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

Williams, AE; Graham, AS; Davies, S; Bowen, CJ

Abstract

Background:
In 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.
Method:
Following 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.
Results:
245 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.
Conclusions:
This 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. Suggestionsare made for improving the implementation of foot health guidelines.

Citation

arthritis: a survey of their use in podiatry practice. Journal of Foot and Ankle Research, 6(23), 1-8. https://doi.org/10.1186/1757-1146-6-23

• Journal Article Type: Article
• Publication Date: Jan 1, 2013
• Deposit Date: Jun 20, 2014
• Publicly Available Date: Jun 20, 2014
• Journal: Journal of foot and ankle research
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 6
• Issue: 23
• Pages: 1-8
• DOI: https://doi.org/10.1186/1757-1146-6-23
• Keywords: Guidelines, Rheumatoid Arthritis, Foot Health, Podiatry
• Publisher URL: http://dx.doi.org/10.1186/1757-1146-6-23
• Related Public URLs: http://www.jfootankleres.com/