Abstract
Background: Clinical practice guidelines are systematically developed recommendations used to inform stakeholders about appropriate health care and assist in clinical decision making. There are many clinical practice guidelines currently available for the management of RA. However, the foot and ankle is still under-represented in these guidelines, even though problems are common. Whilst clinical practice guidelines have many benefits, these are only achievable if the guidelines are good quality. To our knowledge, the quality of guidelines for foot and ankle management in RA has never been appraised. Therefore, the objective was to identify and critically appraise the clinical practice guidelines for the management of foot and ankle problems in RA. Methods: Guidelines were identified in electronic databases (from 1950 to March 2012). Search terms of ‘rheumatoid arthritis’ with ‘clinical practice guidelines’ and related synonyms were used. Foot and ankle search terms were not included, as to not preclude guidelines that did not include foot and ankle care specifically in the title or keywords. Guidelines were also identified by hand searching. Critical appraisal and quality rating were conducted using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Results: The inclusion criteria were met by 22 clinical practice guidelines. Five guidelines were high quality and recommended for use, and five were high quality and recommended for use with modifications. Six guidelines were low quality but recommended for use with modifications, and six were low quality and not recommended for use. Two recommended guidelines were specifically identified for the foot and ankle. There were five early RA guidelines and eleven established RA guidelines recommended for use. Five recommendation domains were found in both early and established RA guidelines. They were multidisciplinary team care, access to foot health care, foot health assessment/review, orthoses/insoles/splints, and therapeutic footwear. A sixth recommendation domain was found in the established RA guidelines. This was ‘other treatments’ and included debridement, nail care, education, injection therapy, and low level laser. Guidelines not recommended for use had no foot and ankle recommendations that were not also present in recommended guidelines. Conclusions: Foot and ankle care features in many RA management guidelines, that following appraisal, would be recommended for use clinically. It is encouraging that foot and ankle care is present in these guidelines. Unfortunately, supporting evidence is low, and the agreement levels are predominantly ‘good clinical practice’ or ‘expert opinion’. Therefore, more research studies in foot and ankle care in RA are needed prior to further inclusion in future high quality clinical practice guidelines.
Original language | English |
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Article number | 139 |
Pages (from-to) | i108 |
Number of pages | 1 |
Journal | Rheumatology |
Volume | 52 |
Issue number | Supp 1 |
Publication status | Published - 2013 |
Externally published | Yes |