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Provision of foot and ankle care services for people with rheumatic and musculoskeletal disease across Europe

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  • Begonya Alcacer-Pitarch
  • Michael Ross Backhouse
  • Gabriel Gijon-Nogueron
  • Devid Biscontini
  • Sofia Bonafede
  • Andre Ferreira
  • Alfred Gatt
  • Yves Lescure
  • Tiziana Nava
  • Anthony Redmond


Publication details

JournalMusculoskeletal Care
DateAccepted/In press - 8 Sep 2019
Original languageEnglish


Background The aim of this study is to explore the variation in the provision of care for people with RMDs and foot & ankle problems between European healthcare systems. Methods An electronic questionnaire was developed and piloted in seven countries prior to being distributed to the presidents of all 23 national Health Professionals in Rheumatology associations within EULAR. Summary data were obtained using SPSS V22. Ethical approval Medical Research Ethics Committee of University of Malaga (CEUMA-91-2015-H) Results Sixteen questionnaires (73% response rate) were completed (Austria, Belgium, Czech Republic, Denmark, France, Hungary, Ireland, Italy, Malta, Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and United Kingdom). All 16 respondents indicated that foot and ankle healthcare services were provided in their country, but only three countries had services specialising in RMD-related foot and ankle problems (Netherlands, UK, Malta). The professions providing care varied depending on the pathology and the country. Foot and ankle pain was mostly treated by rheumatologists and physiotherapists; foot and ankle deformities, by orthopaedic surgeons and orthotist/prosthetists; whereas foot and ankle ulcers were mainly treated by nurses. Services were predominantly delivered through the public sector, and in secondary care (hospital) settings. Discussion and Conclusions Only three countries reported having specialist foot and ankle services addressing the needs of people with RMDs. Variation was seen in which professions provided care between countries, and also between foot and ankle pathologies cared for. There is a lack of clinical pathways and guidelines for the management of patients with RMD-related foot and ankle problems. Keywords Foot and ankle, service variation, Rheumatic and Musculoskeletal diseases, Europe, clinical pathways and guidelines.

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