Implementation of podiatry telephone appointments for people with rheumatic and musculoskeletal diseases

Association of Foot Health and Lower Extremity Function in Older People with Rheumatoid Arthritis: A Cross-Sectional Study

INTRODUCTION

Foot health and lower extremity function are important in older people with rheumatoid arthritis (RA), as they maintain and promote these individuals' independent living and functional health. RA is a long-term inflammatory health condition that alters foot structure and function. Relatively little is known about the association between foot health and lower extremity function in older people with RA. Therefore, the aim of the study was to analyse the levels of foot health and lower extremity function in older people with RA and to explore the associations between these factors.

METHODS

A cross-sectional survey design study was conducted. The data were collected online in April 2023 from a national association of patients with rheumatic conditions in Finland using two instruments: the Self-administered Foot Health Assessment Instrument (S-FHAI) and the Lower Extremity Function Scale (LEFS). The data were analysed using descriptive and inferential statistics.

RESULTS

Older people with RA (n = 270) reported many foot health problems, the most common of which were foot pain, dry skin, and oedema. Lower extremity function in older people with RA was at the mild-to-moderate functional limitation level and respondents reported major difficulties running or hopping, squatting, carrying out their usual hobbies, performing strenuous activities outside their homes or putting on shoes/socks. Poor levels of foot health were correlated with decreased lower extremity function.

CONCLUSION

Foot health is associated with lower extremity function in older people with RA. Therefore, it is essential that older people with RA be provided with systematic foot health assessments, care and rehabilitation to promote their lower extremity health and improve their functional health. Multiprofessional collaboration and seamless care chains at different levels of health care could benefit older people with RA looking to maintain their functional ability and - above all - promote their active ageing.

Patient Outcomes of Virtual Foot and Ankle Telephone Clinics During COVID-19 Pandemic: 1 Year Experience

COVID-19 pandemic has instigated to find alternative methods of assessing and treating patients with foot and ankle disorders. We have implemented virtual telephone clinic consultations along with the face-to-face consultations. It has reduced overcrowding in the busy outpatient waiting area and thus limiting close patient contact. The aim of this study is to audit the patient satisfaction outcomes, assess the feasibility and to find out the potential financial implications of introducing telephone clinic consultations for foot and ankle disorders. A total of 426 patients who had telephone consultations for foot and ankle disorders for a period of 1 year were included. Patients were given individual time slots for the consultations. The patient satisfaction outcomes were assessed using a structured questionnaire. The outcomes following the telephone consultation was audited. The financial cost was calculated for the study period. Following the telephone consultation 35% of the patients were discharged and 36% were given further face to face appointments. 97.5% were very satisfied or satisfied with the methodology and outcomes of the telephone consultation. Ninety-five percent of the patients commented that they would recommend telephone consultations for foot and ankle to their friends and family. The financial savings calculated during the study period was about £25,000 ($30,000). Virtual telephone clinic consultations are safe, efficient and cost effective with good patient satisfaction outcomes. It is an alternative or can be conducted adjunct to face to face consultations with adequate planning, training, good communication skills and proper documentation.

A scoping review of foot and ankle telemedicine guidelines

Background and Aims

The COVID-19 pandemic accelerated the adoption of telemedicine in general. Its use has been widely adopted in the healthcare sector, but relatively little research has been conducted on the use of telemedicine for podiatry. This review aimed to explore and compare existing guidelines on telemedicine related to foot and ankle pathologies within a primary care setting.

Methods

The preferred reporting guidelines for the extension of scoping reviews were used in this review, and a set of inclusion and exclusion criteria were developed and implemented. This study made use of both databases and gray literature searches. Between 2012 and 2022, these databases were searched using various subject headings and free-text terms for the keywords "telemedicine" "foot health" and "guidelines" with appropriate Boolean operators.

Results

The search yielded 356 articles, which were reduced to 283 after removing duplicates. Six more records were discovered through a Google and Google Scholar search and one through an article reference search. Six articles and three institutional practice guidelines were selected for synthesis after screening. The findings were classified according to the level of evidence and research quality, the function of telemedicine and the communication used, the research outcomes sought, and the type of recommendations and guidelines made available.

Conclusion

This review highlights the lack of podiatric telemedicine guidelines for foot and ankle pathologies. Although foot and ankle guidelines for orthopedic and musculoskeletal virtual consultations have been mentioned, they do not cover the full range of potential case scenarios that fall within the remit of podiatric consultations in a primary care setting. This review suggests the development of foot and ankle telemedicine guidelines with recommendations on how they can better provide accessible care to their patients, making foot and ankle care management not only a hand-on-one but also reachable virtually, where applicable.

COVID-19 from a rheumatology perspective: bibliometric and altmetric analysis

The Coronavirus disease 2019 (COVID-19) outbreak turned out the greatest pandemic for decades. It challenged enormously the global health system, forcing it to adjust to the new realities. We aimed to analyze articles covering COVID-19 papers in the rheumatological field and outline emerging topics raising within this frame. We applied the bibliometric database Scopus for our literature search and conducted it on the 5th of June using the following keywords: "rheumatic" OR "rheumatology" OR "rheumatoid arthritis" OR "systemic lupus erythematosus" OR "myositis" OR "systemic sclerosis" OR "vasculitis" OR "arthritis" OR "ankylosing spondylitis" AND "COVID-19". We analyzed all selected articles according to various aspects: type of document, authorship, journal, citations score, rheumatology field, country of origin, language, and keywords. With the help of the software tool VOSviewer version 1.6.15, we have built the visualizing network of authors and keywords co-occurrence. The measurement of the social impact of articles was made using Altmetric data. This study included 1430 retrieved articles with open access mostly. The top five journals in this field were Annals of the Rheumatic Diseases (n = 65), Rheumatology International (n = 51), Clinical Rheumatology (n = 50), Lancet Rheumatology (n = 50), and Frontiers In Immunology (n = 33). Most studies originate from countries with a high incidence of COVID-19 among the general population (the USA-387; Italy-268; UK-184; France-114; Germany-110; India-98 and Spain-96, China-94, Canada-73 Turkey-66). Original Articles (42.1%) were the most common articles' type, following by Letters (24.4%), Reviews (21.7%), Notes (6%), Editorials (4.8%), Erratum (1%). According to the citations scores, articles dedicated to the clinical course of COVID-19 in patients with rheumatic diseases were of the highest importance for the scientific rheumatologic community. Rheumatoid arthritis (n = 527), systemic lupus erythematosus (n = 393), vasculitis (n = 267), myositis (n = 71), systemic sclerosis (n = 68), and psoriatic arthritis (n = 68) were the most widely discussed rheumatic diseases in the view of COVID-19. The analysis of Altmetric and citations scores revealed a moderate correlation between them. This article provides a comprehensive bibliometric and altmetric analysis of COVID-19 related articles in the rheumatology field and summarizes data about features of rheumatology service in the time of the pandemic.