTC QLQ-C30. Data regarding assistive devices were collected using a study-specific questionnaire. Data were analysed using multiple linear regression. The regression coefficients (B) were presented in crude form and adjusted for potential confounding variables (age, gender, cohabiting, receiving help, physical functioning, fatigue and pain). p-Values (p) < 0.05 were considered statistically significant.

RESULTS

Having assistive devices was associated with lower ADL ability (B = -0.923, p = <0.0001), but this association was not significant after adjustment where it was found that physical functioning was a confounder positively associated with ADL ability (B = 0.030, p = <0.0001). No significant association was found between having assistive devices and HRQoL. Both fatigue (B = -0.336, p = <0.0001) and pain (B = -0.124, p = 0.010) were negatively associated with HRQoL.

CONCLUSION

The participants had the same ADL ability and HRQoL regardless of them having assistive devices. Interventions addressing physical functioning or fatigue and pain might contribute to enhancing ADL ability and HRQoL among people with advanced cancer.

Understanding adherence to assistive devices among older adults: a conceptual review

Purpose: The aim of this study was to identify and examine how existing literature has conceptualized adherence to assistive devices (ADs) among older adults. Methods: English articles were searched in MEDLINE, PubMed, and CINAHL (January 1990 to October 2017) for the key words "acceptance", "adherence", "assistive devices", "compliance", "concept," and relevant synonyms. Bibliographies of selected articles were also examined. Articles were analyzed if the following conditions were met conjointly: (1) attempted to define or conceptualize adherence to some degree; (2) were concerned with any AD for older adults; (3) were concerned with adults aged 65 years or older. Results: Sixteen of the 484 articles were included. Adherence to ADs among older adults seemed to be conceptualized under three core themes: psychological, contextual, and functional factors; each with their own unique considerations related to adherence that are analyzed in this study. Conclusion: This review identified a large gap in knowledge about adherence to ADs. Adherence is multi-factorial and highly specific to the individual's circumstances and their relationship with their health care practitioner. Further empirical research should focus on how the three core themes of adherence interact with and influence each other. Implications for rehabilitation Health care professionals who assess for, and recommend ADs should foster a shared decision-making relationship with their clients This review identifies some of the key themes that practitioners should consider when developing and implementing AD regimens with older adults Conceptualizing AD adherence among older adults will help improve monitoring of and quality of care for AD users.

Advantages and disadvantages of interdisciplinary consultation in the prescription of assistive technologies for mobility limitations

PURPOSE

To explore the advantages and disadvantages experienced by professionals in interdisciplinary consultation involving the user, prescriber and technician in the prescription of assistive technologies for mobility limitations.

METHOD

Cross-sectional study. Prescribers (N = 39) and orthopaedic technicians (N = 50), who were regularly involved in an interdisciplinary consultation completed a questionnaire about advantages and disadvantages of the interdisciplinary consultation.

RESULTS

Advantages of the interdisciplinary consultation were mentioned within all CanMEDS areas of medical practice, including better and quicker prescription of the assistive technology, shared knowledge of medical diagnosis and device possibilities, shared decision making of the device prescription and clear communication rules. Disadvantages were mentioned in the CanMEDS areas management and collaboration, including planning problems (financial) reimbursement of this type of consultation, and time efficiency. On a 10-point scale, mean (standard deviation) rates of interdisciplinary consultations were 7.9 (0.6) according to prescribers, and 7.8 (0.9) by technicians. All participants wanted to continue the interdisciplinary consultation.

CONCLUSIONS

Prescribers and technicians in the field of assistive technologies for walking mobility limitations appreciate an interdisciplinary consultation. Advantages are found in all CanMEDS areas, whereas disadvantages only concern coordination. It should be encouraged to realize this kind of consultation in all situations where such technologies are prescribed. Implications for rehabilitation Interdisciplinary consultation involving the user, prescriber and technician to prescribe assistive technologies for mobility limitations has many advantages in all CanMEDS areas of medical practice, and few disadvantages, related to management and collaboration only. The disadvantages of interdisciplinary consultation, such as (financial) reimbursement by health insurance companies, have to be taken into account. Professionals in the field of ankle-foot-orthoses and orthopaedic shoes (medical specialist as prescriber and orthopaedic technician) who are involved in interdisciplinary consultation appreciate it and want to continue.

The use of evidence-based guidance to enable reliable and accurate measurements of the home environment

Introduction

High quality guidance in home strategies is needed to enable older people to measure their home environment and become involved in the provision of assistive devices and to promote consistency among professionals. This study aims to investigate the reliability of such guidance and its ability to promote accuracy of results when measurements are taken by both older people and professionals.

Method

Twenty-five health professionals and 26 older people participated in a within-group design to test the accuracy of measurements taken (that is, person's popliteal height, baths, toilets, beds, stairs and chairs). Data were analysed with descriptive analysis and the Wilcoxon test. The intra-rater reliability was assessed by correlating measurements taken at two different times with guidance use.

Results

The intra-rater reliability analysis revealed statistical significance (P < 0.05) for all measurements except for the bath internal width. The guidance enabled participants to take 90% of measurements that they were not able to complete otherwise, 80.55% of which lay within the acceptable suggested margin of variation. Accuracy was supported by the significant reduction in the standard deviation of the actual measurements and accuracy scores.

Conclusion

This evidence-based guidance can be used in its current format by older people and professionals to facilitate appropriate measurements. Yet, some users might need help from carers or specialists depending on their impairments.

Communication techniques for improved acceptance and adherence with therapeutic footwear

BACKGROUND AND AIM

Clients' acceptance and adherence with orthoses can be influenced by a clinician's communication skills. In this clinical note, we describe two communication techniques, in the context of therapeutic footwear.

TECHNIQUE

Person-centred communication involves engaging with and listening to the attitudes of the client towards their condition, as well as discussing acceptance and expectations, in a structured consultation. Building a relationship is crucial and requires clients to feel heard and understood. An important influence on the acceptance and adherence is that a client makes a conscious decision to receive their device. This active receipt can be facilitated through shared decision making, wherein clinicians give clear, relevant and meaningful examples, based on clinical evidence, and ensure this is understood.

DISCUSSION

Two communication techniques for clinicians providing therapeutic footwear are described. These can be adapted for use with provision of other assistive technologies to improve client acceptance and adherence. Clinical relevance Small changes in how clinicians communicate to their clients in daily practice can have a big influence on the subsequent acceptance and adherence with therapeutic footwear and indeed other prescribed assistive technologies.

Neurological patients and their lower limb orthotics: An observational pilot study about acceptance and satisfaction

BACKGROUND

Although an orthotic device of the lower limb improves the functionality of neurological patients, anecdotally clinical experience suggests that the compliance is rather limited.

OBJECTIVES

The aim was to determine the satisfaction and acceptance of a lower limb orthotic device.

STUDY DESIGN

A qualitative observational pilot study with a mix-method design.

METHODS

Adult neurological patients who had a prescribed lower limb orthotic device were included. One published and clinically used questionnaire about satisfaction (D-Quest) and one ad hoc constructed questionnaire about acceptance of the orthotic device (MIRAD-ACCORT questionnaire) were used for data collection.

RESULTS

In total, 33 patients participated (28 ankle-foot orthotic device, 3 knee-ankle-foot orthotic device and 2 other types). In general, they were satisfied about their orthotic device and the services. Less than one-fourth of the patients had some negative comments about the 'visual aspects' and the 'ability to hide' of their orthotic device. These, however, had a lower priority when compared with functionality, which was reported as a main advantage and is a reason for continuing the use of their orthotic device.

CONCLUSION

Patients were satisfied in relation to their lower limb orthotic device. With regard to acceptance, it can be concluded that factors associated with functionality and comfort are more important than the aesthetic and psychological aspects of the orthotic device. Clinical relevance Patients were satisfied with their lower limb orthotic device. Some patients had some negative comments about the 'aesthetics aspects' and the 'ability to hide' their orthotic device. However, improvements in functionality were mostly reported as a main advantage and a reason for continuing the use of their orthotic device.

Medical-grade footwear: the impact of fit and comfort

Background

Pressure-related skin lesions on the digits are a significant cause of discomfort. Most foot pain related to ill-fitting shoes occurs in the forefoot and digital areas. Pain has been associated with poor shoe fit, reduced toe box volume, as well as contour and shape of the shoe Off-the-shelf medical-grade footwear is designed as an intervention for chronic lesions on the digits. These shoes are designed with a flexible neoprene fabric upper that is thought to reduce pressure on the forefoot and reduce discomfort associated with ill-fitting shoes. The aim of this study was to investigate the effect of an off-the-shelf, medical-grade shoe on dorsal digital pressure and perceived comfort when compared to participant’s own preferred shoe.

Methods

Thirty participants (18 females, 12 males) scored their perceived comfort whilst wearing each footwear style using a visual analog comfort scale. Dorsal digital and interdigital pressures were measured in using the WalkinSense® in-shoe pressure system. Sensors were placed on predetermined anatomical landmarks on the digits. Participants were randomly assigned the test shoe and their own shoe. Once wearing the shoe, the participants walked across a 6 m walkway and pressure data from each sensor was collected and processed to obtain peak pressure, time to peak pressure and contact time.

Results

Participants scored the test shoe with higher comfort points than their own footwear. Overall peak pressure, pressure time integral and contact time decreased, whilst the time taken to reach peak pressure increased across all anatomical landmarks whilst wearing the test shoe. Statistically significant changes were observed for all of the measured variables relating to pressure on the medial border of the first metatarsophalangeal joint.

Conclusion

The test shoe provided greater comfort and reduced the amount of pressure on the forefoot. The medical-grade footwear therefore, is a viable alternative to custom made prescription footwear and is more suitable than a regular everyday shoe when treating digital lesions associated with pressure.

Erosions in the foot at baseline are predictive of orthopaedic shoe use after 10 years of treat to target therapy in patients with recent onset rheumatoid arthritis

The objective of this study is to investigate if foot joint damage due to rheumatoid arthritis (RA) can predict whether patients will start wearing orthopaedic shoes (OS) within 10 years after treatment start. Data from recent onset RA patients with 10 years follow-up from the BeSt (Dutch acronym for treatment strategies) study were used. Treatment was tightly controlled, targeted at disease activity score (DAS) ≤2.4, according to 1 of 4 pre-specified treatment strategies. After 10 years of follow-up, orthopaedic shoe use was recorded in 285/508 patients (responders to questionnaires at 10 years). Between-group differences for orthopaedic shoe users and non-users were calculated at baseline, after 10 years, and change scores over the 10-year period were calculated. Predictors for orthopaedic shoe use were identified by univariable and multivariable logistic regression analyses. Orthopaedic shoe use was reported by 57/285 patients after 10 years. Orthopaedic shoe users had more joint damage, joint swelling and pain in the feet already at baseline and after 10 years. At both time points, DAS of orthopaedic shoe users and non-users was similar. Multivariable logistic regression showed that dichotomized foot erosions score (cut-off ≥1 erosion) (OR 2.42), anti-citrullinated protein antibodies (ACPA) (OR 4.64) and DAS (OR 1.77) were independent predictors of orthopaedic shoe use. Despite intensive targeted treatment, 57/285 recent onset RA patients started using orthopaedic shoes over 10 year of follow-up. Presence of foot erosions at treatment start predicts orthopaedic shoe use after 10 years. The risk of orthopedic shoe use increased for ACPA-positive patients and for those with higher baseline disease activity.

Compliance of patients wearing an orthotic device or orthopedic shoes: A systematic review

BACKGROUND

Alongside the positive effects of use of orthotic devices for the lower extremities (ODLE) and orthopedic shoes, complaints and criticism by users possibly lead to non-compliance.

OBJECTIVE

The purpose is to determine the compliance of patients wearing an ODLE or orthopedic shoes and to describe the main reasons for using and not using.

METHODS

Different online databases were searched for articles about patients' compliance with regard to an ODLE or orthopedic shoes. A methodological quality control was conducted.

RESULTS

Ten studies (1576 patients) were included. The data revealed between 6 and 80% not users. Several reasons for not using the orthotic device were described (e.g. pain, discomfort and cosmetically unacceptable).

CONCLUSIONS

The high percentage of patients who are not wearing the prescribed orthotic devices leads to a high financial loss for society and a waste of therapeutic effort. These results should be taken into account during the design, construction and selection process of orthotic devices.

Self-efficacy and arthritis disability: An updated synthesis of the evidence base and its relevance to optimal patient care

Self-efficacy, denoting the degree of confidence an individual has in carrying out a specific activity, was initially discussed in the 1970s as a potential correlate of disease outcomes. Drawn from 35 years of related research, this review provides an updated understanding of the concept of self-efficacy and its relevance for arthritis management. There is a consistent link between self-efficacy, arthritis pain and disability, and adherence to recommended therapeutic strategies. A wide variety of intervention strategies improve arthritis self-efficacy, as well as outcomes. Steps to assess and intervene thoughtfully to maximize self-efficacy beliefs are likely to impact arthritis disability outcomes quite favorably and significantly, regardless of disease type, duration, or sociodemographic factors.

Ergonomic Design of a Computer Mouse for Clients With Wrist Splints

OBJECTIVE. We explored effects of cutaneous feedback and hump position on efficiency and comfort in mouse use with a splint. We also analyzed the relationship between anthropometric measurements (width of hand and length of hand, palm, and index) and the task performance.

METHOD. Thirty participants performed a computer task with two forms of mice (front hump and rear hump) and two kinds of wrist splints (dorsal and volar). Movement time and satisfaction scores were recorded.

RESULTS. No interaction effect (Hump Position × Splint Type) was found on movement time. Movement time was shorter for rear-hump mouse users than for front-hump mouse users. Movement time was also shorter for wearers of dorsal wrist splints than for wearers of volar wrist splints. Limited differences existed in the satisfaction scores. Participants with a longer index finger had shorter movement time.

CONCLUSION. Both dorsal wrist splints and rear-hump mice are recommended. Length of index finger positively correlated with task performance.

Assistive devices, home adjustments and external help in rheumatoid arthritis

PURPOSE

To explain the determinants of adaptation with disease and self-management of patients with rheumatoid arthritis (RA) in Estonia, focusing on the use of assistive devices, home adjustments and the need for external help.

METHOD

A random sample (n = 1259) of adult Estonian RA patients was selected from the Estonian Health Insurance Fund Database. The patients completed a self-administered questionnaire, which included information about their socio-demographic and disease characteristics, the costs of care, quality of life, use of assistive devices, home adjustments and the need for external help. Regression analysis was used to analyse the predictors of patient's adaptation with disease and self-management.

RESULTS

Twenty-six percent of the respondents used assistive devices, 20% had made home adjustments and 37% needed external help. Disabilities and physical impairments predicted the use of assistive devices, home adjustments and the need for external help. The use of medical rehabilitation services predicted the less frequent use of assistive devices, while female gender and single status predicted a more expressed need for external help.

CONCLUSIONS

Disability and physical impairment are the most important determinants of the use of various technical aids and home adjustments. These factors, along with the female gender and single status of the patient, predict help-dependence.

Nonpharmacological treatment of rheumatoid arthritis

PURPOSE OF REVIEW

To summarize recent literature on nonpharmacological and nonsurgical interventions in patients with rheumatoid arthritis (RA).

RECENT FINDINGS

Recent systematic reviews and individual studies substantiate the effectiveness of aerobic and strength exercise programmes in RA. The evidence for the promotion of physical activity according to public health recommendations is scarce, and implementation research found that the reach and maintenance of exercise or physical activity programmes in RA patients are suboptimal. For self-management interventions, characteristics that increase their effectiveness were identified, including the use of cognitive behavioural approaches and approaches derived from the self-regulation theory. A limited number of recent individual trials substantiate the effectiveness of comprehensive occupational therapy, foot orthoses, finger splints and wrist working splints, but not of wrist resting splints. Overall, the evidence for the effectiveness of assistive devices and dietary interventions is scanty.

SUMMARY

For exercise and physical activity programmes and self-management interventions in RA, research is increasingly directed towards the optimization of their content, intensity, frequency, duration and mode of delivery and effective implementation strategies. A number of studies substantiate the effectiveness of comprehensive occupational therapy, wrist working splints and finger splints. More research into the effectiveness of assistive devices, foot orthoses and dietary interventions is needed.

Arthritis, foot pain and shoe wear: current musculoskeletal research on feet

PURPOSE OF REVIEW

Both arthritis and foot pain are major public health problems. Approximately 24% of adults have foot ailments, and the prevalence increases with age. Foot pain, particularly related to shoes, footwear and rheumatic disorders, may be an important modifiable factor. Surprisingly, this topic has received little attention in the rheumatology community.

RECENT FINDINGS

Despite the major focus of structure and alignment in arthritis, remarkably little work has focused on the foot and nonsurgical foot interventions that might affect lower extremity joint alignment, structure and pain in rheumatic diseases. Emerging research suggests that there may be a significant role for foot orthotics and footwear in the treatment of rheumatoid arthritis and osteoarthritis of the hip, knee and foot. This review highlights the current understanding on the topic of foot orthotics and footwear in adults with rheumatic diseases.

SUMMARY

Biomechanical evidence indicates that foot orthotics and specialized footwear may change muscle activation and gait patterns to reduce joint loading. Emerging evidence suggests that orthotics, specific shoe types and footwear interventions may provide an effective nonsurgical intervention in rheumatic diseases. Yet good data are sparse, and it is premature to recommend guidelines. As there are a limited number of studies that underpin the foot's role in arthritis cause and progression, clinical trials and prospective studies are of utmost importance to unravel the links between foot pain, foot conditions and interventions that lessen the impact of rheumatic diseases.

Patients' expectations and actual use of custom-made orthopaedic shoes

OBJECTIVE

To investigate the association between patients' expectations and the actual use of custom-made orthopaedic shoes.

DESIGN

A prospective cohort study with internal comparison.

SETTING

Twelve orthopaedic shoe companies.

PATIENTS

During six months, consecutive patients who were provided with their first ever pair of orthopaedic shoes and aged 16 years or older were recruited. A total of 339 patients with different pathologies were included (response 67%). Mean (SD) age of the patients was 63 (15) years, and 129 patients (38%) were male.

MAIN MEASURES

A practical and reproducible questionnaire, measuring: frequency of use of orthopaedic shoes, patients' expectations and experiences of aspects of the usability of orthopaedic shoes, and communication about patients' expectations.

RESULTS

Patients' expectations were not associated with the use of orthopaedic shoes (P-values range: 0.106 to 0.607), but the difference between expectations and experiences was (P-values range: <0.001 to 0.012). The expectations of patients who frequently used their orthopaedic shoes were in concordance with their experiences, whereas the expectations of patients who did not use their orthopaedic shoes were much higher than their experiences. There was no communication of patients' expectations with the medical specialist or orthopaedic shoe technician in 34% and 25% of the patients respectively.

CONCLUSIONS

In relation to the actual use of orthopaedic shoes, it is crucial that patients' expectations are not much higher than their experiences.