Factors Predicting the Outcome of Foot and Ankle Surgery in Patients with Rheumatoid Arthritis PDF Download

Author: Michael Ross Backhouse
Publisher:
ISBN:
Category :
Languages : en
Pages : 496

Get Book

Book Description
Rheumatoid arthritis (RA) is the most common autoimmune inflammatory arthropathy. Foot pathology is almost ubiquitous in RA, affecting around 90% of patients during the course of their disease. Many of these require surgery! although reports suggest outcomes are varied and often suboptimal. Research into foot surgery is on the whole limited, methodologically poor, and hampered by a lack of understanding of what patients with RA perceive to be important when determining the outcome of their surgery. The hypothesis for work undertaken in this thesis was that patient specific factors will predict the outcome of foot and ankle surgery in patients with RA. In order to fully explore this, a multi methodological approach was used in a series of coordinated studies. Firstly, a secondary analysis of a large inception cohort of patients with RA was undertaken to explore use of surgical and conservative footcare and identify factors which may differentiate between the two. Then a series of preliminary studies were undertaken to explore what was important to patients when considering the outcome of their operation, compile a list of candidate factors to be tested in the main study, and assess the accuracy of new activity monitors in patients with RA. These preliminary studies then informed the design of a final prospective multicentre cohort of patients undergoing surgery to enable the prognostic ability of candidate factors to be modelled. Results presented in this thesis indicate that patients interpret the outcome of their operation using a multitude of interrelated factors and that further work is required before activity levels can be recorded objectively in patients with RA. Furthermore, patient specific factors may predict both an individual's future need for surgery, and the likely outcome of any surgery. However further work is required to confirm these findings before the evidence can be considered strong enough to inform clinical practice.