Perspectives of patients and health professionals on the experience of living with psoriatic arthritis-related foot problems: a qualitative investigation
The aim of the study was to explore how foot problems impact on the lives of people with psoriatic arthritis by interviewing patients and health professionals.
Participants were recruited from outpatient rheumatology clinics in Sydney, Australia, and in Auckland, New Zealand, using a convenience sampling strategy. People with psoriatic arthritis were asked questions in semi-structured interviews about their foot problems and the impact they have on daily living until qualitative data saturation. Focus groups were undertaken with health professionals to explore their understanding of the patient experience of psoriatic arthritis-related foot problems. All interviews were audio-recorded and transcribed verbatim. Constant comparative analysis was used to identify emerging themes from the data.
Twenty-one people with psoriatic arthritis-related foot problems and 17 health professionals participated. Three overarching key themes were derived from patients and health professionals: (1) structural and functional foot manifestations, (2) impact on daily life leading to social withdrawal and reduced work productivity and (3) mediating factors influencing the severity of impact from foot problems on their lives such as social support, self-management strategies and experiences of health care.
Foot problems caused functional disability and altered self-concept, which lead to a cascade of social, economic and psychological consequences. People with foot problems contend with profound disruption to their functioning and life roles. Whilst health professionals recognised the functional and visual impact that foot problems have on daily life, the emotional burden may be under-appreciated. Future work to determine the scale and types of foot problems in psoriatic arthritis is required.
KeywordsFoot Interviews Podiatry Psoriatic arthritis Qualitative
The authors would like to thank the participating sites in the study including BJC Health, Liverpool Hospital, AUT University and North Shore Hospital.
Compliance with ethical standards
Ethical approval was granted by the South Western Sydney Local Health District (HREC/171/LPOOL/353), the Auckland University of Technology Ethics Committee (AUTEC 17/320) and the Waitemata District Health Board of Auckland New Zealand (RM/3907). Both participants and health professionals provided written informed consent prior to data collection.
- 5.Delle Sedie A, Riente L, Filippucci E, Scire CA, Iagnocco A, Meenagh G, Gutierrez M, Valesini G, Montecucco C, Grassi W, Bombardieri S (2011) Ultrasound imaging for the rheumatologist. XXXII. Sonographic assessment of the foot in patients with psoriatic arthritis. Clin Exp Rheumatol 29:217–222Google Scholar
- 7.Hyslop E, Woodburn J, McInnes IB, Semple R, Newcombe L, Hendry GJ, Rafferty D, De Mits S, Turner DE (2010) A reliability study of biomechanical foot function in psoriatic arthritis based on a novel multi-segmented foot model. Gait Posture 32:619–626. https://doi.org/10.1016/j.gaitpost.2010.09.004 CrossRefGoogle Scholar
- 11.Gossec L, de Wit M, Kiltz U, Braun J, Kalyoncu U, Scrivo R, Maccarone M, Carton L, Otsa K, Sooäär I (2014) A patient-derived and patient-reported outcome measure for assessing psoriatic arthritis: elaboration and preliminary validation of the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire, a 13-country EULAR initiative. Ann Rheum Dis 73:1012–1019. https://doi.org/10.1136/annrheumdis-2014-205207 CrossRefGoogle Scholar
- 13.Orbai AM, de Wit M, Mease P, Shea JA, Gossec L, Leung YY, Tillett W, Elmamoun M, Duffin KC, Campbell W (2016) International patient and physician consensus on a psoriatic arthritis core outcome set for clinical trials. Ann Rheum Dis 76:673–680. https://doi.org/10.1136/annrheumdis-2016-210242 CrossRefGoogle Scholar
- 14.Nordbø ECA, Aamodt G, Ihlebæk CM (2017) Subjective health complaints in individuals with psoriasis and psoriatic arthritis: associations with the severity of the skin condition and illness perceptions–a cross-sectional study. Int J Behav Med 24:438–446. https://doi.org/10.1007/s12529-017-9637-4 CrossRefGoogle Scholar
- 15.Garrido-Cumbrera M, Hillmann O, Mahapatra R, Trigos D, Zajc P, Weiss L, Bostynets G, Gossec L, Coates LC (2017) Improving the management of psoriatic arthritis and axial spondyloarthritis: roundtable discussions with healthcare professionals and patients. Rheumatol Ther 4:219–231. https://doi.org/10.1007/s40744-017-0066-2 CrossRefGoogle Scholar
- 16.Betteridge N, Boehncke WH, Bundy C, Gossec L, Gratacós J, Augustin M (2016) Promoting patient-centred care in psoriatic arthritis: a multidisciplinary European perspective on improving the patient experience. J Eur Acad Dermatol Venereol 30:576–585. https://doi.org/10.1111/jdv.13306 CrossRefGoogle Scholar
- 17.Lebwohl MG, Kavanaugh A, Armstrong AW, Van Voorhees AS (2016) US perspectives in the management of psoriasis and psoriatic arthritis: patient and physician results from the population-based multinational assessment of psoriasis and psoriatic arthritis (MAPP) survey. Am J Clin Dermatol 17:87–97. https://doi.org/10.1007/s40257-015-0169-x CrossRefGoogle Scholar
- 18.Legard R, Keegan J, Ward K (2003) In-depth interviews. In: Ritchie J, Lewis J (eds) Qualitative research practice: a guide for social science students and researchers. Sage Publications, London, pp 138–169Google Scholar
- 19.Thomas L, MacMillan J, McColl E, Hale C, Bond S (1995) Comparison of focus group and individual interview methodology in examining patient satisfaction with nursing care. Soc Sci Health 1:206–220Google Scholar
- 30.Morehouse RE, Maykut P (1994) Beginning qualitative research: a philosophical and practical guide, 1st edn. RoutledgeGoogle Scholar
- 33.Husted JA, Gladman DD, Farewell V, Long J, Cook R (1997) Validating the SF-36 health survey questionnaire in patients with psoriatic arthritis. J Rheumatol 24:511–517Google Scholar
- 34.Tillett W, Shaddick G, Askari A, Cooper A, Creamer P, Clunie G, Helliwell PS, Kay L, Korendowych E, Lane S, Packham J, Shaban R, Williamson L, McHugh NJ (2015) Factors influencing work disability in psoriatic arthritis: first results from a large UK multicentre study. Rheumatology (Oxford) 54:157–162. https://doi.org/10.1093/rheumatology/keu264 CrossRefGoogle Scholar
- 37.Naidoo S, Anderson S, Mills J, Parsons S, Breeden S, Bevan E, Edwards C, Otter SJ (2011) “I could cry, the amount of shoes I can’t get into”: a qualitative exploration of the factors that influence retail footwear selection in women with rheumatoid arthritis. J Foot Ankle Res 4:21. https://doi.org/10.1186/1757-1146-4-21 CrossRefGoogle Scholar
- 38.Hendry GJ, Gibson KA, Pile K, Taylor L, Du Toit V, Burns J, Rome K (2013) “They just scraped off the calluses”: a mixed methods exploration of foot care access and provision for people with rheumatoid arthritis in south-western Sydney, Australia. J Foot Ankle Res 6:34. https://doi.org/10.1186/1757-1146-6-34 CrossRefGoogle Scholar
- 42.Gladman DD, Shuckett R, Russell ML, Thorne JC, Schachter RK (1987) Psoriatic arthritis - an analysis of 220 patients. Q J Med 62:127–141. https://doi.org/10.1093/oxfordjournals.qjmed.a068085 Google Scholar
- 43.Torre Alonso JC, Rodriguez Perez A, Arribas Castrillo JM, Ballina Garcia J, Riestra Noriega JL, Lopez Larrea C (1991) Psoriatic arthritis (PA): a clinical, immunological and radiological study of 180 patients. Bri J Rheumatol 30:245–250. https://doi.org/10.1093/rheumatology/30.4.245 CrossRefGoogle Scholar