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

• Published in: Musculoskeletal care Vol. 18; no. 1; pp. 12 - 19
• Main Authors: Alcacer‐Pitarch, Begonya, Backhouse, Michael Ross, Gijon‐Nogeron, Gabriel, Biscontini, Devid, Bonafede, Sofia, Ferreira, Andre, Gatt, Alfred, Lescure, Yves, Nava, Tiziana, Redmond, Anthony C.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-03-2020
• Subjects: Ankle; clinical pathways and guidelines; Europe; foot and ankle; Musculoskeletal diseases; rheumatic and musculoskeletal diseases; Rheumatic diseases; Rheumatology; service variation; United Kingdom > UK; Netherlands; Malta; clinical pathways and guidelines; service variation; foot and ankle; rheumatic and musculoskeletal diseases; Europe
• ISSN: 1478-2189; 1557-0681
• DOI: 10.1002/msc.1431

Background
The aim of the present study was to explore the variation in the provision of care for people with rheumatic and musculoskeletal diseases (RMDs), and foot and 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 22 national health professionals in rheumatology associations within the European League Against Rheumatism (EULAR). Summary data were obtained using SPSS V22. Ethical approval was sought from the 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, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the UK). All 16 respondents indicated that foot and ankle healthcare services were provided in their country, but only three countries had services specializing in RMD‐related foot and ankle problems (the Netherlands, the UK and 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; and foot and ankle ulcers by nurses. Services were predominantly delivered through the public sector, and in secondary care (hospital) settings.
Conclusions
Only three countries reported having specialist foot and ankle services addressing the needs of people with RMDs. Variation was seen in the professions which provided care between countries, and also between the 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.