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Process evaluation of podiatric treatment of patients with forefoot pain.

van der Zwaard BC, Swagerman WJ, Vanwanseele B, Gorter KJ, van der Horst HE, Elders PJ - J Foot Ankle Res (2013)

Bottom Line: In five other cases the expert panel concluded that the treatment of the podiatrist was not consistent with the cause of the problem recorded by the podiatrist.Three patients did not remember receiving advice at all.Fundamental differences in treatment plans and thus heterogeneous treatments could be a consequence.

View Article: PubMed Central - HTML - PubMed

Affiliation: EMGO+ Institute, Department of general practice and elderly care medicine, VU University Medical Centre, Amsterdam, Netherlands. p.elders@vumc.nl.

ABSTRACT

Background: Foot pain is a common problem for people aged 50 and over and occurs more often in women than in men. About 60% of the foot problems are forefoot problems and slightly more than half of these patients seek medical help, mainly in the form of podiatric care. Podiatric treatment of forefoot problems is known to be heterogeneous. The aims of the present study are to describe the podiatric treatment of patients with forefoot pain and to evaluate the podiatric examination and treatment using an expert panel.

Method: We invited twenty-five randomly selected subjects with forefoot problems who had received podiatric treatment in a pragmatic randomised clinical trial to participate in an analysis of their treatment by an expert panel. The panel retrospectively established the cause of the foot problem as well as the therapeutic goals and evaluated the treatment. These findings were compared to those reported by the treating podiatrist.

Results: Two fundamentally different approaches were found in approach of podiatric examination; a functional approach (n =13) and a non-functional approach (n =12). In nine cases the expert panel agreed with the cause recorded by the podiatrist. In five other cases the expert panel concluded that the treatment of the podiatrist was not consistent with the cause of the problem recorded by the podiatrist. Of the 10 patients for whom the podiatrist had recorded to have given shoe advice, only two were able to recollect the proper advice. Three patients did not remember receiving advice at all.

Conclusion: In this study almost half of the podiatrists worked according to a non-functional approach where the other half (like the expert panel) chose a functional strategy that analyses the underlying problem. Fundamental differences in treatment plans and thus heterogeneous treatments could be a consequence.

No MeSH data available.


Related in: MedlinePlus

Overview of different approaches to establish aetiology. TPM= treatment plan missing.
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Figure 2: Overview of different approaches to establish aetiology. TPM= treatment plan missing.

Mentions: Of the twenty-five causes established by the podiatrists, eight were considered to be correct by the expert panel (Table 2). After further analysis of the data it became evident that the approach of reaching a diagnosis differs between podiatrists. We saw two approaches. First we identified the functional approach that was consistent with the approach of the expert panel. This is an approach in which the kinetic chain is evaluated in order to find underlying (kinematic) impediment of the foot problem or when external influences like foot wear are evaluated as a possible cause of the problem. Secondly we identified another approach in which the podiatrist described local symptoms as a diagnosis without evaluating possible impediments beyond the area of the symptoms; a non-functional approach. Examples of these approaches are shown in Additional file 1. Differences in approach during the analysis of the cause of the foot pain led to establishing different therapeutic goals. A summary of these findings is shown in Figure 2. In twelve of the cases, the expert panel concluded that the podiatrist merely identified non-functional causes.


Process evaluation of podiatric treatment of patients with forefoot pain.

van der Zwaard BC, Swagerman WJ, Vanwanseele B, Gorter KJ, van der Horst HE, Elders PJ - J Foot Ankle Res (2013)

Overview of different approaches to establish aetiology. TPM= treatment plan missing.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750369&req=5

Figure 2: Overview of different approaches to establish aetiology. TPM= treatment plan missing.
Mentions: Of the twenty-five causes established by the podiatrists, eight were considered to be correct by the expert panel (Table 2). After further analysis of the data it became evident that the approach of reaching a diagnosis differs between podiatrists. We saw two approaches. First we identified the functional approach that was consistent with the approach of the expert panel. This is an approach in which the kinetic chain is evaluated in order to find underlying (kinematic) impediment of the foot problem or when external influences like foot wear are evaluated as a possible cause of the problem. Secondly we identified another approach in which the podiatrist described local symptoms as a diagnosis without evaluating possible impediments beyond the area of the symptoms; a non-functional approach. Examples of these approaches are shown in Additional file 1. Differences in approach during the analysis of the cause of the foot pain led to establishing different therapeutic goals. A summary of these findings is shown in Figure 2. In twelve of the cases, the expert panel concluded that the podiatrist merely identified non-functional causes.

Bottom Line: In five other cases the expert panel concluded that the treatment of the podiatrist was not consistent with the cause of the problem recorded by the podiatrist.Three patients did not remember receiving advice at all.Fundamental differences in treatment plans and thus heterogeneous treatments could be a consequence.

View Article: PubMed Central - HTML - PubMed

Affiliation: EMGO+ Institute, Department of general practice and elderly care medicine, VU University Medical Centre, Amsterdam, Netherlands. p.elders@vumc.nl.

ABSTRACT

Background: Foot pain is a common problem for people aged 50 and over and occurs more often in women than in men. About 60% of the foot problems are forefoot problems and slightly more than half of these patients seek medical help, mainly in the form of podiatric care. Podiatric treatment of forefoot problems is known to be heterogeneous. The aims of the present study are to describe the podiatric treatment of patients with forefoot pain and to evaluate the podiatric examination and treatment using an expert panel.

Method: We invited twenty-five randomly selected subjects with forefoot problems who had received podiatric treatment in a pragmatic randomised clinical trial to participate in an analysis of their treatment by an expert panel. The panel retrospectively established the cause of the foot problem as well as the therapeutic goals and evaluated the treatment. These findings were compared to those reported by the treating podiatrist.

Results: Two fundamentally different approaches were found in approach of podiatric examination; a functional approach (n =13) and a non-functional approach (n =12). In nine cases the expert panel agreed with the cause recorded by the podiatrist. In five other cases the expert panel concluded that the treatment of the podiatrist was not consistent with the cause of the problem recorded by the podiatrist. Of the 10 patients for whom the podiatrist had recorded to have given shoe advice, only two were able to recollect the proper advice. Three patients did not remember receiving advice at all.

Conclusion: In this study almost half of the podiatrists worked according to a non-functional approach where the other half (like the expert panel) chose a functional strategy that analyses the underlying problem. Fundamental differences in treatment plans and thus heterogeneous treatments could be a consequence.

No MeSH data available.


Related in: MedlinePlus