Research priorities in foot and ankle conditions: results of a UK priority setting partnership with the James Lind Alliance

OBJECTIVE: To ascertain the priorities of research in surgical interventions and aftercare in foot and ankle conditions in adults, from inclusive viewpoints of patients, carers, allied professionals and clinicians, as a collaboration with James Lind Alliance (JLA) Priority Setting Partnership. Setting A UK-based national study organised through British Orthopaedic Foot and Ankle Society (BOFAS). DESIGN: A cross-section of both medical and allied professionals, with patient involvement, submitted their ‘top priorities’ pertaining to foot and ankle pathology, using both paper and web-based formats, which were synthesised into the primary priorities. Following this, workshop-based reviews were used to determine the top 10 priorities. PARTICIPANTS: Adult patients, carers, allied professionals and clinicians who have experienced or managed foot and ankle conditions in the UK. METHODS: A transparent and well-established process developed by JLA was carried out by a steering group of 16 members. A broad survey was designed and disseminated to the public via clinics, BOFAS meetings and website, JLA platforms and electronic media to establish potential research priority questions. Surveys were analysed and initial questions were categorised and cross-referenced with the literature. Those questions that were out of scope and sufficiently answered by research were excluded. The unanswered questions were ranked by the public via a second survey. The top 10 questions were finalised via an extensive workshop. RESULTS: 472 questions from 198 responders were received from the primary survey. 71% (140) from healthcare professionals, 24% (48) from patients and carers and 5% (10) from other responders. 142 questions were out of scope, leaving 330 questions. These were summarised into 60 indicative questions. Reviewing against current literature, 56 questions were left. From the secondary survey, there were 291 respondents: 79% (230) healthcare professionals and 12% (61) patients and carers. After the secondary survey, the top 16 questions were brought to the final workshop to finalise the top 10 research questions. The top 10 questions were: What are the best outcome measures (ways of assessing the effect of the treatment) after foot and ankle surgery? What treatment is the best for Achilles tendon pain? What is the best treatment (including surgery) for tibialis posterior dysfunction (tendon on the inner side of the ankle), leading to a successful long-term outcome? Should physiotherapy be provided following foot and ankle surgery and is there an optimal amount needed to restore function after foot and ankle surgery? At what stage should a patient with ankle instability (ie, an ankle that keeps giving way) be considered for surgical treatment? How effective are steroid injections in improving pain from arthritis in the foot and ankle? What is the best surgery for bone and cartilage defects in the talus? What is better, ankle fusion or ankle replacements? What is the success of surgical lengthening of the calf muscle in improving forefoot pain? What is the best time to start weight bearing after ankle fusion/replacement surgery? CONCLUSION: Top 10 themes included outcomes following interventions, for example, range of movement, reduction in pain, rehabilitation, which included physiotherapy to optimise post intervention outcomes, rehabilitation and condition-specific treatments. These questions will aid to guide national research into foot and ankle surgery. It will also help national funding bodies to prioritise areas of research interest to improve patient care.