Musculoskeletal Pain Clinical Study Group

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Musculoskeletal Pain Clinical Study
Group Report on Podiatry Consensus
Meeting Prof. Jim Woodburn School of Health
Social Care. Glasgow Caledonian University,
Glasgow, UK
CSG Meeting, Chancellors hotel, Manchester 1-2nd
May 2008
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Background

• Newly formed Musculoskeletal pain CSG
• Scoping exercise to identify priority research
  areas
• Foot and Ankle pain (with relevance to podiatry)
  scoping conducted via consensus type meeting, GCU
  17-18th April 2008
• Initial feedback to CSG today

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Stage 1 Expert Working Party (Podiatry)

• Open invitation on National Academic Mailing List
  Service (JISCmail) Podiatry list
• Members of working party
• Contribute project ideas
• Selected invitations to current/past arc
  grant/fellowship award holders and leading
  clinicians
• Other leaders in the field

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Stage 2 Consensus meeting

• Conducted 17-18th April 2008
• 11 participants
• Scoping exercise (lead from CSG objectives)
• Identify current high quality trials and other
  clinical research activity
• Identify duplication, opportunities for
  collaborations, gaps
• Develop new research questions
• Priority setting
• Modified Delphi technique
• Wider consultation initiative (multi-stakeholders)

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Stage 2 Consensus meeting
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Stage 2 Consensus meeting

• Workshop I review of current evidence
• Identify trials and other clinical research
  activity
• Current research activity in major centres
• Duplication and opportunities for collaborations

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Stage 2 Consensus meeting

• Workshop II scoping exercise
• Projects submitted online
• Small group activity to generate project lists

7 project ideas submitted online from 21 UK
podiatrists 2 rejected (not relevant to MSK foot
and ankle pain) 8 additional projects identified
from group activity Final list of 15 msk foot
and ankle pain related projects
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Stage 2 Consensus meeting

• Workshop III priority setting
• Modified Delphi technique
• Anonymous voting
• 2 scales- rank order by importance / funding
  priority
• Top 5 projects identified
• Group discussion / repeat voting until consensus
  reached

Top 5 projects reached after only one round of
voting / discussion
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Stage 2 Consensus meeting
(1) Foot care provision in rheumatoid
arthritis (2) Therapeutic footwear in common
painful and disabling musculoskeletal and
rheumatological foot and ankle problems (3)
(primary care) foot care in the elderly in
relation to falls, mobility and QoL (4) Foot
orthoses (5) Self-managed foot care
Unresolved tension- Podiatry Vs Foot care
(complex interventions)
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Stage 2 Consensus meeting

• Workshop IV Identification of lead-in projects
• Small group activity to identify lead in studies
  relevant to prioritised list

• Common areas identified across all projects
• Epidemiology
• Disease burden and economic impact
• Mechanisms
• Diagnostic criteria
• Standardised care and outcomes.
• Methodological issues
• Lack of pre-clinical, phase I and II studies

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Stage 3 Consultation / reporting

• 15 prioritised projects to be circulated more
  widely
• Other podiatrists
• Orthopaedic surgery
• Orthotists / appliance staff
• Occupational / physiotherapy / nursing
• Rheumatologists
• Primary care physicians
• Patients
• Report to MSK CSG (stage 1-2 available)

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Conflict of interest statements

• Turner and Woodburn declare a conflict of
  interest in the form of publications related to
  projects 1 and 5 in the prioritised list. Sources
  of funding for these studies were the Medical
  Research Council and the Arthritis Research
  Campaign
• Redmond declares a potential conflict of interest
  in relation to 1 (currently engaged in NIHR
  funded research into podiatry care in RA), 2
  (currently involved in an arc funded project to
  generate a report on the use of footwear in
  people with RA), 4 (previous publications in the
  field) and 5 6 (membership of an organisation
  promoting multidisciplinary team working and self
  management ARMA and involvement in an arc
  funded standards of care project recommending
  integrated team working and empowered self care).
• Williams is currently funded by the European
  League Against Rheumatism (An investigation into
  patients experience of therapeutic footwear)
• No other potential conflicts of interest were
  declared.