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

Abstract

BackgroundIt is unclear if podiatric foot care for people with rheumatoid arthritis (RA) in New South Wales (NSW) meets current clinical recommendations. The objective of this study was to survey podiatrists’ perceptions of the nature of podiatric foot care provision for people who have RA in NSW.MethodsAn anonymous, cross-sectional survey with a web-based questionnaire was conducted. The survey questionnaire was developed according to clinical experience and current foot care recommendations. State registered podiatrists practising in the state of NSW were invited to participate. The survey link was distributed initially via email to members of the Australian Podiatry Association (NSW), and distributed further through snowballing techniques using professional networks. Data was analysed to assess significant associations between adherence to clinical practice guidelines, and private/public podiatry practices.Results86 podiatrists participated in the survey (78% from private practice, 22% from public practice). Respondents largely did not adhere to formal guidelines to manage their patients (88%). Only one respondent offered a dedicated service for patients with RA. Respondents indicated that the primary mode of accessing podiatry was by self-referral (68%). Significant variation was observed regarding access to disease and foot specific assessments and treatment strategies. Assessment methods such as administration of patient reported outcome measures, vascular and neurological assessments were not conducted by all respondents. Similarly, routine foot care strategies such as prescription of foot orthoses, foot health advice and footwear were not employed by all respondents.ConclusionsThe results identified issues in foot care provision which should be explored through further research. Foot care provision in NSW does not appear to meet the current recommended standards for the management of foot problems in people who have RA. Improvements to foot care could be undertaken in terms of providing better access to examination techniques and treatment strategies that are recommended by evidence based treatment paradigms.

Perceived barriers to the management of foot health in patients with rheumatic conditions

“…The current study revealed that most New Zealand podiatrists are not offering clinical sessions specifically for patients with rheumatic conditions. Similar findings have been reported in the UK [ 8 ] and Australia [ 13 ] and emphasize the widely occurring inadequacy in foot health provision for people with rheumatic conditions. It is possible that the lack of specific clinical sessions offered by New Zealand podiatrists is reflective of either an underestimation of the burden of foot involvement in rheumatic conditions, particularly given New Zealand’s comparatively small population or there is a lack of skills from podiatrists in managing people with rheumatic conditions.…”

“…We found that the majority of podiatrists received most referrals from GPs in comparison to other health professions. This referral tendency has also been found in Australia [ 13 ] and may reflect a good working relationship between podiatrists and GPs. The relatively low referral rates from other health professions may also be due to a lack of awareness of the podiatrist’s role by other health professionals.…”

“…Online surveys have the advantages of time efficiency, reduced cost, automated data collection and an ability to overcome distance barriers in participant data collection [ 15 ]. The survey questions were modified from a previous study conducted in Australia [ 13 ]. A mixture of dichotomous and nominal-polytomous close-ended questions were used, which have been shown to yield a higher percentage of answers, less missing data, and more adequate answers in online surveys [ 16 ].…”

Experiences of mobility for people living with rheumatoid arthritis who are receiving biologic drug therapy: implications for podiatry services

“…Despite this, there appears to be a lack of access to podiatry services for PwRA and this has been consistently reported within the recent literature relative to the UK [34, 35] and other countries [13, 36]. Whilst new models of foot care for PwRA have been proposed [37, 38] further exploration of these is recommended for implementation of such strategies within routine practice.…”

Linking the Effect of Psoriatic Arthritis-Related Foot Involvement to the Leeds Foot Impact Scale using the International Classification for Functioning, Disability and Health: A Study to Assess Content Validity.

“…Limited coverage of self-care activity and access to healthcare in the LFIS-RA may re ect the experiences of the study population, who were recruited from sites regarded to be centres of excellence in the UK with an international reputation and where podiatry is embedded into rheumatology services with specialised podiatry roles established. Therefore, the experience of foot care services in the patient cohort from which the LFIS-RA was derived may not be generalisable to Australia or New Zealand (or other countries), where a distinct lack of access to, and provision of, podiatry services and specialist rheumatology services in the public health system have been previously described [41][42][43].…”