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Navigating diagnostic uncertainty in children's chronic lower limb pain: A qualitative study of management strategies using vignette-based focus groups.
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2025-03-01 DOI: 10.1002/jfa2.70032
Jessica Coventry, James J Welch, Verity Pacey, Binh Ta, Elizabeth Sturgiss, Mitchell Smith, Cylie M Williams

Background: Chronic lower limb pain is common in children and adolescents and is frequently managed by podiatrists. Due to the complexities of understanding the cause of chronic pain, clinicians may experience uncertainty around the diagnosis, which in turn may impact their communication and management approaches. Limited research explores how podiatrists manage chronic lower limb pain in children, especially in the presence of diagnostic uncertainty. This study aimed to explore the management strategies including language that podiatrists report using to address the pain experience of children with chronic lower limb pain and to investigate if and how the reported management strategies used by podiatrists to address the pain experience of children with chronic lower limb pain vary based upon the level of diagnostic uncertainty.

Methods: Eight focus groups were conducted with a total of 48 podiatrists. Participants were presented with three vignettes, each describing a child with chronic lower limb pain. They were then asked to discuss their certainty in the child's diagnosis presented and their approaches to explain and manage the child's pain. Audio data were recorded, transcribed and analysed using thematic analysis. Three key themes were generated: Language strategies, non-verbal communication strategies and treatment strategies.

Results: Podiatrists were overall certain in the diagnosis presented in vignettes 1 (calcaneal apophysitis) and 2 (juvenile idiopathic arthritis); however, they expressed significant uncertainty in vignette 3, which was written to elicit uncertainty presenting a case with generalised lower limb pain. Many groups fixated on the Beighton score of 5/9 and interpreted this to mean hypermobility, which is inconsistent with the current clinical guidance. Podiatrists used similar language strategies across all 3 vignettes and supported their language strategies with non-verbal communication strategies. Podiatrists also discussed activity modification, passive and self-care strategies and building a team as the treatment strategies they would use.

Conclusions: This study highlights the variety of clinical management strategies used by approaches and highlights how their approach may change depending on their certainty in the diagnosis.

{"title":"Navigating diagnostic uncertainty in children's chronic lower limb pain: A qualitative study of management strategies using vignette-based focus groups.","authors":"Jessica Coventry, James J Welch, Verity Pacey, Binh Ta, Elizabeth Sturgiss, Mitchell Smith, Cylie M Williams","doi":"10.1002/jfa2.70032","DOIUrl":"10.1002/jfa2.70032","url":null,"abstract":"<p><strong>Background: </strong>Chronic lower limb pain is common in children and adolescents and is frequently managed by podiatrists. Due to the complexities of understanding the cause of chronic pain, clinicians may experience uncertainty around the diagnosis, which in turn may impact their communication and management approaches. Limited research explores how podiatrists manage chronic lower limb pain in children, especially in the presence of diagnostic uncertainty. This study aimed to explore the management strategies including language that podiatrists report using to address the pain experience of children with chronic lower limb pain and to investigate if and how the reported management strategies used by podiatrists to address the pain experience of children with chronic lower limb pain vary based upon the level of diagnostic uncertainty.</p><p><strong>Methods: </strong>Eight focus groups were conducted with a total of 48 podiatrists. Participants were presented with three vignettes, each describing a child with chronic lower limb pain. They were then asked to discuss their certainty in the child's diagnosis presented and their approaches to explain and manage the child's pain. Audio data were recorded, transcribed and analysed using thematic analysis. Three key themes were generated: Language strategies, non-verbal communication strategies and treatment strategies.</p><p><strong>Results: </strong>Podiatrists were overall certain in the diagnosis presented in vignettes 1 (calcaneal apophysitis) and 2 (juvenile idiopathic arthritis); however, they expressed significant uncertainty in vignette 3, which was written to elicit uncertainty presenting a case with generalised lower limb pain. Many groups fixated on the Beighton score of 5/9 and interpreted this to mean hypermobility, which is inconsistent with the current clinical guidance. Podiatrists used similar language strategies across all 3 vignettes and supported their language strategies with non-verbal communication strategies. Podiatrists also discussed activity modification, passive and self-care strategies and building a team as the treatment strategies they would use.</p><p><strong>Conclusions: </strong>This study highlights the variety of clinical management strategies used by approaches and highlights how their approach may change depending on their certainty in the diagnosis.</p>","PeriodicalId":49164,"journal":{"name":"Journal of Foot and Ankle Research","volume":"18 1","pages":"e70032"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Development of a Lateral Longitudinal Arch Evaluation Method for the Foot Using Ultrasonography: Validation With Radiography and Verification of Intrarater and Interrater Reliability.
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2025-03-01 DOI: 10.1002/jfa2.70039
Daichi Kawamura, Takashi Komatsu, Masanobu Suto, Hikaru Narita, Yasuyuki Umezaki, Saki Takahashi, Hiroshi Shinohara

Introduction: The lateral longitudinal arch (LLA) is an essential structure of the foot. However, LLA evaluation methods remain underexplored compared to those of the medial longitudinal arch (MLA). This study sought to develop a method for measuring the cuboid height, the keystone of the LLA, using ultrasonography and to verify its correlation with radiography, as well as intrarater and interrater reliability.

Methods: This cross-sectional study included 21 university students (14 males and seven females). The cuboid height was measured using radiography and ultrasonography. The validity of ultrasonographic measurements was assessed through correlation with radiographic measurements and Bland-Altman analysis. Intrarater and interrater reliabilities were evaluated using intraclass correlation coefficients (ICCs).

Results: A strong correlation was observed between cuboid heights measured using radiography and ultrasonography (r = 0.98, p < 0.01). The Bland-Altman analysis revealed a fixed bias of -0.71 mm (95% confidence interval [95% CI]: -0.96 to -0.46 mm). Intrarater and interrater reliability for ultrasonographic measurements were almost perfect, with ICCs of 0.98 and 0.99, respectively.

Conclusions: Cuboid height measurements using ultrasonography demonstrated high validity and reliability. This method offers a noninvasive and cost-effective alternative to radiography, with potential clinical applications in the evaluation of LLA and related conditions such as cuboid syndrome and lateral foot injuries.

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引用次数: 0
Psychological factors associated with pain and function in adults with hallux valgus.
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2025-03-01 DOI: 10.1002/jfa2.70030
Abdel Kak, Mehak Batra, Bircan Erbas, Sean Sadler, Vivienne Chuter, Jeffery Jenkins, Haydar Ozcan, Damien Lafferty, Ozan Amir, Matthew Cotchett

Introduction: Psychological factors are linked to pain and function in various musculoskeletal conditions, but their impact on hallux valgus is unclear. Health-related quality of life declines with increasing severity of hallux valgus, affecting not only foot pain and physical function, but also general health, vitality and mental health. Previous studies have reported inconsistent associations between psychological factors, such as anxiety and depression, and surgical outcomes, which might relate to variability in measurement approaches. Understanding the associations between psychological factors, including anxiety, depression, pain catastrophizing and kinesiophobia, and hallux valgus-related pain and function may inform more holistic pre-operative care. Therefore, we aimed to assess these associations in adults with hallux valgus pre-surgery.

Methods: A pre-operative cross-sectional study was conducted with 41 adults scheduled for hallux valgus surgery. Participants completed questionnaires measuring continuous psychological variables: depression, anxiety and stress (Depression Anxiety Stress Scale-21, a tool for general psychological distress), kinesiophobia (Tampa Scale for Kinesiophobia, which assesses fear of movement associated with pain) and pain catastrophizing (Pain Catastrophizing Scale, a tool used to evaluate maladaptive pain-coping strategies). Continuous outcomes were evaluated using the Manchester-Oxford Foot Questionnaire for foot function, pain and social interaction. Multiple linear regressions explored the associations between these psychological factors and the outcomes.

Results: When all exposure variables were considered simultaneously, pain catastrophizing emerged as a significant predictor of foot pain and foot function. A one-unit increase in the pain catastrophizing score was associated with a 1.41-point increase in foot pain (β = 1.41, 95% confidence intervals (CIs) 0.73-2.09 and p < 0.001) and a 1.83-point increase in worse foot function (β = 1.83, 95% CI 1.12-2.54 and p < 0.001).

Conclusion: Assessing pain catastrophising pre-operatively is recommended for individuals with hallux valgus, although more structured education may be needed to support health professionals in assessing psychological factors. Future research should evaluate the longitudinal impact of pain catastrophizing on post-operative outcomes and explore other contributing factors, such as comorbidities, lifestyle variables and sex differences, to refine screening and treatment strategies.

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引用次数: 0
Incidence of Adult Acquired Flatfoot Deformity Referred to Specialist Care in Sweden.
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2025-03-01 DOI: 10.1002/jfa2.70042
Ida Osbeck, Maria Cöster, Isam Atroshi

Introduction: Adult acquired flatfoot deformity (AAFD) is a disabling condition that may require complex surgical treatment. Little is known about the incidence of AAFD in the general population and specifically of AAFD requiring specialist care. We aimed to describe the incidence of AAFD referred to specialist care in the Swedish general population.

Methods: We conducted a nation-wide epidemiological register study to estimate the incidence of referred AAFD in the general population. We retrieved data from the Swedish National Patient Register. All individuals aged 16 years or older, with a first-time diagnosis of AAFD (ICD-10 code M214) between 2007 and 2018 were identified. Total incidences, change over time, and gender-specific and age-specific incidences per 100,000 person-years were calculated using population size data from Statistics Sweden. Incidences were compared using the Poisson test.

Results: The incidence rate of referred AAFD in the general population was 23.0 (95% CI 22.7-23.3) per 100,000 person-years. The incidence rate in women was 30.4 (95% CI 29.9-30.8) and in men was 15.4 (95% CI 15.1-15.8). The highest incidence rates were found in the age Group 61-75 years. The incidence rates varied significantly across the 21 regions in Sweden. The age-standardized and sex-standardized incidence rates ranged from 8.3 (95% CI 7.2-9.4) to 69.1 (95% CI 62.4-75.8).

Conclusion: AAFD requiring referral to specialist care is common in the general population. Women had nearly twice the incidence of AAFD compared to men. Large unexplained regional variations in the incidence rates exist.

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引用次数: 0
How Can Podiatrists and Other Health Care Professionals Support the Detection of Atrial Fibrillation?
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2025-03-01 DOI: 10.1002/jfa2.70043
Jane E A Lewis, Joanna Tozer, Trudie Lobban, Andrea Evans, Matthew Banner, Lawrence Ambrose

Atrial fibrillation (AF) is a global health crisis affecting 33.5 million people, with costs projected to reach £75 billion by 2035. A significant concern is that 43-48% of cases are asymptomatic, increasing the risk of stroke and heart failure. While general population screening lacks strong support, targeted screening shows promise in reducing stroke occurrence and healthcare costs. Podiatrists, who frequently treat adults of advancing age, are uniquely positioned to detect AF in high-risk, asymptomatic individuals. This commentary advocates for opportunistic AF screening by podiatrists and other healthcare professionals, offering guidance for implementation. Early detection through defined referral pathways is crucial for timely diagnosis and management, potentially reducing AF-related strokes that can lead to early mortality. Further high-quality podiatry-led studies are recommended to build on this commentary paper.

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引用次数: 0
Investigating pre-registration podiatry students approaches to identifying dermatology conditions in different skin tones: A mixed methods protocol. 调查注册前足科学生识别不同肤色皮肤病的方法:混合方法协议。
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-01 DOI: 10.1002/jfa2.70015
Simon Otter, Deborah Whitham, Gianluca Melotto, Lauren Mann, Yaa Agyare, Joanne Gozo-Reyes, Faye Funnell, Alex Sykes, Penny Dale

Background: Health inequalities are a well-known and widespread phenomenon throughout health care settings. In particular, people of color experience higher rates of delayed and/or misdiagnosis contributing to poorer outcomes and an increased mortality risk. Research suggests that health care professionals find it more difficult to correctly diagnose dermatological conditions in the non-White patient demographic. Although podiatrists routinely examine and assess skin lesions, there is a paucity of research exploring their accuracy or confidence in recognizing skin pathologies. This study aims to investigate podiatry student's ability, confidence, approaches, and perceptions in diagnosing dermatology pathologies in different skin tones. A mixed methods exploratory sequential design is proposed. In stage one, podiatry students from different higher education institutions will be invited to complete a pictorial survey. We have designed a survey comprising six validated images of inflammatory skin pathology (either eczema or psoriasis) in three different skin tone categories, standardized using the Fitzpatrick scale. Data from the survey in stage one will then be utilized to inform the next stage of the research. In stage two, respondents who completed the initial survey will be invited to participate in focus groups to explore their perceptions surrounding diagnostic approaches, confidence, and perceptions of skin conditions in different skin tone. A process of thematic analysis will be employed to identify emergent themes from these data.

Methods: A mixed methods exploratory sequential design is proposed. In stage one, podiatry students from different higher education institutions will be invited to complete a pictorial survey. We have designed a survey comprising six validated images of inflammatory skin pathology (either eczema or psoriasis) in three different skin tone categories, standardized using the Fitzpatrick scale. Data from the survey in stage one will then be utilized to inform the next stage of the research. In stage two, respondents who completed the initial survey will be invited to participate in focus groups to explore their perceptions surrounding diagnostic approaches, confidence, and perceptions of skin conditions in different skin tone. A process of thematic analysis will be employed to identify emergent themes from these data.

背景:卫生不平等是整个卫生保健环境中众所周知的普遍现象。特别是,有色人种经历了更高的延迟和/或误诊率,导致较差的结果和更高的死亡风险。研究表明,卫生保健专业人员发现正确诊断非白人患者的皮肤病更加困难。虽然足病医生经常检查和评估皮肤病变,但缺乏研究探索他们在识别皮肤病变方面的准确性或信心。本研究旨在探讨足科学生诊断不同肤色皮肤疾病的能力、信心、方法及认知。提出了一种混合探索性序列设计方法。在第一阶段,来自不同高等教育机构的足部学生将被邀请完成一份图片调查。我们设计了一项调查,包括三种不同肤色类别的六张有效的炎症性皮肤病理(湿疹或牛皮癣)图像,使用Fitzpatrick量表进行标准化。第一阶段的调查数据将用于下一阶段的研究。在第二阶段,完成初步调查的受访者将被邀请参加焦点小组,探讨他们对不同肤色的诊断方法、信心和皮肤状况的看法。将采用主题分析过程从这些数据中确定紧急主题。方法:提出一种混合方法探索性序贯设计。在第一阶段,来自不同高等教育机构的足部学生将被邀请完成一份图片调查。我们设计了一项调查,包括三种不同肤色类别的六张有效的炎症性皮肤病理(湿疹或牛皮癣)图像,使用Fitzpatrick量表进行标准化。第一阶段的调查数据将用于下一阶段的研究。在第二阶段,完成初步调查的受访者将被邀请参加焦点小组,探讨他们对不同肤色的诊断方法、信心和皮肤状况的看法。将采用主题分析过程从这些数据中确定紧急主题。
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引用次数: 0
Factors associated with the development of recurrent and contralateral Charcot neuroarthropathy in individuals with diabetes mellitus: A scoping review. 糖尿病患者发生复发性和对侧夏科神经关节病的相关因素:范围综述。
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-01 DOI: 10.1002/jfa2.70016
Keet Yeng Cheong, Shan M Bergin, Shannon E Munteanu, Byron M Perrin, Karl B Landorf

Introduction: Charcot neuroarthropathy (CN) can result in fractures and dislocations of the foot and ankle in individuals with diabetes and neuropathy, leading to ulceration, amputation and a poor quality of life. Additional episodes of acute CN can lead to extended periods of physical and psychosocial distress. The aim of this scoping review was to identify and synthesise the evidence relating to factors associated with the development of recurrent and contralateral Charcot neuroarthropathy (CN) in individuals with diabetes.

Methods: A systematic search of four electronic databases was conducted from inception to February 06, 2023. All relevant study designs, except single case studies, that had been published in full in peer-reviewed journals were included. Studies were excluded if they were not published in English and did not provide data on individuals with diabetes.

Results: The search identified two studies that investigated factors associated with the development of recurrent CN, but none that related to the development of contralateral CN. Ten factors were investigated for association with recurrent CN development: age, body mass index, diabetes type and duration, glycated haemoglobin, anatomical site affected, duration of offloading applied to treat the primary CN episode, use of pharmacological intervention, severity of neuropathy, and skin temperature. However, no significant associations were reported.

Conclusions: There is an alarming lack of evidence-based findings in this research area to guide practice. Clearly, more research in the form of rigorous prospective studies is urgently required to identify risk factors for the development of recurrent and contralateral CN in individuals with diabetes.

简介Charcot 神经性关节病(CN)可导致糖尿病和神经病变患者的足部和踝部骨折和脱位,导致溃疡、截肢和生活质量下降。急性踝关节病变的再次发作可导致长时间的身体和心理困扰。本范围综述旨在确定和综合与糖尿病患者复发和对侧夏科神经关节病(CN)相关因素的证据:方法:从开始到 2023 年 2 月 6 日,对四个电子数据库进行了系统检索。除单一病例研究外,所有在同行评审期刊上全文发表的相关研究设计均被纳入。如果研究不是以英语发表,也没有提供糖尿病患者的数据,则排除在外:搜索发现了两项研究,调查了与复发性中枢神经瘫痪相关的因素,但没有一项研究与对侧中枢神经瘫痪相关。研究调查了十个因素与复发性中枢神经瘫痪的关系:年龄、体重指数、糖尿病类型和病程、糖化血红蛋白、受影响的解剖部位、治疗原发性中枢神经瘫痪的卸载时间、药物干预的使用、神经病变的严重程度以及皮肤温度。然而,这些因素之间并无明显关联:在这一研究领域,令人担忧的是缺乏以证据为基础的研究结果来指导实践。显然,迫切需要以严格的前瞻性研究形式开展更多研究,以确定糖尿病患者发生复发性和对侧 CN 的风险因素。
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引用次数: 0
The association of demographic, psychological, social and activity factors with foot health in people with plantar heel pain. 人口统计学、心理、社会和活动因素与足底跟痛患者足部健康的关系
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-01 DOI: 10.1002/jfa2.70022
Halime Gulle, Dylan Morrissey, Abdulhamit Tayfur, Dilber Karagozoglu Coskunsu, Stuart Miller, Aleksandra V Birn-Jeffery, Trevor Prior

Background: Plantar Heel Pain (PHP) can be a debilitating musculoskeletal condition from which only 50% recover within a year due to poor understanding of the mechanisms explaining severity and predicting outcomes specific to PHP.

Objective: To explore associations between biopsychosocial variables and the severity of people with PHP. Secondly, to determine what combination of self-reported factors distinguishes people with PHP from other foot pain (OFP).

Methods: We collected data from 235 participants, including 135 (%57) PHP (age 44 ± 12 years, 66% female) and 99 OFP (%43) (age 38 ± 11 years, 57% female) using 5 demographic, 13 biomedical, 8 psychological, 3 social and 8 activity-related factors. These were tested in linear and logistic regression models.

Results: Quality of life (QoL) (β = 0.35; p < 0.001), education (β = -0.22; p = 0.003), gender (β = -0.20; p = 0.007), morning pain duration (β = -0.18; p = 0.01) and disease duration (β = -0.15; p = 0.040) were significantly associated with severity of PHP. The second model, without QoL, showed that having sensitisation (β = -0.18; p = 0.002) and a higher level of morning pain (β = -0.20; p = 0.01) are associated with severity. The logistic regression results revealed that people with PHP tend to have a systemic disease (OR = 3.34; 1.53-7.76), express more kinesiophobia (OR = 1.02; 1.01-1.14), are less likely to have previous injuries (OR = 0.40; 0.19-0.81), worse morning pain (OR = 1.02; 1.01-1.03) and standing pain (OR = 2.60; 1.39-4.87) compared to people with OFP.

Conclusions: People with PHP have higher associated levels of a range of psychological, social and activity related factors than people with OFP. The findings highlight the importance of considering psychosocial assessments alongside physical examination.

背景:足底跟痛(PHP)可能是一种使人衰弱的肌肉骨骼疾病,由于对解释严重程度的机制和预测PHP特异性结果的理解不足,只有50%的人在一年内康复。目的:探讨生物社会心理变量与PHP患者严重程度的关系。其次,确定自我报告的因素组合将PHP患者与其他足部疼痛(OFP)区分开来。方法:采用5个人口学因素、13个生物医学因素、8个心理因素、3个社会因素和8个活动相关因素,收集235名参与者的资料,其中PHP 135例(%57)(年龄44±12岁,女性66%)和OFP 99例(%43)(年龄38±11岁,女性57%)。这些在线性和逻辑回归模型中进行了检验。结果:生活质量(QoL) (β = 0.35;结论:与OFP患者相比,PHP患者的一系列心理、社会和活动相关因素的相关水平更高。研究结果强调了在体检的同时考虑心理社会评估的重要性。
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引用次数: 0
Efficacy of heel lifts for insertional Achilles tendinopathy (LIFTIT): A randomised feasibility trial. 脚跟提升术治疗插入性跟腱病(LIFTIT)的疗效:一项随机可行性试验。
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-01 DOI: 10.1002/jfa2.70025
Jaryd Bourke, Shannon Munteanu, Alessandro Garofolini, Simon Taylor, Peter Malliaras

Objectives: Insertional Achilles tendinopathy is a common and disabling condition. This trial aimed to determine the feasibility of conducting a parallel group randomised trial to evaluate the efficacy of heel lifts compared to a sham intervention for reducing pain intensity associated with insertional Achilles tendinopathy.

Methods: Twenty-six people with insertional Achilles tendinopathy were randomised to either the heel lift group or sham intervention group. Outcome measures were obtained at baseline, 4, 8 and 12 weeks. The primary outcome was feasibility, evaluated according to demand (recruitment rate and conversion rate), acceptability, adherence, adverse events and retention. Limited efficacy testing was conducted on secondary outcome measures including pain intensity, function, physical activity, health-related quality of life, use of co-interventions and global rating of change.

Results: Between August 25, 2023, and April 7, 2024, we recruited and tested 26 participants (aged 28-65 years, mean [SD] 51 [8]). The pre-determined thresholds were met for demand, acceptability, adherence, retention, pain intensity, function, quality of life and global rating of change and partly met for adverse events, physical activity and use of co-interventions. Between 47 and 241, participants will be needed for a fully powered randomised trial.

Conclusion: In its current form, a randomised trial of heel lifts compared to a sham intervention is feasible. However, future triallists may need to consider strategies to manage the risk of adverse events and plan to adjust the analyses to account for the use of co-interventions.

Trial registration: ACTRN12623000721606.

目的:插入性跟腱病是一种常见的致残性疾病。本试验旨在确定进行平行组随机试验的可行性,以评估与假干预相比,提跟术对减轻与插入性跟腱病相关的疼痛强度的疗效。方法:26例插入性跟腱病患者随机分为足跟抬高组和假干预组。在基线、4周、8周和12周时获得结果测量。主要结局是可行性,根据需求(招募率和转换率)、可接受性、依从性、不良事件和保留进行评估。次要结局指标包括疼痛强度、功能、身体活动、健康相关生活质量、联合干预措施的使用和总体变化评级,进行了有限的疗效测试。结果:在2023年8月25日至2024年4月7日期间,我们招募并测试了26名参与者(年龄28-65岁,平均[SD] 51[8])。预先确定的阈值在需求、可接受性、依从性、保留、疼痛强度、功能、生活质量和总体变化评分方面得到满足,在不良事件、身体活动和使用联合干预措施方面部分得到满足。在47到241名参与者之间,将需要进行全动力随机试验。结论:在目前的形式下,与假干预相比,脚跟提升的随机试验是可行的。然而,未来的试验人员可能需要考虑管理不良事件风险的策略,并计划调整分析以考虑联合干预措施的使用。试验注册:ACTRN12623000721606。
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引用次数: 0
Revised minimal important difference values for the visual analogue scale and Foot Health Status Questionnaire when used for plantar heel pain. 修订了视觉模拟量表和足部健康状况问卷用于足底跟痛的最小重要差异值。
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-01 DOI: 10.1002/jfa2.70021
Karl B Landorf, Georgia N Twyford, Matthew P Cotchett, Glen A Whittaker

Background: The visual analogue scale (VAS) and the Foot Health Status Questionnaire (FHSQ) are patient-reported outcome measures that are frequently used to evaluate the management of plantar heel pain. This study aimed to re-calculate (i.e. revise) the minimal important differences (MIDs) of the VAS and the FHSQ when used for plantar heel pain to enhance the validity and precision of previous estimates.

Methods: This study used an anchor-based method to calculate MIDs and incorporated best-practice analyses to ensure credibility of the estimates. Data from 369 participants previously recruited from the community into four randomised controlled trials that evaluated interventions for plantar heel pain were used. VAS and FHSQ data from these participants at baseline and follow-up were pooled to calculate the MIDs (95% confidence intervals). A 15-point global rating of change Likert scale was used at follow-up as the transition scale, which was anchored to baseline. For the VAS, MIDs for two distinct types of pain were calculated: average pain and first-step pain. For the FHSQ, MIDs for two domains were calculated: foot pain and foot function.

Results: The revised MIDs for the 100 mm VAS were -8.5 mm (95% CI: -12.2 to -4.7) for average pain and -19.2 mm (95% CI: -24.7 to -13.8) for first-step pain, which represent improvements in pain. The MIDs for the FHSQ were 12.4 points (95% CI: 6.9 to 18.0) for foot pain and 6.4 points (95% CI: 0.9 to 11.9) for foot function, which represent improvements in foot health status.

Conclusions: The revised MIDs from this study for the VAS and the FHSQ when used for plantar heel pain have enhanced validity and precision compared to previous estimates. This is important for clinicians and researchers as it provides a better understanding of how much improvement is required by an individual before an important change is experienced. The revised MIDs will also assist researchers with prospective sample size calculations, so future clinical trials are appropriately powered from a statistical standpoint.

背景:视觉模拟量表(VAS)和足部健康状况问卷(FHSQ)是患者报告的结果测量方法,常用于评估足跟痛的治疗效果。本研究旨在重新计算(即修订)视觉模拟量表和足部健康状况调查表用于足跟痛时的最小重要差异(MIDs),以提高之前估计值的有效性和精确性:本研究采用基于锚的方法计算最小重要差异,并纳入最佳实践分析,以确保估计值的可信度。研究使用了之前从社区招募的 369 名参与者的数据,这些参与者参加了四项评估足跟痛干预措施的随机对照试验。将这些参与者在基线和随访期间的 VAS 和 FHSQ 数据进行汇总,计算出中位数(95% 置信区间)。随访时使用 15 分的总体变化李克特量表作为过渡量表,该量表与基线锚定。对于 VAS,计算了两种不同类型疼痛的中位数:平均疼痛和第一步疼痛。对于 FHSQ,计算了两个领域的中位数:足部疼痛和足部功能:修订后的 100 毫米 VAS 平均疼痛中位数为-8.5 毫米(95% CI:-12.2 至-4.7),第一步疼痛中位数为-19.2 毫米(95% CI:-24.7 至-13.8),这代表疼痛有所改善。FHSQ 的中位数分别为:足部疼痛 12.4 分(95% CI:6.9 至 18.0),足部功能 6.4 分(95% CI:0.9 至 11.9),代表足部健康状况有所改善:本研究修订的 VAS 和 FHSQ 中值用于足跟痛时,与之前的估计值相比,有效性和精确性都有所提高。这对于临床医生和研究人员来说非常重要,因为他们可以更好地了解个人需要改善多少才能体验到重要的变化。修订后的中位数还将有助于研究人员进行前瞻性样本量计算,从而使未来的临床试验从统计学角度获得适当的动力。
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引用次数: 0
期刊
Journal of Foot and Ankle Research
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