title: Interpreting outcome following foot surgery in people with rheumatoid arthritis.
abstract: BACKGROUND
  Foot surgery is common in RA but the current lack of understanding of how patients interpret outcomes inhibits evaluation of procedures in clinical and research settings. This study aimed to explore which factors are important to people with RA when they evaluate the outcome of foot and ankle surgery.
  
  
  RESULTS
  Semi structured interviews with 11 RA participants who had mixed experiences of foot surgery were conducted and analysed using thematic analysis. Responses showed that while participants interpreted surgical outcome in respect to a multitude of factors, five major themes emerged: functional ability, participation, appearance of feet and footwear, surgeons' opinion, and pain. Participants interpreted levels of physical function in light of other aspects of their disease, reflecting on relative change from their preoperative state more than absolute levels of ability. Appearance was important to almost all participants: physical appearance, foot shape, and footwear were closely interlinked, yet participants saw these as distinct concepts and frequently entered into a defensive repertoire, feeling the need to justify that their perception of outcome was not about cosmesis. Surgeons' post-operative evaluation of the procedure was highly influential and made a lasting impression, irrespective of how the outcome compared to the participants' initial goals. Whilst pain was important to almost all participants, it had the greatest impact upon them when it interfered with their ability to undertake valued activities.
  
  
  CONCLUSIONS
  People with RA interpret the outcome of foot surgery using multiple interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than anticipated. These factors can help clinicians in discussing surgical options in patients.
authors.affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA UK ; NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Backhouse
authors.affiliation: Dental Public Health, University of Leeds, Leeds, UK ; Academic Unit of Health Economics, University of Leeds, Leeds, UK.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Vinall-Collier
authors.affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA UK ; NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Redmond
authors.affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA UK ; Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Helliwell
authors.affiliation: NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK ; School of Healthcare, University of Leeds, Leeds, UK.
authors.forename: Anne-Maree
authors.initials: AM
authors.lastname: Keenan
mesh_terms: D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D004954:Esthetics; D005260:Female; D033023:Foot Joints / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000523:psychology; D000071066:Patient Reported Outcome Measures; D020127:Recovery of Function; D012775:Shoes; D016138:Walking
keywords: Activity; Foot surgery; Footwear; Outcome; Participation; Rheumatoid arthritis; Surgeon