Abstract
BackgroundThe foot is often the first area of the body to be systematically affected by rheumatoid arthritis. The multidimensional consequences of foot problems for patients can be subjectively evaluated using patient-reported outcome measures (PROMs). However, there is currently no systematic review which has focused specifically upon the PROMs available for the foot with rheumatoid arthritis. The aim of this systematic review was to appraise the foot-specific PROMs available for the assessment and/or evaluation of the foot affected with rheumatoid arthritis.MethodsA systematic search of databases was conducted according to pre-defined inclusion/exclusion criteria. PROMs identified were reviewed in terms of: conceptual bases, quality of construction, measurement aims and evidence to support their measurement properties.ResultsA total of 11 PROMs were identified and 5 papers that provided evidence for the measurement properties of some of the PROMs. Only one of the PROMs was found to be RA disease-specific. The quality of construction, pretesting and presence of evidence for their measurement properties was found to be highly variable. Conceptual bases of many of the PROMs was either restricted or based on reductionist biomedical models. All of the PROMs were found to consist of fixed scales.ConclusionsThere is a need to develop an RA-disease and foot-specific PROM with a greater emphasis on a biopsychosocial conceptual basis, cognitive pre-testing methods, patient preference-based qualities and evidence to support the full complement of measurement properties.
Highlights
The foot is often the first area of the body to be systematically affected by rheumatoid arthritis
Non-disease specific patient-reported outcome measures (PROMs) (Classical Test Theory-based) The Foot Function Index (FFI) The Foot Function Index [22] is an evaluative PROM providing a measure of pain and disability, over a time period of one week, arising from joint diseases associated with older populations (See Additional File 1, Table 2)
The PROM does not evaluate other valid and important potential constructs, such as footwear, participation restriction [6,23] and other biopsychosocial factors associated with chronic pain and reflected in the International Classification for Functioning, Disability and Health (ICF) [24]
Summary
The foot is often the first area of the body to be systematically affected by rheumatoid arthritis. Approximately 16% of patients with RA have foot involvement [3], in 15% of cases the forefoot is the first area of the body to become symptomatic [4], and virtually 100% of patients report foot problems within 10 years of RA onset [5]. PROMs record patients’ perspectives of their health, illnesses and the impact of any clinical interventions in a valid, reliable and feasible way [7] They are an objective means of recording largely subjective outcomes and represent an ideal, economical and efficient method of measuring the quality and efficacy of care provided [8], integrating important psychosocial factors into a clinical assessment that otherwise may not be gathered
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