Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, Melbourne, Victoria, 3010, Australia.
School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
J Foot Ankle Res. 2020 Mar 13;13(1):14. doi: 10.1186/s13047-020-0382-6.
First metatarsophalangeal (MTP) joint osteoarthritis (OA) is a common and painful problem that causes significant disability. There is limited research on assessment and treatment options, and the efficacy of current management strategies is unknown. The aim of this study was to determine how podiatrists and physical therapists in Australia and the United Kingdom (UK) manage people with first MTP joint OA.
A survey of podiatrists and physiotherapists was conducted. Potential respondents were recruited through professional representative organisations in Australia and the UK. Participants completed a bespoke online survey regarding the assessment and treatment approaches they most commonly use for patients with first MTP joint OA. Descriptive statistics were calculated and differences between professions compared using chi-square.
Two hundred respondents (n = 113 (57%) podiatrists and n = 140 (70%) from Australia) completed the survey. Assessment tests were similar between professions and included x-ray (n = 151/164; 92%), range of motion (n = 127/141; 90%), and a pain scale (n = 78/99; 79%). Podiatrists were more likely than physical therapists to discuss over-the-counter medication (42% vs 17%; p < 0.001), prescribe orthoses (97% vs 66%; p < 0.001), particularly custom orthoses (78% vs 42%; p < 0.001), and provide advice on footwear (92% vs 78%; p < 0.01) when treating first MTP joint OA. In contrast, physical therapists used more exercise-based approaches to treatment, including exercise therapy (91% vs 34%; p < 0.001), increasing general activity (70% vs 49%; p < 0.01), and advice to pace activities (83% vs 48%; p < 0.001).
Podiatrists and physical therapists use an array of assessment and treatment approaches for people with first MTP joint OA, albeit there is limited evidence to support their clinical utility. Treatment strategies differ between professions, particularly with respect to medication, orthoses and exercise. It is unclear whether these commonly-used strategies improve symptoms associated with first MTP joint OA.
第一跖趾关节（MTP）骨关节炎（OA）是一种常见且疼痛的问题，会导致严重的残疾。目前对于评估和治疗选择的研究有限，并且当前管理策略的疗效尚不清楚。本研究的目的是确定澳大利亚和英国（UK）的足病医生和物理治疗师如何治疗第一跖趾关节 OA 患者。
对足病医生和物理治疗师进行了调查。通过澳大利亚和英国的专业代表组织招募潜在的受访者。参与者完成了一项专门针对他们对第一跖趾关节 OA 患者最常使用的评估和治疗方法的在线调查。计算了描述性统计数据，并使用卡方检验比较了不同专业之间的差异。
共有 200 名受访者（n=113（57%）足病医生和 n=140（70%）来自澳大利亚）完成了调查。评估测试在专业之间相似，包括 X 光（n=151/164；92%）、运动范围（n=127/141；90%）和疼痛量表（n=78/99；79%）。与物理治疗师相比，足病医生更有可能讨论非处方药物（42%对 17%；p<0.001）、开矫形器（97%对 66%；p<0.001），特别是定制矫形器（78%对 42%；p<0.001），并提供有关鞋类的建议（92%对 78%；p<0.01）治疗第一跖趾关节 OA。相比之下，物理治疗师更倾向于使用基于运动的治疗方法，包括运动疗法（91%对 34%；p<0.001）、增加一般活动（70%对 49%；p<0.01）和建议活动节奏（83%对 48%；p<0.001）。
足病医生和物理治疗师对第一跖趾关节 OA 患者使用了一系列评估和治疗方法，尽管目前尚缺乏支持其临床实用性的证据。治疗策略在专业之间存在差异，特别是在药物、矫形器和运动方面。目前尚不清楚这些常用策略是否能改善与第一跖趾关节 OA 相关的症状。
