The rheumatoid foot: a systematic literature review of patient reported outcome measures

BackgroundThe foot is often the first area of the body to be systematically affected by rheumatoidarthritis. The multidimensional consequences of foot problems for patients can besubjectively evaluated using patient-reported outcome measures (PROMs). However,there is currently no systematic review which has focused specifically upon the PROMsavailable for the foot with rheumatoid arthritis. The aim of this systematic review was toappraise the foot-specific PROMs available for the assessment and/or evaluation of thefoot affected with rheumatoid arthritis.MethodsA systematic search of databases was conducted according to pre-definedinclusion/exclusion criteria. PROMs identified were reviewed in terms of: conceptualbases, quality of construction, measurement aims and evidence to support theirmeasurement properties.ResultsA total of 11 PROMs were identified and 5 papers that provided evidence for themeasurement properties of some of the PROMs. Only one of the PROMs was found to beRA disease-specific. The quality of construction, pretesting and presence of evidence fortheir measurement properties was found to be highly variable. Conceptual bases of manyof the PROMs was either restricted or based on reductionist biomedical models. All of thePROMs were found to consist of fixed scalesConclusionsThere is a need to develop an RA-disease and foot-specific PROM with a greater emphasison a biopsychosocial conceptual basis, cognitive pre-testing methods, patient preferencebasedqualities and evidence to support the full complement of measurement propertie

Women’s experiences of wearing therapeutic footwear in three European countries

Background: Therapeutic footwear is recommended for those people with severe foot problems associated withrheumatoid arthritis (RA). However, it is known that many do not wear them. Although previous European studieshave recommended service and footwear design improvements, it is not known if services have improved or if thisfootwear meets the personal needs of people with RA. As an earlier study found that this footwear has moreimpact on women than males, this study explores women’s experiences of the process of being provided with itand 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.Method: Women with RA and experience of wearing therapeutic footwear were purposively recruited. Ten womenwith RA were interviewed in each of the three countries. An interpretive phenomenological approach (IPA) wasadopted during data collection and analysis. Conversational style interviews were used to collect the data.Results: Six themes were identified: feet being visibly different because of RA; the referring practitioners’ approachto the patient; the dispensing practitioners’ approach to the patient; the footwear being visible as different toothers; footwear influencing social participation; and the women’s wishes for improved footwear services. Despitetheir nationality, these women revealed that therapeutic footwear invokes emotions of sadness, shame and angerand 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, theacceptance of this footwear was much more evident and there was less wastage as a result of the footwear beingprescribed and then not worn. In the UK, the women were more likely to passively accept the footwear with theonly choice being to reject it once it had been provided. All the women were vocal about what would improvetheir experiences and this centred on the consultation with both the referring practitioner and the practitioner thatprovides the footwear.Conclusion: This unique study, carried out in three countries has revealed emotive and personal accounts of whatit is like to have an item of clothing replaced with an ‘intervention’. The participant’s experience of theirconsultations 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 usingtherapeutic footwear as an intervention

Women’s experiences of wearing therapeutic footwear in three European countries

Background: 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. Method: 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. Results: 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. Conclusion: 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

The fire toxicity of polyurethane foams [Review]

Polyurethane is widely used, with its two major applications, soft furnishings and insulation, having low thermal inertia, and hence enhanced flammability. In addition to their flammability, polyurethanes form carbon monoxide, hydrogen cyanide and other toxic products on decomposition and combustion. The chemistry of polyurethane foams and their thermal decomposition are discussed in order to assess the relationship between the chemical and physical composition of the foam and the toxic products generated during their decomposition. The toxic product generation during flaming combustion of polyurethane foams is reviewed, in order to relate the yields of toxic products and the overall fire toxicity to the fire conditions. The methods of assessment of fire toxicity are outlined in order to understand how the fire toxicity of polyurethane foams may be quantified. In particular, the ventilation condition has a critical effect on the yield of the two major asphyxiants, carbon monoxide and hydrogen cyanid

Rheumatoid arthritis patients' experiences of wearing therapeutic footwear - A qualitative investigation

Background: Specialist 'therapeutic' footwear is recommended for patients with diseases such as rheumatoid arthritis (RA) as a beneficial intervention for reducing foot pain, improving foot health, and increasing general mobility. However, many patients choose not to wear this footwear. Recommendations from previous studies have been implemented but have had little impact in improving this situation. The aim of this study was to explore RA patients' experiences of this footwear to ascertain the factors which influence their choice to wear it or not. Method: Ten females and three males with RA and experience of wearing specialist footwear were recruited from four National Health Service orthotic services. Semi-structured interviews were carried out in the participants own homes. A hermeneutic phenomenological analysis of the transcripts was carried out to identify themes. Results: The analysis revealed two main themes from both the female and male groups. These were the participants' feelings about their footwear and their experiences of the practitioner/s involved in providing the footwear. In addition, further themes were revealed from the female participants. These were feelings about their feet, behaviour associated with the footwear, and their feelings about what would have improved their experience. Conclusion: Unlike any other intervention specialist therapeutic footwear replaces something that is normally worn and is part of an individual's body image. It has much more of a negative impact on the female patients' emotions and activities than previously acknowledged and this influences their behaviour with it. The patients' consultations with the referring and dispensing practitioners are pivotal moments within the patient/practitioner relationship that have the potential to influence whether patients choose to wear the footwear or not