Guidelines for the management of people with foot health problems related to rheumatoid arthritis: a survey of their use in podiatry practice

Abstract

BackgroundIn the last decade there has been a significant expansion in the body of knowledge on the effects of rheumatoid arthritis (RA) on the foot and the management of these problems. Aligned with this has been the development of specialist clinical roles for podiatrists. However, despite being recommended by national guidelines, specialist podiatrists are scarce. In order to inform non-specialist podiatrists of the appropriate interventions for these foot problems, management guidelines have been developed and disseminated by a group of specialist podiatrists. The aim of this survey was to investigate the use of these guidelines in clinical practice.MethodFollowing ethical approval an online questionnaire survey was carried out. The questions were formulated from a focus group and comprised fixed response and open response questions. The survey underwent cognitive testing with two podiatrists before being finalised. An inductive approach using thematic analysis was used with the qualitative data.Results245 questionnaires were completed (128–non-specialist working in the private sector, 101 non–specialists working in the NHS and 16 specialist podiatrists). Overall, 97% of the non-specialists (n = 222) had not heard of the guidelines. The non-specialists identified other influences on their management of people with RA, such as their undergraduate training and professional body branch meetings. Three main themes emerged from the qualitative data: (i) the benefits of the foot health management guidelines, (ii) the barriers to the use of guidelines generally and (iii) the features of useable clinical guidelines.ConclusionsThis study has revealed some crucial information about podiatrists’ level of engagement with the foot health management guidelines and the use of guidelines in general. Specifically, the non-specialist podiatrists were less likely to use the foot health management guidelines than the specialist podiatrists. The positive aspects were that for the specialist practitioners, the guidelines helped them to identify their professional development needs and for the few non-specialists that did use them, they enabled appropriate referral to the rheumatology team for foot health management. The barriers to their use included a lack of understanding of the risk associated with managing people with RA and that guidelines can be too long and detailed for use in clinical practice. Suggestions are made for improving the implementation of foot health guidelines.

Provision of foot health services for people with rheumatoid arthritis in New South Wales: a web‐based survey of local podiatrists

“…Similar findings have been demonstrated in the UK, with non-specialist podiatrists being less likely to use RA foot care guidelines to inform their podiatric practice [19]. The vast majority of respondents (88%) in this study indicated that they do not use formal guidelines to inform their management of patients with RA who have foot problems.…”

“…It is possible that some podiatrists may not have access to certain published articles due to subscription-only access restrictions, particularly those who work predominantly in private practice. Moreover podiatrists have previously identified that they lacked time in clinical practice to read any guidelines [19]. However, a significant association was found between private practice and access to FOs ( p  = 0.021, OR 0.21), suggesting greater odds of patients accessing FOs through private practice compared to public podiatry services.…”

Foot Health Education for People with Rheumatoid Arthritis: '…. A Game of Chance…' – A Survey of Patients' Experiences

“…Participants found that when they had raised concerns about their foot health with other members of the medical team, they found that their knowledge was lacking, highlighting the need for a specialist podiatry service. Additionally, poor awareness of how RA can have an impact on the foot was also perceived to be evident in podiatrists who were not specialists; indeed, this problem has already been identified (Williams et al, ).…”

Footwear Experiences of People With Chronic Musculoskeletal Diseases

“…A possible explanation for the high rate of reported satisfaction with this service is the high level of experience and specialist training for managing rheumatology‐related foot problems that was undertaken by the podiatrists delivering care at this site. This highlights an issue with current foot care services, as recent research from the UK suggests that there are large proportions of non‐specialist podiatrists who are unaware of clinical practice guidelines for RA and that there may be a lack of specialist podiatrists to meet the specific needs of the RA population . Further training options and subsequent funding of specialist podiatrists may be required in order to improve access to and provision of foot care for people with chronic musculoskeletal diseases in New Zealand.…”