Directorate of Prosthetics, Orthotics and Podiatry, University of Salford, Frederick Road, Salford, UK.
J Foot Ankle Res. 2010 Oct 8;3:23. doi: 10.1186/1757-1146-3-23.
Therapeutic footwear is recommended for those people with severe foot problems associated with rheumatoid arthritis (RA). However, it is known that many do not wear them. Although previous European studies have recommended service and footwear design improvements, it is not known if services have improved or if this footwear meets the personal needs of people with RA. As an earlier study found that this footwear has more impact on women than males, this study explores women's experiences of the process of being provided with it and wearing it. No previous work has compared women's experiences of this footwear in different countries, therefore this study aimed to explore the potential differences between the UK, the Netherlands and Spain.
Women with RA and experience of wearing therapeutic footwear were purposively recruited. Ten women with RA were interviewed in each of the three countries. An interpretive phenomenological approach (IPA) was adopted during data collection and analysis. Conversational style interviews were used to collect the data.
Six themes were identified: feet being visibly different because of RA; the referring practitioners' approach to the patient; the dispensing practitioners' approach to the patient; the footwear being visible as different to others; footwear influencing social participation; and the women's wishes for improved footwear services. Despite their nationality, these women revealed that therapeutic footwear invokes emotions of sadness, shame and anger and that it is often the final and symbolic marker of the effects of RA on self perception and their changed lives. This results in severe restriction of important activities, particularly those involving social participation. However, where a patient focussed approach was used, particularly by the practitioners in Spain and the Netherlands, the acceptance of this footwear was much more evident and there was less wastage as a result of the footwear being prescribed and then not worn. In the UK, the women were more likely to passively accept the footwear with the only choice being to reject it once it had been provided. All the women were vocal about what would improve their experiences and this centred on the consultation with both the referring practitioner and the practitioner that provides the footwear.
This unique study, carried out in three countries has revealed emotive and personal accounts of what it is like to have an item of clothing replaced with an 'intervention'. The participant's experience of their consultations with practitioners has revealed the tension between the practitioners' requirements and the women's 'social' needs. Practitioners need greater understanding of the social and emotional consequences of using therapeutic footwear as an intervention.
对于患有类风湿关节炎 (RA) 相关严重足部问题的人，建议使用治疗性鞋具。然而，我们知道很多人并不穿这种鞋。尽管之前的欧洲研究建议改进服务和鞋具设计，但尚不清楚服务是否有所改善，或者这种鞋具是否满足 RA 患者的个人需求。由于之前的研究发现这种鞋具对女性的影响大于男性，因此本研究旨在探索提供和穿着这种鞋具过程中女性的体验。以前没有研究比较过不同国家女性对这种鞋具的体验，因此本研究旨在探讨英国、荷兰和西班牙之间的潜在差异。
我们有目的地招募了有 RA 病史且有穿着治疗性鞋具经验的女性。在这三个国家中，每个国家各有 10 名 RA 女性接受了采访。在数据收集和分析过程中，我们采用了解释现象学方法（IPA）。我们使用对话式访谈来收集数据。
确定了六个主题：由于 RA，脚部外观明显不同；参考医生对患者的态度；配药医生对患者的态度；鞋具与他人的不同显而易见；鞋具影响社会参与；以及女性对改进鞋具服务的愿望。尽管她们来自不同的国家，但这些女性都表示，治疗性鞋具会引起悲伤、羞耻和愤怒等情绪，而且它往往是 RA 对自我认知和生活变化影响的最终和象征性标志。这导致了重要活动的严重受限，特别是那些涉及社会参与的活动。然而，在使用以患者为中心的方法时，特别是在西班牙和荷兰的医生中，患者对这种鞋具的接受程度明显更高，而且由于鞋具被开处方但随后未被佩戴而导致的浪费也更少。在英国，女性更倾向于被动接受这种鞋具，唯一的选择是在提供鞋具后拒绝接受。所有女性都对改善体验的方法提出了看法，这主要集中在与参考医生和提供鞋具的医生的咨询上。
这项在三个国家进行的独特研究揭示了将一件衣服换成“干预措施”的感觉和个人体验。参与者对与医生的咨询的体验揭示了医生的要求与女性的“社会”需求之间的紧张关系。医生需要更好地理解使用治疗性鞋具作为干预措施的社会和情感后果。
