Abstract
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.
Highlights
Foot pain is common in rheumatoid arthritis and appears to persist despite modern day medical management
Outcome measures collected at baseline, 6 and 12 months will be used to evaluate the comparative clinicaland cost- effectiveness of customised versus prefabricated orthoses for this treatment of early rheumatoid arthritis foot conditions
Foot Orthoses (FO) have been used clinically for many decades for the treatment of foot pain in patients with Rheumatoid arthritis (RA), their effectiveness has not been rigorously evaluated as a management method
Summary
Foot 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. An evidence gap currently exists concerning the comparative clinical- and cost-effectiveness of prefabricated and customised foot orthoses in people with early rheumatoid arthritis. 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. The majority of people with RA will develop foot and ankle problems over the course of their disease that will impact upon their health-related quality of life [1,2,3]. Large-scale cross-sectional surveys have demonstrated that foot pain and walking disability are commonly experienced by people with RA [4, 5]. Management strategies for RA-related foot problems include suppression of disease activity with disease-modifying anti-rheumatic, biologic drugs, and/or intra-articular corticosteroids; as well as non-medical management strategies including, therapeutic footwear and foot orthoses (FOs) [11]
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