Patients’ and clinicians’ perspectives on the clinical utility of the Rheumatoid Arthritis Foot Disease Activity Index

Abstract

Although patient-reported outcome measures (PROMs) are recommended in clinical practice, their application in routine care is limited. The Rheumatoid Arthritis Foot Disease Activity Index (RADAI-F5) is a validated PROM for assessing foot disease in rheumatoid arthritis (RA). To explore patient and clinician opinions and perceptions of the clinical utility of the Rheumatoid Arthritis Foot Disease Activity Index (RADAI-F5), eight RA patients and eight clinicians routinely involved in the management of RA patients participated in one semi-structured remote video-based interview. They provided their perspectives on the barriers and facilitators to clinical implementation of the RADAI-F5. Three global themes were identified; 'Feet are a priority' as the impact of RA on the feet negatively impacted upon patient quality of life. The second theme was 'Need for a clinically feasible foot PROM' as participants recognised the current lack of a clinically feasible tool to determine RA foot disease. The third global theme of ‘Implementation’ was drawn together to form two subordinate themes: ‘Facilitators to RADAI-F5 implementation’ as the tool can promote communication, guide management, help screen foot symptoms, monitor foot disease status and treatments, and promote patient education and; ‘Barriers to RADAI-F5 implementation’ as there were associated practical difficulties, including lack of appointment time, administrative burdens, IT barriers and preference for further RADAI-F5 validation using imaging. The RADAI-F5 has significant potential as a clinical tool to aid foot disease management. However, implementation challenges must be overcome before broad adoption in rheumatology clinics.

Location of joint involvement differentiates rheumatoid arthritis into different clinical subsets

“…This observation is relevant as foot complaints are quite common [35], yet many disease activity scores exclude the joints in the lower extremities. The problem of this was previously noted by patients and rheumatologists who called for methods that consider the lower extremities [36]. Our study further supports this notion.…”

Assessing the construct validity of musculoskeletal ultrasound and the rheumatoid arthritis foot disease activity index (RADAI-F5) for managing rheumatoid foot disease

“…For self-reporting, several RA foot-specific patient-reported outcome measures (PROMs) have been developed and validated to quantify foot impairments and disability in RA, such as the foot impact scale [ 10 ], foot function index [ 11 ] and Salford arthritis foot examination instrument [ 12 ]. Nonetheless, it appears that these PROMs lack clinical feasibility owing to their lengthiness and associated time burden for completion and scoring [ 13 , 14 ]. Additionally, these PROMs focus on measurements of foot disability and impairment domains, which are less likely to have clinical utility for a treat-to-target approach with emphasis on early detection of disease activity and intervention to prevent poor outcomes.…”

“…Qualitative research to identify barriers and facilitators to implementation of the RADAI-F5 in routine clinical practice suggested that the RADAI-F5 could be used to promote clinician–patient communication, to guide management, to screen patients and to monitor foot disease [ 14 ]. However, despite its apparent clinical utility, rheumatologists perceived the demonstration of construct validity of the RADAI-F5 relative to MSUS as crucial before widespread uptake and clinical implementation of this tool [ 14 ]. Accordingly, the aim of this study is to evaluate the construct validity of the RADAI-F5 compared with both MSUS and clinical examinations of foot joint and soft tissue tenderness and swelling.…”