BHPR research: qualitative * 1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

M. R. Backhouse(University of Leeds), K. A. Vinall(University of Leeds), A. Redmond(University of Leeds), P. Helliwell(University of Leeds), A.-M. Keenan(University of Leeds), R. M. Dale, Anne Thomas, Daniël C. Aronson(University of Leeds), Julie M. Turner‐Cobb(Newcastle University), Raj Sengupta(University of Leeds), B France(University of Leeds), Iwan A. Hill(University of Leeds), C. A. Flurey(University of Leeds), Michelle Morris(University of Leeds), Jonathan I Pollock(Newcastle University), Rod Hughes(University of Leeds), P. Richards(University of Leeds), S. Hewlett(University of Leeds), Sarah Ryan(University of Leeds), K. Lille(University of Leeds), Josephine C. Adams(Newcastle University), Inaamul Haq(University of Leeds), M J McArthur(University of Leeds), Lynne Goodacre(University of Leeds), Linda Birt(University of Leeds), Oliver W.A. Wilson(University of Leeds), John Kirwan(Newcastle University), E. Dures(University of Leeds), Enid Quest(University of Leeds), S. Hewlett(University of Leeds), R. Rajak(University of Leeds), Tinku Thomas(University of Leeds), T. Lawson(University of Leeds), Sharon Petford(University of Leeds), Elizabeth Hale(University of Leeds), George D. Kitas, Sarah Ryan(University of Leeds), Rachael Gooberman‐Hill(University of Leeds), C. Jinks(University of Leeds), Krysia Dziedzic(University of Leeds), S. Barbosa Boucas, K. Hislop(University of Leeds), C. Rhodes(University of Leeds), Josephine C. Adams(Newcastle University), Farman Ali(Newcastle University), C. Jinks(University of Leeds), Bie Nio Ong, M. R. Backhouse(University of Leeds), Derrick White(University of Leeds), E. Hensor(University of Leeds), A.-M. Keenan(University of Leeds), P. Helliwell(University of Leeds), A. Redmond(University of Leeds), A. M. Ferguson(University of Leeds), Abdel Douiri, D. L. Scott, Heidi Lempp(University of Leeds), Serena Halls(University of Leeds), R.-J. Law, Jennifer Jones(Newcastle University), D. Markland(University of Leeds), Peter J. Maddison(University of Leeds), Jeanette M. Thom(Newcastle University), R.-J. Law, Jeanette M. Thom, Peter J. Maddison(University of Leeds), A. Breslin, A Kraus, Chandrika Gordhan(University of Leeds), Sarah Dennis(University of Leeds), Jay Connor(Newcastle University), Buddhadev Chowdhary(University of Leeds), N. Lottay(University of Leeds), P. Juneja(University of Leeds), P. A. Bacon(University of Leeds), David A. Isaacs(University of Leeds), Julian Jack(Newcastle University), Majella Keller(University of Leeds), Jeremy Tibble(Newcastle University), Inaamul Haq(University of Leeds), A. Hammond, Rachel Gill(University of Leeds), Sarah Tyson(University of Leeds), A. Tennant, Ulla Nordenskiöld(University of Leeds), E. Pease(University of Leeds), CT Pease, A. Trehane, F. Rahmeh, P. Cornell(University of Leeds), Sarah Westlake, Ken Rose(University of Leeds), C. F. Alber, Lyn Watson(University of Leeds), Richard Stratton(University of Leeds), Martin L. Lazarus(University of Leeds), N. E. McNeilly(University of Leeds), J. Douglas Waterfield(Newcastle University), M. Hurley(University of Leeds), James Greenwood(Newcastle University), A. M. Clayton(University of Leeds), Mary Lynch(University of Leeds), A. Clewes, Julie Dawson(Newcastle University), Virginia Abernethy(University of Leeds), Alex Griffiths(University of Leeds), Valerie M. Chamberlain(University of Leeds), Y. McLoughlin(University of Leeds), S. Campbell(University of Leeds), J. Hayes(Newcastle University), Claire Moffat(University of Leeds), Frank McKenna, P. Shah(University of Leeds), R. Rajak(University of Leeds), Andy Williams, C. Rhys-Dillon(University of Leeds), Rhian Goodfellow(University of Leeds), Joan C. Martin, R. Rajak(University of Leeds), Flavia Di Bari, Gemma Hughes(Newcastle University), E. Thomas(University of Leeds), Stephen R. Baker(University of Leeds), D. N. Collins(University of Leeds), E. Price(University of Leeds), L. Williamson(University of Leeds), Lisa Dunkley(University of Leeds), M. J. Youll, Mia Rodziewicz(University of Leeds), J. A. Reynolds(Newcastle University), J. Berry(Newcastle University), Chris R. Pavey(University of Leeds), K. Hyrich(University of Leeds), Rachel Gorodkin(University of Leeds), K. Wilkinson(University of Leeds), Ian N Bruce(University of Leeds), A. Barton, Alan J. Silman, Peter Ho(University of Leeds), T. Cornell(University of Leeds), Sarah Westlake, Suzanne H Richards(University of Leeds), Alison Holmes, Sophie Parker(University of Leeds), H. Smith(University of Leeds), Natalie Briggs(University of Leeds), S. Arthanari(University of Leeds), Muhammad Nisar(University of Leeds), Cath Thwaites(University of Leeds), Sarah Ryan(University of Leeds), S. Kamath(University of Leeds), Sarah Price(University of Leeds), Siân Robinson(Newcastle University), David Walker(University of Leeds), H. Coop(University of Leeds), W Al-Allaf(University of Leeds), Stephen R. Baker(University of Leeds), L. Williamson(University of Leeds), E. Price(University of Leeds), D. N. Collins(University of Leeds), R. C. Charleton, Bridget Griffiths(University of Leeds), E. A. Edwards(University of Leeds), R. Partlett(University of Leeds), Kathryn R. Martin(University of Leeds), Michael Tarzi(University of Leeds), S. Panthakalam(University of Leeds), Tami Freeman(University of Leeds), L. Ainley(University of Leeds), Katrina Turner(University of Leeds), Lynda Hughes(University of Leeds), Barry C. Russell(University of Leeds), Sarah C. Jenkins(University of Leeds), John Done(Newcastle University), Alexander S. Young, Taryn Jones(University of Leeds), Ian Gaywood(University of Leeds), Ira Pande(University of Leeds), Marie-Josèphe Pradère, Mahua Bhaduri(University of Leeds), Andrew G. Smith, H. Cook(University of Leeds), Suja Abraham(University of Leeds), Tanaka Ngcozana(University of Leeds), C. P. Denton, Lee D. Parker(University of Leeds), C. M. Black, V. Ong(University of Leeds), Noel Thompson(University of Leeds), Carole L. White(University of Leeds), Martin Duddy(University of Leeds), Paresh Jobanputra(University of Leeds), Paul Bacon(University of Leeds), Johanna Smith(Newcastle University), A. Richardson, Giulia Giancola(Newcastle University), Vanessa Soh(University of Leeds), Sarah Spencer(University of Leeds), Andrew D. Greenhalgh, M Hanson(University of Leeds), D. De Lord(University of Leeds), Mark Lloyd(University of Leeds), Hee‐Kit Wong(University of Leeds), Denise Wren(University of Leeds), Blaine Grover(University of Leeds), Jennifer Hall(Newcastle University), Christine Neville(University of Leeds), P. B. Alton(University of Leeds), S. Kelly(University of Leeds), Stefano Bombardieri(University of Leeds), F. Humby, Nora Ng(University of Leeds), Maria Di Cicco(University of Leeds), Rebecca Hands(University of Leeds), Oscar Massimiliano Epis(University of Leeds), Andrew Filer, Craig E. Buckley(University of Leeds), I. McInnes(University of Leeds), P. Taylor(University of Leeds), Costantino Pitzalis(University of Leeds), Jonathan Freeston(Newcastle University), Philip G. Conaghan(University of Leeds), Andrew J. Grainger, P. J. O'Connor, R. M. L. Evans(University of Leeds), Paul Emery(University of Leeds), Richard Hodgson(University of Leeds), P. Emery(University of Leeds), Roy Fleischmann(University of Leeds), C. Han(University of Leeds), D. van der Heijde(University of Leeds), Philip G. Conaghan(University of Leeds), Wei Xu(University of Leeds), E. C. Hsia(University of Leeds), A. Kavanaugh, Dafna D. Gladman(University of Leeds), C Chattopadhyay(University of Leeds), Anna Beutler, C. Han(University of Leeds), A. Zayat(University of Leeds), Philip G. Conaghan(University of Leeds), Jonathan Freeston(Newcastle University), E. Hensor(University of Leeds), K. Ellegard(University of Leeds), Lene Terslev(University of Leeds), Paul Emery(University of Leeds), R. J. Wakefield, Coziana Ciurtin(University of Leeds), Maria Leandro(University of Leeds), Debankur Dey(University of Leeds), Anupama Nandagudi, Ian Giles(University of Leeds), M. Shipley(University of Leeds), V. Morris(University of Leeds), J Ioannou(Newcastle University), Michael R. Ehrenstein(University of Leeds), Debajit Sen(University of Leeds), M. F. W.-Y. Chan(University of Leeds), Teresa Quinlan, Robert H. Brophy(University of Leeds), Devesh Mewar(University of Leeds), Dipen Patel(University of Leeds), Martin Wilby, Vincent D. Pellegrini(University of Leeds), B Eyes(University of Leeds), Dauna Crooks(University of Leeds), Marina Anderson(University of Leeds), Eric Ball(University of Leeds), Helen M A McKeeman(University of Leeds), James A. Burns(Newcastle University), W. H. Yau, Oliver Moore(University of Leeds), Jonathan Foo(Newcastle University), Christopher J. Benson(University of Leeds), Charles W. Patterson(University of Leeds), Geraldine A. Wright(Newcastle University), A. Taggart, Steve Drew(University of Leeds), Lynn Tanner(University of Leeds), Kaushik Sanyal(University of Leeds), B. Bourke(Newcastle University), Mark Lloyd(University of Leeds), Cheryl Alston(University of Leeds), Charu Baqai(University of Leeds), M D Chard(University of Leeds), V. Sandhu(University of Leeds), Christine Neville(University of Leeds), Kelvin P. Jordan(University of Leeds), Craig F. Munns(University of Leeds), Louisa Zouita(University of Leeds), Warren Shattles(University of Leeds), Usa Davies(University of Leeds), Raad Makadsi(University of Leeds), Steven L. Griffith(University of Leeds), Patrick Kiely, Coziana Ciurtin(University of Leeds), I. Dimofte(University of Leeds), M. Dabu(University of Leeds), Bulus A. Dabu(University of Leeds), David Dobarro(University of Leeds), Benjamin Schreiber(Newcastle University), Clare E Warrell(University of Leeds), Clive Handler(University of Leeds), Gerry Coghlan(Newcastle University), Christopher P. Denton(University of Leeds), J. Ishorari(Newcastle University), Christopher Bunn(University of Leeds), Huw Beynon(University of Leeds), C. P. Denton, Richard Stratton(University of Leeds), Joby Jacob George Malal, B. Boton-Maggs(University of Leeds), Ann N. Leung, Daniel Farewell(University of Leeds), Ernest Choy(University of Leeds), N. J. Gullick, Alexander S. Young, Ernest Choy, D L Scott, Chris Wincup(University of Leeds), BA Fisher(University of Leeds), P. Charles(University of Leeds), P. Taylor(University of Leeds), N. J. Gullick, Louise Pollard, Bruce Kirkham, D. L. Scott, M. H.(University of Leeds), Saroja Ramanujan(University of Leeds), Guy Cavet(Newcastle University), Douglas J. Haney(University of Leeds), Gabrielle Kingsley, David L. Scott(University of Leeds), Andrew P. Cope, Aneesha Singh, J. A. Wilson(Newcastle University), Abby Isaacs, Cheung Kin Wing(University of Leeds), M. McLaughlin(University of Leeds), Henry Penn(University of Leeds), M. C. Genovese, Anthony Sebba, Andrea Rubbert‐Roth, J. Scali(Newcastle University), Moshe Zilberstein(University of Leeds), L. Thompson(University of Leeds), R. Van Vollenhoven(University of Leeds), Federico de Benedetti, H. Brunner(University of Leeds), RC Allen(University of Leeds), Darren A. Brown(University of Leeds), J. Chaitow(Newcastle University), M. Pardeo(University of Leeds), Graciela Espada(Newcastle University), B. Flatø(University of Leeds), G. Horneff(Newcastle University), Clare Devlin(University of Leeds), A. Kenwright, R. Schneider(University of Leeds), Patricia Woo(University of Leeds), Alberto Martini, D. Lovell(University of Leeds), Nicolino Ruperto(University of Leeds), H. John(University of Leeds), Elizabeth Hale(University of Leeds), Gareth J. Treharne, George D. Kitas, Douglas Carroll(University of Leeds), Louise Mercer(University of Leeds), Andrea Hsiu Ling Low, J. Galloway(Newcastle University), K Watson(University of Leeds), Mark Lunt(University of Leeds), D. Symmons(University of Leeds), K. Hyrich(University of Leeds), on behalf of the BSRBR, Andrea Hsiu Ling Low(University of Leeds), Louise Mercer(Newcastle University), J. Galloway(University of Leeds), Rachel Davies(University of Leeds), K Watson(University of Leeds), Mark Lunt(University of Leeds), William G Dixon(University of Leeds), Kimme L Hyrich(University of Leeds), D. Symmons(University of Leeds), on behalf of the BSRBR, Sharmili Balarajah(University of Leeds), Alexander T. Sandhu(University of Leeds), M. Ariyo, Edward A. Rankin, Aamer Sandoo, Johann J van Zanten(University of Leeds), Tracey E. Toms, D. Carroll, George D. Kitas, Aamer Sandoo, J. P. Smith(University of Leeds), George D. Kitas(University of Leeds), S. Malik(University of Leeds), E. Toberty(Newcastle University), Nishanthi Thalayasingam(University of Leeds), J. Hamilton(University of Leeds), Clive Kelly(University of Leeds), Daniel J. Puntis(Newcastle University), S. Malik(University of Leeds), J. Hamilton(University of Leeds), VR Saravanan(University of Leeds), M. Rynne(University of Leeds), C. Heycock(University of Leeds), Clive Kelly(University of Leeds), R. Rajak(University of Leeds), R. Goodfellow(University of Leeds), C. Rhys-Dillon(University of Leeds), Robert W. Winter, Peter G. Wardle(University of Leeds), Joan C. Martin, Tracey E. Toms(Newcastle University), Aamer Sandoo(University of Leeds), Johanna Smith(University of Leeds), Susan Cadman(Newcastle University), P. Nightingale, George D. Kitas(Newcastle University), Awal Alhusain(University of Leeds), Suzanne Verstappen(University of Leeds), H. Mirjafari(University of Leeds), Mark Lunt(University of Leeds), V. Charlton-Menys(University of Leeds), Diane Bunn(University of Leeds), Deborah Symmons(University of Leeds), P Durrington, Ian N Bruce, Jennifer Cooney, Jeanette M. Thom, Jonathan P. Moore, Andrew Lemmey, J. G. Jones(University of Leeds), P Maddison, Yasmeen A. Ahmad, Tehseen Ahmed, Maria Florencia González Leone, Patrick Kiely(University of Leeds), Harry Browne(University of Leeds), C. Rhys-Dillon, Surabhi Wig(University of Leeds), Astrid Chevance(Newcastle University), Tonia Moore, J. Manning(University of Leeds), Andy Vail(University of Leeds), A. L. Herrick(University of Leeds), Emma Derrett‐Smith(University of Leeds), Rachel K. Hoyles(University of Leeds), P. Moinzadeh(University of Leeds), Cecilia Beatrice Chighizola(University of Leeds), K. Khan(University of Leeds), V. Ong, David Abraham(Newcastle University), C. P. Denton(University of Leeds), Benjamin Schreiber, David Dobarro(University of Leeds), Clare E Warrell, C. Handler(Newcastle University), C. P. Denton(University of Leeds), Gerry Coghlan(University of Leeds), R Sykes(University of Leeds), Lindsay Muir(University of Leeds), Holly Ennis, A. L. Herrick(University of Leeds), X. Shiwen(University of Leeds), K. Thompson(University of Leeds), K. Khan, S. Liu, C. P. Denton, A. Leask(Newcastle University), David Abraham(Newcastle University), G. Strickland, John D Pauling(Newcastle University), Zoë Betteridge(University of Leeds), J. Englebert Dunphy(University of Leeds), Patrick J. Owen(Newcastle University), N. McHugh(Newcastle University), Giuseppina Abignano, Giovanna Cuomo, MH Buch(Newcastle University), William Rosenberg(University of Leeds), Gabriele Valentini, P. Emery(Newcastle University), F. Galdo, J T Jenkins(University of Leeds), J. D. Pauling(University of Leeds), N. McHugh, K. Khan(University of Leeds), X. Shiwen, David Abraham(University of Leeds), C. P. Denton(University of Leeds), V. Ong(University of Leeds), P. Moinzadeh(University of Leeds), Kevin Howell(University of Leeds), V. Ong, Svetlana I. Nihtyanova(University of Leeds), C. P. Denton(University of Leeds), P. Moinzadeh(University of Leeds), Carmen Fonseca(University of Leeds), K. Khan(University of Leeds), David Abraham, V. Ong(University of Leeds), C. P. Denton(University of Leeds), A. P. Malaviya, Andreas V. Hadjinicolaou(University of Leeds), Muhammad K Nisar, M. Ruddlesden(University of Leeds), A. Furlong, Stephen R. Baker(University of Leeds), Frances Hall(University of Leeds), Andreas V. Hadjinicolaou, A. P. Malaviya(University of Leeds), Muhammad K Nisar(University of Leeds), M. Ruddlesden, D. Raut-Roy(University of Leeds), A. Furlong, S. Baker(University of Leeds), Frances Hall, Rosalia Peluso(University of Leeds), Matteo Nicola Dario Di Minno(University of Leeds), Salvatore Iervolino(University of Leeds), Lauren Costa(University of Leeds), Mariangela Atteno(University of Leeds), Mara Cristina Lofrano‐Prado, Ernesto Soscia, F. Castiglione(University of Leeds), Francesca Foglia(University of Leeds), Raffaele Scarpa, D. Wallis(University of Leeds), Anne Thomas(University of Leeds), Iwan A. Hill(University of Leeds), B. France(University of Leeds), R. Sengupta(University of Leeds), Maxime Dougados(University of Leeds), E. Keystone(University of Leeds), M. Heckaman(University of Leeds), Philip J. Mease(University of Leeds), Robert Landewé(University of Leeds), Dương Nguyễn(University of Leeds), M. Heckaman(University of Leeds), Philip J. Mease(University of Leeds), Robert D. Winfield(University of Leeds), Christina Van Dyke(University of Leeds), Mark L Clemence, K. Mackay(Newcastle University), Kirstie Haywood, Jon Packham(University of Leeds), Kelvin P. Jordan(University of Leeds), Henry Davies(University of Leeds), Sinéad Brophy(University of Leeds), E. D. Irvine, Roxanne Cooksey(University of Leeds), Michael Dennis, S. Siebert, Gabrielle Kingsley, Fowzia Ibrahim, D L Scott(University of Leeds), A. Kavanaugh(University of Leeds), I. McInnes(Newcastle University), C Chattopadhyay(University of Leeds), G.G. Krueger, Dafna D. Gladman(University of Leeds), A. Beutler(University of Leeds), T. Gathany(University of Leeds), S. Mudivarthy(University of Leeds), M. Mack(University of Leeds), Neeta Tandon(University of Leeds), C. Han(University of Leeds), Philip J. Mease(Newcastle University), I. McInnes(Newcastle University), J. Sieper(University of Leeds), Jürgen Braun(University of Leeds), P. Emery(Newcastle University), D. van der Heijde(Newcastle University), J. Isaacs(Newcastle University), G Dahmen(University of Leeds), J. Wollenhaupt(University of Leeds), H. Schulze-Koops, Sandro Gsteiger(University of Leeds), A Bertolino, W. Hueber, P. P. Tak(University of Leeds), C. Cohen, T. Karaderi, J. J. Pointon(University of Leeds), B P Wordsworth(University of Leeds), Roxanne Cooksey, Henry Davies(University of Leeds), Michael Dennis(University of Leeds), S. Siebert(University of Leeds), Sinéad Brophy, Sarah Keidel(University of Leeds), J. J. Pointon(University of Leeds), C. Farrar, T. Karaderi, Louise Appleton(University of Leeds), B P Wordsworth(University of Leeds), Rebecca Adshead(University of Leeds), Hasan Tahir, Malcolm Greenwood(Newcastle University), S. P. Donnelly(University of Leeds), J. Wajed, Bruce Kirkham
Lara D. Veeken
April 3, 2012
10.1093/rheumatology/kes110
Cited by 2Open Access
Full Text

Abstract

<b>Background:</b> Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA <b>Methods:</b> Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. <b>Results:</b> 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception (“I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire (“it’s not cosmetic surgery; it’s something that’s more important than that, you know?”). Clinician opinion: Surgeons’ post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients’ lasting impression irrespective of how the outcome compared to their initial goals (“when he’d done it … he said that hasn’t worked as good as he’d wanted to … but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously (“in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). <b>Conclusions:</b> Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons’ appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome <b>Disclosure statement:</b> All authors have declared no conflicts of interest.

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