P041 Living with foot and ankle disorders in rheumatic and musculoskeletal diseases: a thematic synthesis of qualitative studies to inform the work of the Outcome Measures in Rheumatology (OMERACT) Foot and Ankle Working Group
Authors: Chapman Lara S , Flurey Caroline , Redmond Anthony C , Richards Pamela , Hofstetter Catherine , Tapster Bethany , Emmel Jenny , Helliwell Philip S , Menz Hylton B , Hannan Marian T , Shea Beverley , Siddle Heidi J 
Published: April 2023

Abstract

Background/Aims
Foot and ankle involvement is common in rheumatic and musculoskeletal diseases (RMDs), but high-quality evidence is lacking to determine the effectiveness of foot and ankle treatments. Heterogeneity in the outcomes used across clinical trials in this area hinders the ability to compare study findings, and some outcomes are not always meaningful to patients. This study aimed to determine what outcomes are important to patients by exploring and synthesising qualitative data relating to the symptoms and impact of living with foot and ankle disorders in RMDs.

Methods
Six databases (CINAHL; Ovid Embase; Ovid MEDLINE; Psycinfo; Cochrane Database of Systematic Reviews; CENTRAL) were searched from inception to March 2022. Qualitative interview or focus group studies published in English and involving participants living with foot or ankle disorders in RMDs (inflammatory arthritis, osteoarthritis, crystal arthropathies, connective tissue diseases, and musculoskeletal conditions in the absence of systemic disease) were included. Quality was assessed using the Critical Appraisal Skills Programme qualitative tool. All data from the results section of included studies were extracted, coded and synthesised to develop themes. Patient and public involvement contributors were involved throughout the review, from design of the study to interpretation of the results and discussions about the findings.

Results
Of 1,440 database records screened, 34 studies were included, with a total of 581 participants. Studies focused on living with foot or ankle disorders in rheumatoid arthritis (n = 18), osteoarthritis (n = 5), gout (n = 3), psoriatic arthritis (n = 1), lupus (n = 1), posterior tibial tendon dysfunction (n = 1), plantar heel pain (n = 1), Achilles tendonitis (n = 1), and mixed population (n = 3) patients. Six themes were generated from the thematic synthesis: pain, change in appearance, activity limitations, social isolation, limited work ability and emotional impact. Foot or ankle pain was the predominant symptom experienced by patients in all included studies and was closely linked to other themes. Both pain and change in appearance of the feet or ankles (deformity), and subsequent limitations in footwear and clothing choices, led to restrictions in physical activities, social participation and work. Emotional distress, including anxiety, anger and embarrassment, was common among patients with foot and ankle disorders across all of the RMDs explored in this review.

Conclusion
This is the first study to synthesise findings of qualitative research exploring the lived experience of patients with foot and ankle disorders in RMDs. Findings indicate that these disorders impact on multiple areas of patients’ lives, both physically and psychologically. Patients’ experiences of foot and ankle disorders are similar across different RMDs, although there are a limited number of qualitative studies focusing on conditions other than rheumatoid arthritis. These findings will inform a future consensus study prioritising the outcomes that should be measured in future research studies and clinical practice.
Disclosure
L.S. Chapman: None. C. Flurey: None. A.C. Redmond: None. P. Richards: None. C. Hofstetter: None. B. Tapster: None. J. Emmel: None. P.S. Helliwell: None. H.B. Menz: None. M.T. Hannan: None. B. Shea: None. H.J. Siddle: None.