The efficacy of custom-made offloading devices for diabetic foot ulcer prevention: a systematic review.

INTRODUCTION: Therapeutic offloading devices, including insoles, shoes, and other orthoses, are some of the most commonly used interventions to treat or prevent diabetic foot ulceration. Custom-made offloading devices are increasingly used to offset the development of foot ulcers. However, whether these devices are more effective than prefabricated standard offloading devices is uncertain. Therefore, this systematic review collates and examines evidence on the efficacy of custom-made offloading devices in preventing foot ulcer incidence and recurrence in people diagnosed with diabetes. METHODS: Five scientific databases were searched, covering 2011-2023. Initial searches and screening were carried out independently by two researchers. Studies meeting the inclusion criteria were further examined through additional screenings, and critical appraisal. Data relevant to the review aims were extracted and analysed within a narrative synthesis. RESULTS: Of the 1,715 articles found in the initial searches, nine papers were found to meet inclusion criteria and were included in the review. The evidence shows that custom-made offloading devices are likely to be more effective for reducing or preventing diabetic foot ulcers than standard offloading devices. However, due to a lack of data it remains uncertain whether custom-made offloading devices are more cost-effective for preventing ulceration compared to standard insoles. Likewise, due to measurement heterogeneity between studies and lack of data, it is unclear whether adherence is higher in users of custom-made offloading devices, and whether such devices deliver significantly greater reductions in peak pressure as compared to standard offloading devices. CONCLUSION: Custom-made offloading devices are more effective than standard devices for preventing diabetic foot ulceration, and we recommended their use when feasible; however, there remains uncertainty regarding their cost-effectiveness compared to standard insoles and offloading devices.

Adaptation and psychometric testing of the Turkish evaluation of daily activity questionnaire in people with rheumatoid arthritis.

PURPOSE: The aims were to translate the Evaluation of Daily Activity Questionnaire (EDAQ) into Turkish, then test validity and reliability in people with rheumatoid arthritis (RA) in Turkey. MATERIAL AND METHODS: Phase 1: The EDAQ was forward and backward translated, culturally adapted following cognitive debriefing interviews with participants with RA (n = 10) and finalized by an expert committee. Phase 2: Participants (n = 215) completed a questionnaire including the EDAQ, Health Assessment Questionnaire (HAQ), and Short-Form 36 v1 (SF-36v1). Two weeks later, the EDAQ was again completed for test-retest reliability (n = 82:38%). Internal construct validity was assessed using Rasch analysis. Internal consistency, concurrent validity, and test-retest reliability were assessed. RESULTS: Following cultural adaptation, one item was removed, and examples increased or changed. Cronbach's α values were 0.71 - 0.93 for all EDAQ domains, that is, acceptable to good. The EDAQ met Rasch model requirements for fit (excellent construct validity: p > 0.05). Concurrent validity was moderate to strong for most EDAQ domains with HAQ (rs 0.49-0.81) and SF-36-v1 Physical Function (rs 0.42-0.70). There was excellent test-retest reliability for all domains (ICC (2,1): 0.95-1.00). CONCLUSION: The Turkish EDAQ is a valid, reliable measure of daily activity ability for use in practice and research with Turkish speakers with RA.

The Evaluation of Daily Activity Questionnaire provides a comprehensive evaluation of daily activity ability for people with rheumatic and musculoskeletal diseases.The Turkish Evaluation of Daily Activity Questionnaire is a valid, reliable patient-reported outcome measure in patients with rheumatoid arthritis, who considered it easy to complete.The Turkish Evaluation of Daily Activity Questionnaire is suitable for use in clinical practice and research to evaluate daily activity ability in people with rheumatoid arthritis.

Protocol of a feasibility randomised controlled trial of Empowered Conversations: training family carers to enhance their relationships and communication with people living with dementia.

Background: Communication difficulties can cause frustration, low mood, and stress for people living with dementia and their carer. Carers should be offered training on adapting their communication skills. However, it is not common for skills-based education to examine emotional aspects of care and the effect of dementia on relationships. The Empowered Conversations (EC) training course was developed in response to a gap in service provision and has been adapted to a virtual format (Zoom). It addresses the specific psychological, relationship, and communication needs of informal and family dementia carers. The primary aim of the study is to investigate the feasibility of conducting a multi-centre randomised controlled evaluation trial of EC. Secondary aims include exploring the acceptability of delivering the intervention online and examining the optimum way of establishing cost-effectiveness. Methods: The feasibility trial uses a pragmatic data-collector blind parallel two-group RCT design with two arms (EC intervention plus treatment as usual, and treatment as usual waitlist control). There will be a 2:1 allocation in favour of the EC-training intervention arm. 75 participants will complete baseline outcome measures exploring their role as a carer, including their physical and mental health, attitudes to caring, quality of life, and use of health and social care services. These will be repeated after six-months. Participants allocated to the treatment group who complete the course will be invited to participate in a qualitative interview discussing their experience of EC. Conclusions: The study will investigate recruitment pathways (including facilitators and barriers to recruitment), estimate retention levels and response rates to questionnaires, obtain additional evidence regarding proof of concept, and consider the most appropriate primary outcome measures and methods for evaluating cost-effectiveness. The results of the feasibility study will be used to inform the development of a multicentre randomised controlled trial in the United Kingdom. Registration: ISRCTN15261686 (02/03/2022).

There are 700,000 family and informal carers for people living with dementia in the UK alone. Sixty-four percent of informal carers in England say they have limited support for the range of psychological and social needs they experience. It can be difficult to keep communicating well due to thinking and memory changes that caused by dementia. This can lead to frustration, low-mood and stress for both people living with dementia and their carers. The 6-session online Empowered Conversations course is designed to enable carers to maintain and improve good communication and relationships with those they support. Course facilitators are trained to provide specific communication techniques, ways of managing conflicts, and working with difficult emotions. The course has been tried out over the last 4-years and changes made. Feedback from informal carers indicates it is in an optimum form and we are ready to test it further in a large trial. Before this is done, it is necessary to complete a smaller 'feasibility' trial to check whether such a larger trial is possible. This article explains how the feasibility trial will be carried out. Our 'feasibility' trial will check several things. We want to make sure that carers would be willing to have an only 66% chance of receiving the course straight away, because it is essential to have a comparison group. The remaining 33% of carers would be offered the course 6-months later. We want to ensure that our design is good enough to identify any improvement in carers' well-being, relationships and communication. We will also ask carers to take part in a one-to-one interview about their experiences of the course, including their views on the course being delivered on Zoom.

Psychometric testing of the Rheumatoid Arthritis Work Instability Scale in employed people with fibromyalgia.

OBJECTIVE: The aim of the study was to establish whether the Rheumatoid Arthritis Work Instability Scale (RA-WIS), in its current form, is applicable for use with employed people with fibromyalgia (FM) to identify the risk of work disability and need for work rehabilitation. METHODS: Content validity was first investigated using cognitive debriefing interviews. Participants completed a postal questionnaire. Construct validity was assessed using Rasch analysis. Concurrent validity included testing between the RA-WIS and work (e.g., Workplace Activity Limitations Scale) and health (FM Impact Questionnaire-Revised (FIQ-R) scales. Two weeks later, participants were mailed a second questionnaire to measure test-retest reliability. RESULTS: Interviews were conducted with 13 participants with FM. All RA-WIS items were considered very or extremely relevant by almost all participants, with only one suggesting other items (anxiety and brain fog). Questionnaire responses were analysed from 156 employed participants: 94% women; 45.71 (SD 10.05) years of age; with time since FM diagnosis 2.99 (4.17) years (symptom duration 8.36 (SD 7.16) years). The RA-WIS mostly satisfied Rasch model requirements and a Rasch transformation scale was created. Concurrent validity was generally good (rs = 0.55-0.66) with work scales and the FIQ-R. Internal consistency (Person Separation Index values) was consistent with group use in FM, not individual level use. Test-retest reliability was excellent, with intraclass coefficient (2, 1) = 0.90. DISCUSSION: The RA-WIS is valid and reliable for group use in employed people with FM. However, further work is needed to develop a WIS for individual use in FM.

Psychometric testing of the British-English Perceived Workplace Support Scale, Work Accommodations, Benefits, Policies and Practices Scale, and Work Transitions Index in four rheumatic and musculoskeletal conditions.

OBJECTIVE: The aims were to validate linguistically British-English versions of the Perceived Workplace Support Scale (PWSS), Work Accommodations, Benefits, Policies and Practices Scale (WABPPS), and Work Transitions Index (WTI) in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), osteoarthritis (OA) and fibromyalgia (FM). METHODS: The three scales were adapted into British-English and reviewed by an expert panel prior to cognitive debriefing interviews. Participants completed postal questionnaires. Construct validity for the PWSS was assessed using Rasch analysis. Concurrent validity included testing between the three scales and work, job strain and work-life balance scales. Two weeks later, participants were mailed a second questionnaire to measure test-retest reliability. RESULTS: The questionnaire was completed by 831 employed participants: 68% women, 53.50 (SD 8.9) years of age, with condition duration 7.70 (SD 8.00) years. The PWSS satisfied Rasch model requirements. Concurrent validity was mostly as hypothesised, that is, weak to moderate negative correlations for the PWSS (rs  = 0.07 to -0.61), and weak to moderate positive correlations for the WABPPS and WTI (rs  = 0.20-0.52). Some correlations were stronger, mostly in axSpA. Internal consistency (Cronbach's alpha) for all three scales was consistent with group use in all conditions. Test-retest reliability was generally excellent, with intraclass coefficients (2,1) of 0.80-0.93 for the three scales in the four conditions. DISCUSSION: Reliable, valid versions of the British-English PWSS, WABPPS, and WTI are now available for use in research, organisational level studies and vocational rehabilitation.

Biopsychosocial, work-related, and environmental factors affecting work participation in people with Osteoarthritis: a systematic review.

PURPOSE: Osteoarthritis (OA) causes pain and disability, with onset often during working age. Joint pain is associated with functional difficulties and may lead to work instability. The aims of this systematic review are to identify: the impact of OA on work participation; and biopsychosocial and work-related factors associated with absenteeism, presenteeism, work transitions, work impairment, work accommodations, and premature work loss. METHODS: Four databases were searched, including Medline. The Joanna Briggs Institute Critical Appraisal tools were used for quality assessment, with narrative synthesis to pool findings due to heterogeneity of study designs and work outcomes. RESULTS: Nineteen studies met quality criteria (eight cohort; 11 cross-sectional): nine included OA of any joint(s), five knee-only, four knee and/or hip, and one knee, hip, and hand OA. All were conducted in high income countries. Absenteeism due to OA was low. Presenteeism rates were four times greater than absenteeism. Performing physically intensive work was associated with absenteeism, presenteeism, and premature work loss due to OA. Moderate-to-severe joint pain and pain interference were associated with presenteeism, work transition, and premature work loss. A smaller number of studies found that comorbidities were associated with absenteeism and work transitions. Two studies reported low co-worker support was associated with work transitions and premature work loss. CONCLUSIONS: Physically intensive work, moderate-to-severe joint pain, co-morbidities, and low co-worker support potentially affects work participation in OA. Further research, using longitudinal study designs and examining the links between OA and biopsychosocial factors e.g., workplace accommodations, is needed to identify targets for interventions. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2019 CRD42019133343 .

Psychometric testing of the British-English Long-Term Conditions Job Strain Scale, Long-Term Conditions Work Spillover Scale and Work-Health-Personal Life Perceptions Scale in four rheumatic and musculoskeletal conditions.

OBJECTIVE: The aims were to validate linguistically British-English versions of the Long-Term Conditions Job Strain Scale (LTCJSS), Long-Term Conditions Work Spillover Scale (LTCWSS) and Work-Health-Personal Life Perceptions Scale (WHPLPS) in rheumatoid arthritis, axial spondyloarthritis, osteoarthritis and fibromyalgia (FM). METHODS: The three scales were forward translated and reviewed by an expert panel prior to cognitive debriefing interviews. Participants completed a postal questionnaire. Construct validity was assessed using Rasch analysis. Concurrent validity included testing between the three scales and work (e.g., Workplace Activity Limitations Scale [WALS]) and condition-specific health scales. Two weeks later, participants were mailed a second questionnaire to measure test-retest reliability. RESULTS: The questionnaire was completed by 831 employed participants: 68% women, 53.5 (SD 8.9) years of age, with condition duration 7.7 (SD 8.0) years. The LTCJSS, LTCWSS and WHPLPS Parts 1 and 2 satisfied Rasch model requirements, but Part 3 did not. A Rasch transformation scale and Reference Metric equating scales with the WALS were created. Concurrent validity was generally good (rs = 0.41-0.85) for the three scales, except the WHPLPS Part 3. Internal consistency (Person Separation Index values) was consistent with group use in all conditions, and individual use except for the LTCWSS and WHPLSP Parts 1 and 2 in FM. Test-retest reliability was excellent, with intraclass coefficients (2,1) of 0.80-0.96 for the three scales in the four conditions. DISCUSSION: Reliable, valid versions of the British-English LTCJSS, LTCWSS and WHPLPS Parts 1 and 2 are now available for use in the UK.

Where do you stand?: an exploration of perspectives toward feet, foot health, and footwear using innovative digital methods.

BACKGROUND: The cost of losing foot health is significant to the person, healthcare systems, and economy, with diabetes related foot health issues alone costing over £1 billion annually in the UK. Yet many foot health problems are preventable through alternative health behaviour. It is therefore important to understand how feet, foot health and footwear are conceptualised to gain understanding about how these might influence foot health behaviour and inform health messages that seek to protect or improve foot health through altered health behaviour. This research seeks to explore attitudes and beliefs and identify phenomena that may act as barriers or motivators to the proactive self-management of foot health. METHODS: Public conversations involving 2,699 expressions related to feet, footwear or foot health on Facebook, Twitter, and Instagram were extracted. Conversations on Facebook and Twitter were scraped with NVivo's NCapture plugin whereby data is extracted and downloaded to NVivo. Extracted files were uploaded to the Big Content Machine (software developed at the University of Salford) which facilitated the search for keywords 'foot', 'feet', 'footwear', 'shoe', and 'shoes'. Instagram was scraped by hand. Data was analysed using a Thematic Analysis approach. RESULTS: Three themes were identified; 1) connections and disconnections derived from social and cultural constructs, 2) phenomena beyond attitudes and beliefs that relate to symbolic representations and the impact when foot health is lost, and 3) phenomena relating to Social Media as a conduit for the exploration of attitudes and beliefs. CONCLUSIONS: This novel research exemplifies complex and sometimes incongruous perspectives about feet including their value for what they facilitate, contrasted with negative feelings about the negative impact that can have aesthetically when feet work hard. Sometimes feet were devalued, with expressions of disgust, disconnection, and ridicule. The importance of contextual, social, and cultural phenomena with implications for optimising foot health messages. Knowledge gaps including factors related to children's foot health and development, and how to treat foot health problems. The power of communities with shared experience to influence decisions, theories, and behaviour about foot health was also revealed. While people do talk about feet in some social contexts, it is not always in a way that promotes overt, positive foot health behaviour. Finally, this research demonstrates the benefit of exploring perspectives in uncontrived settings and illuminates the potential utility of social media (SoMe) platforms Facebook, Instagram, and Twitter as vehicles to promote foot health self-management behaviour that is responsive to the social and demographic variances of engagers who inhabit those spaces.

Psychometric testing of the British English Workplace Activity Limitations Scale in four rheumatic and musculoskeletal conditions.

Objectives: The aims were to validate a British English version of the Workplace Activity Limitations Scale (WALS) linguistically, then test this psychometrically in RA, axial spondyloarthritis (axSpA), OA and FM. Methods: The WALS was forward translated, reviewed by an expert panel, and cognitive debriefing interviews were conducted. Participants completed a postal questionnaire booklet. Construct (structural) validity was examined by fit to the Rasch measurement model. Concurrent validity included testing between the WALS and the Work Limitations Questionnaire-25 (WLQ-25). Two weeks later, participants were mailed a second questionnaire booklet for test-retest reliability. Results: Minor wording changes were made to the WALS, then 831 employed participants completed questionnaires: 267 men and 564 women; 53.5 (s.d. 8.9) years of age; with condition duration 7.7 (s.d. 8.0) years. The WALS satisfied Rasch model requirements, and a WALS Rasch transformation table was created. Concurrent validity was strong with the WLQ-25 (RA r s = 0.78; axSpA r s = 0.83; OA r s = 0.63; FM r s = 0.64). Internal consistency was consistent with group use (α = 0.80-0.87). Test-retest reliability was excellent, with intraclass correlation coefficient (2,1) at ≥0.90. Conclusion: A reliable, valid British English version of the WALS is now available for use in the UK.

Exploring the perceptions of how living with osteoarthritis affects employed people's work productivity.

BACKGROUND: Working people with osteoarthritis (OA) can experience difficulties at work due to pain and activity limitation. OBJECTIVE: To explore the impact of biopsychosocial factors on work participation in employed people with OA. METHODS: An explorative, qualitative, semi-structured one-to-one telephone interview study. Employed people living with OA were recruited through an arthritis volunteer database and social media. Data was analysed using Thematic Analysis. FINDINGS: Participants (n = 15) included people with OA in any joints from mixture of careers. Themes were: (1) Effects of OA on work participation, (2) Impact of workplace support and accommodations on employment, and (3) Importance of clinical support and management. CONCLUSION: Impact of OA on people's work productivity results in a spill over into their home lives. Work transitions and adaptations are not always available. Employers need to be educated to support employees to create a positive work environment and promote available workplace support.

The use of technology to support lifestyle interventions in knee osteoarthritis: A scoping review.

Introduction: Technological tools that promote the adoption of physical activity to increase individuals' functional ability in knee osteoarthritis (OA) are desired to support lifestyle interventions. However, there is little consensus as to the current use of such supportive interventions for knee OA. The aim of this scoping review is therefore to provide an overview on the current use of technology within lifestyle interventions for individuals with knee OA. Methods: Scoping review as per PRISMA guidance. Structured search of Cochrane Central Register for Controlled Trials, ELSEVIER, IEEExplore, GOOGLE Scholar, MEDLINE, PEDRO, PUBMED, WEB OF SCIENCE from 2010 to 2020 inclusive. Hits were screened by title and abstract and then full text review based on pre-defined criteria. Results were synthesised and pooled by theme for reporting. Results: 2508 papers were identified, and following review, 78 studies included. Papers included interventions for individuals with knee osteoarthritis (n â€‹= â€‹31), total or partial knee arthroplasty (n â€‹= â€‹20) and developmental work in healthy controls (n â€‹= â€‹27). Of the 78 studies, 47 were carried out in laboratory settings and 31 in the field. The identified themes included Movement measurement (n â€‹= â€‹24), Tele-rehabilitation (n â€‹= â€‹22), Biofeedback (n â€‹= â€‹20), Directly applied interventions (n â€‹= â€‹3), Virtual or augmented reality (n â€‹= â€‹5) and Machine learning (n â€‹= â€‹4). Conclusions: The predominant current use of technology in OA lifestyle interventions is through well-established telecommunication and commercially available activity, joint angle and loading based measurement devices, while integrating new advanced technologies seems a longer-term goal. There is great potential for the engineering and clinical community to use technology to develop systems that offer real-time feedback to patients and clinician as part of rehabilitative interventions to inform treatment.

Perceptions of arthritis glove wear of patients with rheumatoid arthritis and persistent hand pain: A nested questionnaire study within the A-Gloves trial.

INTRODUCTION: Arthritis gloves are prescribed in rheumatoid arthritis (RA) to reduce hand pain, stiffness, and improve hand function. As part of a randomised controlled trial, this study investigated participants' perceptions of wearing arthritis gloves. METHOD: Participants with RA and persistent hand pain (n = 206) were randomly assigned and prescribed either loose-fitting gloves (control) or arthritis gloves (intervention), for day and/or night wear (as per individual need). At 12-weeks, the trial follow-up questionnaire also included items about whether the gloves prescribed were: beneficial or not; if yes, the benefits experienced; any problems encountered; if they stopped wearing gloves day and/or night, and why. RESULTS: The questionnaire response rate was 154/206 (75%). In both groups, 73% reported gloves were beneficial (p = 0.97). There were no differences in types of benefits reported. The most common were: warmth (59% control: 54% intervention; p = 0.53); and comfort (54%: 62%; p = 0.29). Fewer reported problems with glove wear in the control group (33%), compared to the intervention group (49%); p = 0.05. In both groups, the most common daytime problem was inability to wear gloves for wet or dirty activities; and at night, gloves being too hot. Similar numbers in the control and intervention groups stopped wearing gloves either day or night (23%: 31%; p = 0.26), primarily for these reasons. DISCUSSION: Participants' perceptions about wearing arthritis or loose-fitting gloves were very similar. Wearing ordinary gloves could result in similar perceived benefits to arthritis gloves.

The Workwell trial: protocol for the process evaluation of a randomised controlled trial of job retention vocational rehabilitation for employed people with inflammatory arthritis.

BACKGROUND: The Workwell trial is a multi-centre randomised controlled trial with the aims of evaluating the effectiveness and cost-effectiveness of job retention vocational rehabilitation for employed people with inflammatory arthritis, who are experiencing work difficulties due to their arthritis. Vocational rehabilitation is delivered by health service occupational therapists, who have received additional training in providing this Workwell intervention. A process evaluation will be undertaken alongside the main trial to investigate implementation fidelity; understand key stakeholders' perspectives of the intervention and the social and structural context in which the intervention is provided; and explore issues related to future implementation in clinical practice. This protocol describes the aims, objectives, and methodology of the Workwell trial process evaluation. METHODS: This mixed methods process evaluation will follow the Medical Research Council's Guidance on process evaluations for complex interventions. It will be underpinned by the conceptual framework for implementation fidelity (CFIF) and normalisation process theory (NPT). We will analyse treatment records, work assessments, and treatment notes to ascertain implementation fidelity. Semi-structured interviews with trial participants, their employer/line managers, treating therapists, and their therapy service managers will be undertaken to explore perceptions of the intervention, contextual factors, and potential for future implementation in practice. Interview topic guides will be informed by NPT. Therapists' views about Workwell training will be explored via questionnaires following training, and interviews and focus groups following treatment delivery to inform future implementation. Quantitative data will be analysed descriptively. Qualitative data will be analysed using thematic analysis. NPT will guide data analysis and interpretation. Findings from the different elements of this embedded design process evaluation will be reported separately and then the elements integrated. The process evaluation data will be analysed independently of the Workwell trial outcome evaluation. The process evaluation data will then be reviewed in the light of the trial findings. DISCUSSION: Few trials of job retention vocational rehabilitation in arthritis have included process evaluations. This process evaluation will assist in understanding factors influencing trial outcomes and identifying potential contextual barriers and facilitators for the potential implementation of Workwell vocational rehabilitation into clinical services. TRIAL REGISTRATION: ClinicalTrials.gov NCT03942783 . Registered on 08 May 2019. ISRCTN Registry ISRCTN61762297 . Registered on 13 May 2019. Retrospectively registered.

2022 EULAR points to consider for remote care in rheumatic and musculoskeletal diseases.

BACKGROUND: Remote care and telehealth have the potential to expand healthcare access, and the COVID-19 pandemic has called for alternative solutions to conventional face-to-face follow-up and monitoring. However, guidance is needed on the integration of telehealth into clinical care of people with rheumatic and musculoskeletal diseases (RMD). OBJECTIVE: To develop EULAR points to consider (PtC) for the development, prioritisation and implementation of telehealth for people with RMD. METHODS: A multidisciplinary EULAR task force (TF) of 30 members from 14 European countries was established, and the EULAR standardised operating procedures for development of PtC were followed. A systematic literature review was conducted to support the TF in formulating the PtC. The level of agreement among the TF was established by anonymous online voting. RESULTS: Four overarching principles and nine PtC were formulated. The use of telehealth should be tailored to patient's needs and preferences. The healthcare team should have adequate equipment and training and have telecommunication skills. Telehealth can be used in screening for RMD as preassessment in the referral process, for disease monitoring and regulation of medication dosages and in some non-pharmacological interventions. People with RMD should be offered training in using telehealth, and barriers should be resolved whenever possible.The level of agreement to each statement ranged from 8.5 to 9.8/10. CONCLUSION: The PtC have identified areas where telehealth could improve quality of care and increase healthcare access. Knowing about drivers and barriers of telehealth is a prerequisite to successfully establish remote care approaches in rheumatologic clinical practice.

Does wearing arthritis gloves help with hand pain and function? A qualitative study into patients' views and experiences.

OBJECTIVE: Arthritis gloves are frequently prescribed to people with undifferentiated inflammatory arthritis (UIA) or RA to help reduce hand pain and improve function. Nested within a randomized controlled trial testing the effectiveness of arthritis gloves (Isotoner gloves vs loose-fitting placebo gloves) in people with RA and UIA, this qualitative study aimed to explore participants' views on the impact of wearing arthritis gloves on their hand pain and function. METHODS: Semi-structured one-to-one interviews were conducted with purposively selected participants following 12 weeks of glove wearing. Participants and the interviewer were blinded to the treatment allocation. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS: Participants (intervention: n = 10; control: n = 9) recruited from 13 National Health Service hospital sites in the UK participated in the interviews. Two main themes, with sub-themes, were elicited from the data: mechanisms determining glove use: 'As soon as your joints get a bit warmer, the pain actually eases' (thermal qualities; glove use in daily activities; glove use during sleep); and ambivalence about benefits of arthritis gloves: 'I suppose a normal pair of gloves would do the same sort of thing?' (are they a help or hindrance?; aesthetic appeal; future use of gloves). CONCLUSION: Participants had ambivalent views on the impact of both the intervention and the loose-fitting placebo gloves on their hand pain and function, identifying warmth as the main benefit. Ordinary mid-finger-length gloves widely accessible from high street suppliers could deliver warmth and provide the perceived benefits to hand pain and function. Trial registration: ISRCTN, ISRCTN25892131; registered 5 September 2016 : retrospectively registered.

Arthritis glove provision in rheumatoid arthritis and hand osteoarthritis: A survey of United Kingdom rheumatology occupational therapists.

Introduction: Hand pain and function limitations are common in rheumatoid arthritis (RA) and hand osteoarthritis (HOA). Provision of arthritis (compression) gloves to relieve hand symptoms is increasing in occupational therapy. Research evaluating arthritis gloves dates to the 1990s, focussing on night-wear of full-length finger gloves in RA. This survey examined glove provision in contemporary clinical practice in the United Kingdom. Methods: A survey of arthritis glove provision in RA was conducted with Royal College of Occupational Therapists Rheumatology Specialist Section members. A more detailed survey about glove provision in RA and HOA was conducted with rheumatology occupational therapists in North-West England. Results: Response rates were good, with 60 (73%) therapists responding to the national and 24 (69%) to the regional surveys. Most therapists provided open-finger gloves (commonly IsotonerTM) to about a third of their RA and HOA patients, and to those with any arthritic condition causing significant hand pain and/or swelling. Day-wear was as common as night-wear, and patients were advised to wear these 'as and when' for hand symptom relief and support for hand function. They were advised not to wear gloves continually in the day, and regularly perform hand exercises and monitor for potential adverse effects, for example, skin discolouration. Therapists commonly provide replacement gloves as these are often used long-term. Conclusion: Prescription of arthritis gloves has changed considerably in the last 30 years, with open-finger gloves provided to a wider range of people with arthritis, for a broader range of clinical reasons.

EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis.

OBJECTIVE: To develop evidence-based European Alliance of Associations for Rheumatology (EULAR) points to consider (PtCs) for the management of difficult-to-treat rheumatoid arthritis (D2T RA). METHODS: An EULAR Task Force was established comprising 34 individuals: 26 rheumatologists, patient partners and rheumatology experienced health professionals. Two systematic literature reviews addressed clinical questions around diagnostic challenges, and pharmacological and non-pharmacological therapeutic strategies in D2T RA. PtCs were formulated based on the identified evidence and expert opinion. Strength of recommendations (SoR, scale A-D: A typically consistent level 1 studies and D level 5 evidence or inconsistent studies) and level of agreement (LoA, scale 0-10: 0 completely disagree and 10 completely agree) of the PtCs were determined by the Task Force members. RESULTS: Two overarching principles and 11 PtCs were defined concerning diagnostic confirmation of RA, evaluation of inflammatory disease activity, pharmacological and non-pharmacological interventions, treatment adherence, functional disability, pain, fatigue, goal setting and self-efficacy and the impact of comorbidities. The SoR varied from level C to level D. The mean LoA with the overarching principles and PtCs was generally high (8.4-9.6). CONCLUSIONS: These PtCs for D2T RA can serve as a clinical roadmap to support healthcare professionals and patients to deliver holistic management and more personalised pharmacological and non-pharmacological therapeutic strategies. High-quality evidence was scarce. A research agenda was created to guide future research.

Patient and Provider Perspective of Smart Wearable Technology in Diabetic Foot Ulcer Prevention: A Systematic Review.

Background and Objectives: Smart wearable devices are effective in diabetic foot ulcer (DFU) prevention. However, factors determining their acceptance are poorly understood. This systematic review aims to examine the literature on patient and provider perspectives of smart wearable devices in DFU prevention. Materials and Methods: PubMed, Scopus, and Web of Science were systematically searched up to October 2021. The selected articles were assessed for methodological quality using the quality assessment tool for studies with diverse designs. Results: A total of five articles were identified and described. The methodological quality of the studies ranged from low to moderate. Two studies employed a quantitative study design and focused on the patient perspective, whereas three studies included a mixed, quantitative/qualitative design and explored patient or provider (podiatrist) perspectives. Four studies focused on an insole system and one included a smart sock device. The quantitative studies demonstrated that devices were comfortable, well designed and useful in preventing DFU. One mixed design study reported that patients did not intend to adopt an insole device in its current design because of malfunctions, a lack of comfort. and alert intrusiveness, despite the general perception that the device was a useful tool for foot risk monitoring. Two mixed design studies found that performance expectancy was a predictor of a podiatrist's behavioural intention to recommend an insole device in clinical practice. Disappointing participant experiences negatively impacted the podiatrists' intention to adopt a smart device. The need for additional refinements of the device was indicated by patients and providers before its use in this population. Conclusions: The current evidence about patient and provider perspectives on smart wearable technology is limited by scarce methodological quality and conflicting results. It is, thus, not possible to draw definitive conclusions regarding acceptability of these devices for the prevention of DFU in people with diabetes.

Clinical and cost effectiveness of arthritis gloves in rheumatoid arthritis (A-GLOVES): randomised controlled trial with economic analysis.

BACKGROUND: Arthritis (or compression) gloves are widely prescribed to people with rheumatoid arthritis and other forms of hand arthritis. They are prescribed for daytime wear to reduce hand pain and improve hand function, and/or night-time wear to reduce pain, improve sleep and reduce morning stiffness. However, evidence for their effectiveness is limited. The aims of this study were to investigate the clinical and cost effectiveness of arthritis gloves compared to placebo gloves on hand pain, stiffness and function in people with rheumatoid arthritis and persistent hand pain. METHODS: A parallel randomised controlled trial, in adults (≥ 18 years) with rheumatoid or undifferentiated inflammatory arthritis at 16 National Health Service sites in the UK. Patients with persistent hand pain affecting function and/or sleep were eligible. Randomisation (1:1) was stratified by recent change (or not) in medication, using permuted blocks of random sizes. Three-quarter-finger length arthritis gloves (Isotoner®: applying 23-32 mmHg pressure) (intervention) were compared to loose-fitting placebo gloves (Jobskin® classic: providing no/minimal pressure) (control). Both gloves (considered to have similar thermal qualities) were provided by occupational therapists. Patients and outcome assessors were blinded; clinicians were not. The primary outcome was dominant hand pain on activity (0-10) at 12 weeks, analysed using linear regression and intention to treat principles. RESULTS: Two hundred six participants were randomly assigned (103 per arm) and 163 (84 intervention: 79 control) completed 12-week follow-up. Hand pain improved by 1.0 (intervention) and 1.2 (control), an adjusted mean difference of 0.10 (95% CI: - 0.47 to 0.67; p = 0.72). Adverse events were reported by 51% of intervention and 36% of control group participants; with 6 and 7% respectively, discontinuing glove wear. Provision of arthritis gloves cost £129, with no additional benefit. CONCLUSION: The trial provides evidence of no clinically important effect of arthritis gloves on any of the trial outcomes (hand pain, function and stiffness) and arthritis gloves are not cost-effective. The clinical and cost-effectiveness results support ceasing provision of arthritis gloves in routine clinical practice. FUNDING: National Institute for Health Research. TRIAL REGISTRATION: ISRCTN, ISRCTN25892131 ; Registered 05/09/2016: retrospectively registered.

Compression gloves for patients with hand arthritis (C-GLOVES): A feasibility study.

Introduction: Compression gloves are frequently provided to patients with hand arthritis. Evidence for effectiveness is limited. The aim of this study was to determine feasibility of recruitment, assessment and treatment procedures, in preparation for a future compression glove trial. Methods: A non-randomised feasibility study with out-patients with either undifferentiated inflammatory arthritis, rheumatoid arthritis or hand osteoarthritis, with moderate to severe hand pain. All received Isotoner™ compression gloves provided by rheumatology occupational therapists. The main outcomes were feasibility of recruitment, assessment and treatment procedures, trial outcome selection and sample size calculation. Participants were assessed at baseline and four weeks. Assessments included: numeric rating scales (0-10) of hand pain (on activity, at rest, at night) and stiffness; hand joint swelling; finger flexion; and hand function (Grip Ability Test). Results: Of 318 patients screened, 86/204 (42%) of inflammatory and 68/114 (60%) of hand osteoarthritis patients were eligible. Of these, 41 (48%: age: 59.10 (SD 12.54) years) and 32 (47%: age: 60.75 (SD 8.64) years) respectively, consented. All completed four-week follow-up. Assessment and treatment protocols were feasible. Hand pain on activity and at night, stiffness, joint swelling, finger flexion and hand function improved: e.g. hand pain on activity: inflammatory arthritis change = -0.95 (SD 2.26; p = 0.01); osteoarthritis -1.57 (SD 1.78; p = 0.001). Participants reported improved hand pain, stiffness and hand function as main benefits. Conclusion: Procedures tested were feasible. The most relevant primary outcome was hand pain on activity. Future trials would need 161 participants (Inflammatory arthritis) and 151 (hand osteoarthritis).Trial registration: Clinical Trials.Gov: NCT01874067.