None listed
Conditions
Brief summary
Disabling foot pain affects 24% of adults aged =45 years. Some episodes of foot pain may be related to inflammatory or degenerative changes and, as such, general practitioners refer patients to orthopaedic departments for surgical management. This model of care may be neither appropriate nor sufficient as many foot complaints referred to orthopaedic departments trigger a lengthy process that commonly does not result in an operation. Health units have utilised podiatrists to consult with patients on waiting-lists to ensure non-surgical interventions are provided before the patient sees a surgeon. These triage clinics appear to be successful, as the podiatrist progresses only those likely to require operative intervention, and therefore have face validity that they are effective. But given the uncontrolled nature, and potential for bias in previous studies, a formal clinical and economic evaluation, via a clinical trial is required to formally test their efficacy. Waiting-lists and chronic pain threaten health networks now and will continue to do so in the future. Without formal evaluation of the clinical and cost-effectiveness of triage clinics, executives, managers and administrators cannot make truly informed decisions on their effectiveness and where funding should be allocated along the patient journey. Depending on the outcome of this study, there may be radical (re)thinking of how patients are assessed and managed on foot/ankle waiting-lists. This may result in a more efficient, timely and cost-effective model of care for managing foot/ankle orthopaedic waiting-lists across Queensland Health networks, and more broadly across Australia.
Interventions
A pragmatic randomised controlled trial (RCT) design will be used, with a cross-over waiting-list group. Participants will be allocated with either Group (1): immediate access to the podiatry-triage clinic, or Group (2): 6-month waiting-list allocation prior to accessing the podiatry-triage clinic.
A podiatry-led triage clinic will be provided to participants. This is a pragmatic intervention, where the podiatrist will undertake assessments (clinical and radiographic) provide non-surgical trea
A pragmatic randomised controlled trial (RCT) design will be used, with a cross-over waiting-list group. Participants will be allocated with either Group (1): immediate access to the podiatry-triage clinic, or Group (2): 6-month waiting-list allocation prior to accessing the podiatry-triage clinic. A podiatry-led triage clinic will be provided to participants. This is a pragmatic intervention, where the podiatrist will undertake assessments (clinical and radiographic) provide non-surgical treatments (e.g. physical therapy, footwear modification, orthoses, injections) aimed at managing a specific complaint, rather than a standardised treatment. The intervention will be recorded, and may include no treatment. The podiatrist’s responsibilities will be to evaluate the participant, provide a diagnosis and provide non-surgical treatments where indicated. Participants will be discharged from the orthopaedic waiting-list, with their consent if; (i) their symptoms resolve with non-surgical treatment, (ii) their condition is not amenable to surgical intervention, or (iii) they do not want surgery. Participants will be referred for an orthopaedic consultation if; (i) there is no indication for non-surgical treatment, (ii) they fail non-surgical treatment, or (iii) they request an appointment with a surgeon following their triage appointment(s). The frequency of the assessment and intervention will be determined by the condition being managed during the 6-month period. Each appointment will be scheduled for 30 minutes.
Sponsors
Gold Coast University Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
i) Referred to see foot/ankle orthopaedic surgeon ii) Categorised as non-urgent following paper triage by orthopaedic surgeon iii) Aged >= 18 years iv) Report foot pain of >= 3/10 on a 0-10 rating scale on most days for >=3 months. v) Willing to see a podiatrist at Gold Coast University Hospital (either immediately or after 6-months) vi) Willing to complete questionnaires at 6-months and 12-months post group allocation
Exclusion criteria
i) History of cognitive impairment, ii) An inability to understand English or an inability to provide consent. In relation to participants having “adequate English”, this will be determined during the initial screening process. In accordance with contemporary research, two Single-Item Literacy Screening (SILS) questions will be asked during the screening interviews: 1. How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy? (Never, Rarely, Sometimes, Often, Always) 2. How confident are you filling out medical forms by yourself? (Not at all, A little bit, Somewhat, Quite a bit, Extremely) Patients who answer “Sometimes”, “Often”, “Always” to the first question and “Somewhat”, “A little bit”, “Not at all” to the second question will be excluded from this study.
Outcome results
None listed