Amsterdam Rehabilitation Research Centre | Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040, HG, Amsterdam, The Netherlands.
Fontys University of applied sciences | Department of allied health professionals, Fontys Paramedische Hogeschool, Eindhoven, The Netherlands.
J Foot Ankle Res. 2021 Feb 25;14(1):15. doi: 10.1186/s13047-020-00435-7.
Foot and ankle problems are common in rheumatic disorders and often lead to pain and limitations in functioning, affecting quality of life. There appears to be large variability in the management of foot problems in rheumatic disorders across podiatrists. To increase uniformity and quality of podiatry care for rheumatoid arthritis (RA), osteoarthritis (OA), spondyloarthritis (SpA), and gout a clinical protocol has been developed.
[1] to evaluate an educational programme to train podiatrists in the use of the protocol and [2] to explore barriers and facilitators for the use of the protocol in daily practice.
This study used a mixed method design and included 32 podiatrists in the Netherlands. An educational programme was developed and provided to train the podiatrists in the use of the protocol. They thereafter received a digital questionnaire to evaluate the educational programme. Subsequently, podiatrists used the protocol for three months in their practice. Facilitators and barriers that they experienced in the use of the protocol were determined by a questionnaire. Semi-structured interviews were held to get more in-depth understanding.
The mean satisfaction with the educational programme was 7.6 (SD 1.11), on a 11 point scale. Practical knowledge on joint palpation, programme variation and the use of practice cases were valued most. The protocol appeared to provide support in the diagnosis, treatment and evaluation of foot problems in rheumatic disorders and the treatment recommendations were clear and understandable. The main barrier for use of the protocol was time. The protocol has not yet been implemented in the electronic patient file, which makes it more time consuming. Other experienced barriers were the reimbursement for the treatment and financial compensation.
The educational programme concerning the clinical protocol for foot problems in rheumatic disorders appears to be helpful for podiatrists. Podiatrists perceived the protocol as being supportive during patient management. Barriers for use of the protocol were identified and should be addressed prior to large scale implementation. Whether the protocol is also beneficial for patients, needs to be determined in future research.
足部和踝关节问题在风湿性疾病中很常见，常导致疼痛和功能受限，影响生活质量。足病在风湿性疾病中的管理在足病医生中似乎存在很大差异。为了提高类风湿关节炎（RA）、骨关节炎（OA）、脊柱关节炎（SpA）和痛风的足病护理的一致性和质量，已经制定了临床方案。
[1]评估培训足病医生使用方案的教育计划，[2]探讨在日常实践中使用方案的障碍和促进因素。
本研究采用混合方法设计，包括荷兰的 32 名足病医生。制定并提供了一个教育计划来培训足病医生使用该方案。之后，他们收到了一份数字问卷来评估教育计划。随后，足病医生在他们的实践中使用该方案三个月。通过问卷确定他们在使用该方案时遇到的促进因素和障碍。进行半结构化访谈以获得更深入的理解。
教育计划的平均满意度为 7.6（SD 1.11），满分 11 分。对关节触诊、方案变化和实践案例使用的实用知识评价最高。该方案似乎为风湿性疾病中足部问题的诊断、治疗和评估提供了支持，治疗建议明确且易于理解。使用该方案的主要障碍是时间。该方案尚未在电子患者档案中实施，这使得它更加耗时。其他经验证的障碍包括治疗费用报销和经济补偿。
针对风湿性疾病足部问题的临床方案教育计划似乎对足病医生有帮助。足病医生认为该方案在患者管理过程中具有支持作用。已经确定了使用该方案的障碍，在大规模实施之前应予以解决。该方案是否对患者也有益，需要在未来的研究中确定。
