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Multidisciplinary recommendations for diagnosis and treatment of foot problems in people with rheumatoid arthritis

BACKGROUND: Foot problems in people with rheumatoid arthritis (RA) are highly prevalent and have a substantial impact on quality of life. Healthcare professionals from various professions can be involved in the management of these foot problems. There is currently no consensus on optimal management....

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Autores principales: Tenten-Diepenmaat, Marloes, van der Leeden, Marike, Vliet Vlieland, Thea P. M., Dekker, Joost
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6030746/
https://www.ncbi.nlm.nih.gov/pubmed/29988776
http://dx.doi.org/10.1186/s13047-018-0276-z
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author Tenten-Diepenmaat, Marloes
van der Leeden, Marike
Vliet Vlieland, Thea P. M.
Dekker, Joost
author_facet Tenten-Diepenmaat, Marloes
van der Leeden, Marike
Vliet Vlieland, Thea P. M.
Dekker, Joost
author_sort Tenten-Diepenmaat, Marloes
collection PubMed
description BACKGROUND: Foot problems in people with rheumatoid arthritis (RA) are highly prevalent and have a substantial impact on quality of life. Healthcare professionals from various professions can be involved in the management of these foot problems. There is currently no consensus on optimal management. Therefore, the aim of the present study was to develop multidisciplinary recommendations for the management of foot problems in people with RA in the Netherlands. METHODS: The recommendations were based on research evidence and consensus among experts, following published strategies for the development of practice recommendations. The expert group was composed of 2 patients and 22 experienced professionals (rheumatologists, rehabilitation physicians, orthopaedic surgeons, specialized nurses, podiatrists, orthopaedic shoe technicians, pedicurists, and researchers) in the Netherlands. For each developed recommendation i) the level of evidence was determined, and ii) the level of agreement (among the expert group) was set by an anonymous voting procedure using a numeric rating scale. The mean and range of the level of agreement for each recommendation was calculated. A recommendation was approved when ≥70% of the expert group voted an NRS-agreement ≥7. RESULTS: In total, 41 recommendations were developed. Two recommendations concerned a framework for diagnosis and treatment. Thirty-nine recommendations on foot care were developed: seven on diagnosis (including check-ups of feet and shoes and diagnostic imaging), 27 on treatment (including corticosteroid injections, foot surgery, therapeutic shoes, foot orthoses, exercise therapy, toe-orthoses and toenail-braces, treatment of toenails and skin), four on communication, and one on organisation of RA-related footcare. All recommendations were approved by the expert group. The percentage score of NRS-agreement ≥7 ranged from 80 to 100%. CONCLUSIONS: These are the first published multidisciplinary recommendations specific to the management of foot problems in people with RA. Multidisciplinary recommendations can provide guidance in timely referrals and access to adequate footcare. More research is needed to strengthen the evidence on diagnosis and treatment of RA-related foot problems. These national recommendations may be a first step towards developing international multidisciplinary recommendations for the management of foot problems in RA. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13047-018-0276-z) contains supplementary material, which is available to authorized users.
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spelling pubmed-60307462018-07-09 Multidisciplinary recommendations for diagnosis and treatment of foot problems in people with rheumatoid arthritis Tenten-Diepenmaat, Marloes van der Leeden, Marike Vliet Vlieland, Thea P. M. Dekker, Joost J Foot Ankle Res Research BACKGROUND: Foot problems in people with rheumatoid arthritis (RA) are highly prevalent and have a substantial impact on quality of life. Healthcare professionals from various professions can be involved in the management of these foot problems. There is currently no consensus on optimal management. Therefore, the aim of the present study was to develop multidisciplinary recommendations for the management of foot problems in people with RA in the Netherlands. METHODS: The recommendations were based on research evidence and consensus among experts, following published strategies for the development of practice recommendations. The expert group was composed of 2 patients and 22 experienced professionals (rheumatologists, rehabilitation physicians, orthopaedic surgeons, specialized nurses, podiatrists, orthopaedic shoe technicians, pedicurists, and researchers) in the Netherlands. For each developed recommendation i) the level of evidence was determined, and ii) the level of agreement (among the expert group) was set by an anonymous voting procedure using a numeric rating scale. The mean and range of the level of agreement for each recommendation was calculated. A recommendation was approved when ≥70% of the expert group voted an NRS-agreement ≥7. RESULTS: In total, 41 recommendations were developed. Two recommendations concerned a framework for diagnosis and treatment. Thirty-nine recommendations on foot care were developed: seven on diagnosis (including check-ups of feet and shoes and diagnostic imaging), 27 on treatment (including corticosteroid injections, foot surgery, therapeutic shoes, foot orthoses, exercise therapy, toe-orthoses and toenail-braces, treatment of toenails and skin), four on communication, and one on organisation of RA-related footcare. All recommendations were approved by the expert group. The percentage score of NRS-agreement ≥7 ranged from 80 to 100%. CONCLUSIONS: These are the first published multidisciplinary recommendations specific to the management of foot problems in people with RA. Multidisciplinary recommendations can provide guidance in timely referrals and access to adequate footcare. More research is needed to strengthen the evidence on diagnosis and treatment of RA-related foot problems. These national recommendations may be a first step towards developing international multidisciplinary recommendations for the management of foot problems in RA. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13047-018-0276-z) contains supplementary material, which is available to authorized users. BioMed Central 2018-07-04 /pmc/articles/PMC6030746/ /pubmed/29988776 http://dx.doi.org/10.1186/s13047-018-0276-z Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Tenten-Diepenmaat, Marloes
van der Leeden, Marike
Vliet Vlieland, Thea P. M.
Dekker, Joost
Multidisciplinary recommendations for diagnosis and treatment of foot problems in people with rheumatoid arthritis
title Multidisciplinary recommendations for diagnosis and treatment of foot problems in people with rheumatoid arthritis
title_full Multidisciplinary recommendations for diagnosis and treatment of foot problems in people with rheumatoid arthritis
title_fullStr Multidisciplinary recommendations for diagnosis and treatment of foot problems in people with rheumatoid arthritis
title_full_unstemmed Multidisciplinary recommendations for diagnosis and treatment of foot problems in people with rheumatoid arthritis
title_short Multidisciplinary recommendations for diagnosis and treatment of foot problems in people with rheumatoid arthritis
title_sort multidisciplinary recommendations for diagnosis and treatment of foot problems in people with rheumatoid arthritis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6030746/
https://www.ncbi.nlm.nih.gov/pubmed/29988776
http://dx.doi.org/10.1186/s13047-018-0276-z
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