Exploring the use of musculoskeletal ultrasound imaging by podiatrists: an international survey

Abstract

Background Podiatrists, in musculoskeletal services, are demonstrating an expansion of their practice skills through the use of ultrasound imaging. There is an assumption that this practice is beneficial within the context of patient care and health systems. The aim of this research was to further investigate the use of musculoskeletal ultrasound (MSUS) by podiatrists within their clinical setting and gain additional insights into the impact that they perceive use of MSUS has on their approaches to management of musculoskeletal foot and ankle problems. Method An international study utilising a cross-sectional design and an internet-based platform was undertaken. The survey was developed and implemented through three phases: 1. survey development, 2. face validity agreement via questionnaire review, and 3. survey distribution and data collection. Twenty-two survey questions were developed and set as a two-step approach collecting quantitative data (part 1) and qualitative free text data (part 2). Data was exported from SurveyMonkey and analysed using Microsoft Excel software. Counts and frequencies were calculated for responses to all twenty closed questions. Responses to the two final open-ended questions were analysed using thematic analysis to search for patterns related to podiatrists’ perceptions of impact. Results Two hundred and thirty-two eligible participants consented to complete the survey. The majority (n = 159) of respondents were from the UK and Spain. Commonly MSUS has been used in practice for (i) diagnosing pathology, (ii) supporting rehabilitation, (iii) supporting interventions or (iv) research purposes. Most frequently, MSUS was used to assist in the diagnosis of injury/pathology (84%). A range of free text comments were received from the participants in response to the question relating to their thoughts on the impact of using MSUS imaging in their practice (n = 109) and on their perceptions of how the use of MSUS has influenced their approaches to management of their patients’ musculoskeletal foot and ankle problems (n = 108). Thematic analysis of the free text comments generated four themes: (i) diagnosis, (ii) delivery and access of care, (iii) patient education and engagement, and (iv) patient empowerment. Conclusion The perceived benefit podiatrists indicated in using MSUS as part of their practice is the perceived improvement in patient journeys through tighter, focused management plans and reduced waiting times. An additional novel finding was that MSUS provided the capacity for podiatrists to better inform patients of their diagnosis, which they believed led to improved engagement and consequent empowerment of patients in their treatment plans. We propose further investigation of patient experiences as well as testing of the model that embeds podiatrists’ use of MSUS as a key skill in musculoskeletal foot and ankle services.

A bibliometric analysis of published research employing musculoskeletal imaging modalities to evaluate foot osteoarthritis

“…This may reflect the more frequent publication of studies employing CT, MRI and USI in European countries. Clinical-based surveys have shown that specific imaging modalities, for example USI, are more widely used in Europe compared with USA and Australasia [48,49], which may be due to variations in the structure of musculoskeletal radiology training across countries [50]. This finding highlights the importance of ongoing international collaboration in this research field [51][52][53][54], with different researchers and institutions contributing different skill sets based on their specific knowledge of different imaging modalities.…”

The evaluation of podiatrists, with knowledge and training in diagnostic musculoskeletal ultrasound, to describe sonographic images of diabetic foot wounds in the United Kingdom and Australia

“…This formulaic response is likely a result of training in ultrasound report writing. This approach may not be optimal when looking at the less organised tissues that results from a wound, and perhaps a more lesioncentric approach, akin to that adopted when reporting (28), oedema (21), skin (13) Morphology Irregular (17), sinus (16), tracking (10), regular (9), Shallow (6) Bone Bone (84), joint (23), metatarsal head (19), osteomyelitis (19), styloid process (7) Sonography terms Deep/depth (48), hypoechoic (45), transverse (16), diameter (15), measuring (13) breast tumours, would enhance the quality of [32].…”

“…This information, in combination with a medical history, can be used to help support clinical decision-making plus and as an educational tool to more comprehensively inform a person of their condition. Notably, of podiatrists completing a recent international survey ( n = 239), USI is expanding in Europe (Ireland (0.43%; Italy 0.86%; Malta 1.29%; Spain 31.47%; Netherlands 11.64%; UK 37.07%) and also Canada (12.5%), Australia (3.5%), South Africa (0.45%), USA (0.43%) and Kenya (0.43%) [ 23 ]. Contrary to this there is no legal requirement for podiatrists to hold a recognised ultrasound qualification in order to practice as a sonographer in the UK or Australia and sonography is not recognised as a profession by the Health and Care Professions Council (HCPC) nor the Australian Health Practitioner Regulation Agency (AHPRA).…”

“…Contrary to this there is no legal requirement for podiatrists to hold a recognised ultrasound qualification in order to practice as a sonographer in the UK or Australia and sonography is not recognised as a profession by the Health and Care Professions Council (HCPC) nor the Australian Health Practitioner Regulation Agency (AHPRA). Variability in training pathways for USI exists such that the level of USI competency those podiatrists have is not known [ 23 ]. However it is known that the majority of work in this field by podiatrists has been conducted in people with MSK injury or people with inflammatory conditions [ 22 ].…”

“…Given that current tools for wound assessment are unable to comprehensively map the sub-wound space at point-of-care, in the concept of utilising USI in clinic to support empirical thinking when evaluating DFU has appeal. USI has been shown to be portable, safe and non-invasive to the person receiving the scan, as well having low costs to running and maintaining the equipment [ 22 , 23 ]. Thus, this technology could be deployed at point of care to review characteristics of tissue structure including depth, tracking or sinuses, monitoring vascularity, stiffness and to identify bone and tendon changes.…”