Clinical effectiveness and cost-effectiveness of foot orthoses for people with established rheumatoid arthritis: an exploratory clinical trial

Rome, Keith; Clark, Heidi; Gray, Joanne; McMeekin, Peter; Plant, Michael; Dixon, John

doi:10.1080/03009742.2016.1196500

Cited by 25 publications

(81 citation statements)

References 28 publications

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“…The majority (81%) of Australian respondents worked solely in private practice, compared to 35% in the UK and 44% in New Zealand. Findings indicated that although respondents in Australia prescribed far fewer FOs overall, they prescribed more customised FOs, which previous studies have shown to be more expensive to produce than prefabricated and simple FOs [ 3 , 16 ]. Differences in the types of FOs prescribed between UK respondents working in the public sector and those working in private practice were also identified.…”

Section: Discussionmentioning

confidence: 99%

“…The cost of providing FOs remains an ongoing issue for healthcare providers, patients and practitioners. A recent exploratory clinical trial [ 16 ] that also evaluated cost effectiveness found that a pair of customised FOs were £52.60 more expensive to produce than a simple FO when costed from a National Health Service (NHS) perspective, and £80.00 more expensive from an NHS and societal perspective. The authors of this trial attributed these additional costs to manufacturing time and cost of materials used in the manufacturing process.…”

Section: Introductionmentioning

confidence: 99%

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A survey of foot orthoses prescription habits amongst podiatrists in the UK, Australia and New Zealand

Chapman

Redmond

Landorf

et al. 2018

Journal of Foot and Ankle Research

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BackgroundFoot orthoses are frequently used but little is known about which types are used in contemporary practice. This study aimed to explore the types of foot orthoses currently used by podiatrists and the prescription variations in a range of conditions.MethodsA web-based, cross-sectional survey was distributed through professional bodies in the United Kingdom (UK), Australia, and New Zealand. Questions focussed on foot orthosis prescription habits in relation to 26 conditions affecting the back and lower limb.ResultsTwo hundred and sixty-four podiatrists practising in 19 different countries completed the survey; the majority practised in the UK (47%, n = 124), Australia (30%, n = 79) and New Zealand (12%, n = 32). Respondents qualified between 1968 and 2016, and 147 (56%) were female. Respondents worked in different healthcare sectors and this varied between countries: 42 (34%) respondents in the UK worked solely in the public sector, compared to 3 (4%) in Australia and 2 (6%) in New Zealand. Forty-four (35%) respondents in the UK worked solely in private practice, compared to 64 (81%) in Australia and 14 (44%) in New Zealand.UK respondents prescribed more prefabricated orthoses per week (mean 5.5 pairs) than simple insole-type devices (±2.7) and customised devices (±2.9). Similarly, respondents in New Zealand prescribed more prefabricated orthoses per week (±7.7) than simple (±1.4) and customised (±2.8) devices. In contrast, those in Australia prescribed more customised orthoses per week (±4.4) than simple (±0.8) and prefabricated (±1.9) orthoses. Differences in the types of orthoses prescribed were observed between country of practice, working sector, and the condition targeted. Generally, prefabricated orthoses were commonly prescribed for the 26 highlighted conditions in the UK and New Zealand. Australian podiatrists prescribed far fewer devices overall, but when they did prescribe, they were more likely to prescribe custom devices. Respondents in all three countries were more likely to prescribe customised orthoses for people with diabetes complicated by peripheral neuropathy than for diabetes without this complication.ConclusionsFoot orthosis prescription habits vary between countries. Prefabricated orthoses were frequently prescribed in the UK and New Zealand, and customised orthoses in Australia. Prescriptions for people with diabetes differed depending on the presence of neuropathy, despite a lack of robust evidence supporting these decisions. This study provides new insight into contemporary practice.Electronic supplementary materialThe online version of this article (10.1186/s13047-018-0304-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A survey of foot orthoses prescription habits amongst podiatrists in the UK, Australia and New Zealand

Chapman

Redmond

Landorf

et al. 2018

Journal of Foot and Ankle Research

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“…This should also make the prefabricated customizable insoles a cheaper alternative. This is supported by a study by Rome et al (), in which the authors found that customized foot orthoses were far more expensive than semi‐rigid customized insoles, partly because of the time spent for the therapist and travel expenses for the patient.…”

Section: Discussionmentioning

confidence: 66%

Effect of a thin customized insole on pain and walking ability in rheumatoid arthritis: A randomized study

Linberg¹,

Mengshoel

2017

Musculoskeletal Care

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“…To date, the comparative clinical- and cost- effectiveness of customised versus prefabricated orthoses in early RA has not been tested. A recent study investigated clinical- and cost- effectiveness in established RA [ 38 ]. Although this was an exploratory trial with a small sample size, results indicated a decrease of foot pain when using customised FOs compared to simple insoles with no significant cost per quality-adjusted life year gain [ 38 ].…”

Section: Introductionmentioning

confidence: 99%

A protocol for a randomised controlled trial of prefabricated versus customised foot orthoses for people with rheumatoid arthritis: the FOCOS RA trial [Foot Orthoses – Customised v Off‐the‐Shelf in Rheumatoid Arthritis]

Gallagher

Godwin

Hendry

et al. 2018

Journal of Foot and Ankle Research

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BackgroundFoot pain is common in rheumatoid arthritis and appears to persist despite modern day medical management. Several clinical practice guidelines currently recommend the use of foot orthoses for the treatment of foot pain in people with rheumatoid arthritis. However, an evidence gap currently exists concerning the comparative clinical- and cost-effectiveness of prefabricated and customised foot orthoses in people with early rheumatoid arthritis. Early intervention with orthotics may offer the best opportunity for positive therapeutic outcomes. The primary aim of this study is to evaluate the comparative clinical- and cost-effectiveness of prefabricated versus customised orthoses for reducing foot pain over 12 months.Methods/designThis is a multi-centre two-arm parallel randomised controlled trial comparing prefabricated versus customised orthoses in participants with early rheumatoid arthritis (< 2 years disease duration). A total of 160 (a minimum of 80 randomised to each arm) eligible participants will be recruited from United Kingdom National Health Service Rheumatology Outpatient Clinics. The primary outcome will be foot pain measured via the Foot Function Index pain subscale at 12 months. Secondary outcomes will include foot related impairments and disability via the Foot Impact Scale for rheumatoid arthritis, global functional status via the Stanford Health Assessment Questionnaire, foot disease activity via the Rheumatoid Arthritis Foot Disease Activity Index, and health-related quality of life at baseline, 6 and 12 months. Process outcomes will include recruitment/retention rates, data completion rates, intervention adherence rates, and participant intervention and trial participation satisfaction. Cost-utility and cost-effectiveness analyses will be undertaken.DiscussionOutcome measures collected at baseline, 6 and 12 months will be used to evaluate the comparative clinical- and cost- effectiveness of customised versus prefabricated orthoses for this treatment of early rheumatoid arthritis foot conditions. This trial will help to guide orthotic prescription recommendations for the management of foot pain for people with early rheumatoid arthritis in future.Trial registrationISRCTN13654421. Registered 09 February 2016.

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Clinical effectiveness and cost-effectiveness of foot orthoses for people with established rheumatoid arthritis: an exploratory clinical trial

Cited by 25 publications

References 28 publications

A survey of foot orthoses prescription habits amongst podiatrists in the UK, Australia and New Zealand

A survey of foot orthoses prescription habits amongst podiatrists in the UK, Australia and New Zealand

Effect of a thin customized insole on pain and walking ability in rheumatoid arthritis: A randomized study

A protocol for a randomised controlled trial of prefabricated versus customised foot orthoses for people with rheumatoid arthritis: the FOCOS RA trial [Foot Orthoses – Customised v Off‐the‐Shelf in Rheumatoid Arthritis]

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