Abstract
BackgroundFoot surgery is common in RA but the current lack of understanding of how patients interpret outcomes inhibits evaluation of procedures in clinical and research settings. This study aimed to explore which factors are important to people with RA when they evaluate the outcome of foot and ankle surgery.Methods and ResultsSemi structured interviews with 11 RA participants who had mixed experiences of foot surgery were conducted and analysed using thematic analysis. Responses showed that while participants interpreted surgical outcome in respect to a multitude of factors, five major themes emerged: functional ability, participation, appearance of feet and footwear, surgeons’ opinion, and pain. Participants interpreted levels of physical function in light of other aspects of their disease, reflecting on relative change from their preoperative state more than absolute levels of ability. Appearance was important to almost all participants: physical appearance, foot shape, and footwear were closely interlinked, yet participants saw these as distinct concepts and frequently entered into a defensive repertoire, feeling the need to justify that their perception of outcome was not about cosmesis.Surgeons’ post-operative evaluation of the procedure was highly influential and made a lasting impression, irrespective of how the outcome compared to the participants’ initial goals. Whilst pain was important to almost all participants, it had the greatest impact upon them when it interfered with their ability to undertake valued activities.ConclusionsPeople with RA interpret the outcome of foot surgery using multiple interrelated factors, particularly functional ability, appearance and surgeons’ appraisal of the procedure. While pain was often noted, this appeared less important than anticipated. These factors can help clinicians in discussing surgical options in patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-016-0153-6) contains supplementary material, which is available to authorized users.
Highlights
Foot surgery is common in rheumatoid arthritis (RA) but the current lack of understanding of how patients interpret outcomes inhibits evaluation of procedures in clinical and research settings
People with RA interpret the outcome of foot surgery using multiple interrelated factors, functional ability, appearance and surgeons’ appraisal of the procedure
The propensity of rheumatoid arthritis (RA) to affect the joints of the feet is well established and foot pathology is thought to be almost ubiquitous in people with RA [1]
Summary
Foot surgery is common in RA but the current lack of understanding of how patients interpret outcomes inhibits evaluation of procedures in clinical and research settings. The importance of a patient-centered approach is widely regarded as a crucial component in the delivery of high quality care and has led to recognition of the key role of the patients when determining treatment outcomes [5, 6]. This fundamental lack of understanding of what is important to people with RA having foot surgery hampers the research required to refine surgical procedures and reduce variation in outcome and hampers clinical consultations [7]. Patient centred care requires clinicians to delve beyond standardised PROMs, which are developed on a group level, and Backhouse et al Journal of Foot and Ankle Research (2016) 9:20 explore issues that are important to the individual patient during consultations
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