Health professional views on the assessment and management of foot problems in people with psoriatic arthritis in Australia and New Zealand: a qualitative investigation

Abstract

Background Active foot disease persists in a high proportion of people with psoriatic arthritis despite the availability of pharmacological and non-pharmacological interventions to modify the course of the disease. Limited information exists on the provision of health care for foot disease in psoriatic arthritis. The objective of this study was to explore the views of health professionals on the assessment and management of people with psoriatic arthritis-related foot involvement. Methods Convenience sampling was used to recruit health professionals working in rheumatology outpatient clinics in Sydney, Australia and Auckland, New Zealand. Three focus groups were undertaken to explore the views and experiences of health professionals on the assessment and management of foot problems in people with psoriatic arthritis. All interviews were audio-recorded and transcribed verbatim. Qualitative data was analysed using a constant comparative analytic approach to identify themes. Results A total of seventeen health professionals participated including rheumatologists, podiatrists and a physiotherapist. Key themes derived from the focus groups suggest that health professionals perceived that people with psoriatic arthritis-related foot problems experience suboptimal management from symptom onset, to diagnosis and treatment. Frustration was expressed throughout discussions relating to lack of appropriate training and expertise required for the specialised management of foot problems typically encountered with psoriatic arthritis and poor access for patients to specialist podiatry services. Conclusions This study provides new insight into the perspectives of health professionals on the management of foot problems related to psoriatic arthritis. Deficiencies in the diagnosis, assessment and treatment of foot problems were revealed. To meet the foot health needs of people with psoriatic arthritis, reducing diagnostic delay, improving knowledge and awareness about the disease among people with psoriatic arthritis and health professionals, and increasing specialist podiatry service provision may be required.

Linking the patient experience of foot involvement related to psoriatic arthritis to the International Classification of Functioning, Disability and Health

“…Using the ICF, the full spectrum of foot-specific problems in PsA and the dynamic interaction between domains of impact can be understood better. The physical domain of body structure and function was well represented, reflecting the high foot disease burden and unmet need for specialist foot care reported in other studies in PsA [ 14 , 23 ]. Important concepts in the component body function were body image and emotional well-being.…”

“…Ethical approval was granted by the South Western Sydney Local Health District (HREC/171/LPOOL/353), the Auckland University of Technology Ethics Committee (AUTEC 17/320) and the Waitemata District Health Board of Auckland New Zealand (RM/3907), and informed consent was obtained from all participants. Detailed descriptions of the preliminary work have been reported previously [ 22 , 23 ].…”

“…Whilst this approach has merit in that the Leeds Foot Impact Scale was developed robustly using patient perspectives in RA, it is unlikely to capture the combined musculoskeletal and dermatological impact adequately in PsA. Indeed, few qualitative studies have identified that local foot disease in PsA can cause substantial functional impairments and visual differences, which can negatively impact on emotional well-being and on all aspects of life [ 22 , 23 ]. To date, little is known about the patient experience of foot involvement and how this might link to the ICF to capture and describe disease impact.…”

Development of a national survey on foot involvement among people with psoriatic arthritis in Australia using a best practice approach: A survey development protocol

“…Results were re ned by discussion between the investigators (KC, SW and DET). Detailed descriptions of the preliminary work involved in phase 1 have been previously reported [9,35,36]. In brief, a qualitative study of people with PsA and rheumatology health professionals (rheumatologists, podiatrists and physiotherapists) revealed key themes on the impact of PsA-related foot problems on daily life [9,35].…”

“…Detailed descriptions of the preliminary work involved in phase 1 have been previously reported [9,35,36]. In brief, a qualitative study of people with PsA and rheumatology health professionals (rheumatologists, podiatrists and physiotherapists) revealed key themes on the impact of PsA-related foot problems on daily life [9,35]. Concepts important and relevant to the patient experience of foot involvement in PsA, obtained from the qualitative study, were subsequently linked to the International Classi cation of Functioning, Disability and Health (ICF) model and a list of over 100 distinct ICF categories were identi ed, which comprehensively described the impact of localised disease in the foot on daily functioning [36].…”