title: Clinical practice guidelines for the foot and ankle in rheumatoid arthritis: a critical appraisal.
abstract: BACKGROUND
  Clinical practice guidelines are recommendations systematically developed to assist clinical decision-making and inform healthcare. In current rheumatoid arthritis (RA) guidelines, management of the foot and ankle is under-represented and the quality of recommendation is uncertain. This study aimed to identify and critically appraise clinical practice guidelines for foot and ankle management in RA.
  
  
  METHODS
  Guidelines were identified electronically and through hand searching. Search terms 'rheumatoid arthritis', 'clinical practice guidelines' and related synonyms were used. Critical appraisal and quality rating were conducted using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument.
  
  
  RESULTS
  Twenty-four guidelines were included. Five guidelines were high quality and recommended for use. Five high quality and seven low quality guidelines were recommended for use with modifications. Seven guidelines were low quality and not recommended for use. Five early and twelve established RA guidelines were recommended for use. Only two guidelines were foot and ankle specific. Five recommendation domains were identified in both early and established RA guidelines. These were multidisciplinary team care, foot healthcare access, foot health assessment/review, orthoses/insoles/splints, and therapeutic footwear. Established RA guidelines also had an 'other foot care treatments' domain.
  
  
  CONCLUSIONS
  Foot and ankle management for RA features in many clinical practice guidelines recommended for use. Unfortunately, supporting evidence in the guidelines is low quality. Agreement levels are predominantly 'expert opinion' or 'good clinical practice'. More research investigating foot and ankle management for RA is needed prior to inclusion in clinical practice guidelines.
authors.affiliation: Institute for Applied Health Research, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK ; Department of Podiatric Medicine, School of Science & Health, Western Sydney University, Sydney, Australia.
authors.forename: Kym
authors.initials: K
authors.lastname: Hennessy
authors.affiliation: Institute for Applied Health Research, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK.
authors.forename: James
authors.identifier: 0000-0002-5497-8739
authors.initials: J
authors.lastname: Woodburn
authors.affiliation: Institute for Applied Health Research, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK.
authors.forename: Martijn
authors.initials: M
authors.lastname: Steultjens
mesh_terms: D000843:Ankle Joint / Q000503:physiopathology; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D019468:Disease Management; D019317:Evidence-Based Medicine / Q000379:methods / Q000592:standards; D005534:Foot Diseases / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D033023:Foot Joints / Q000503:physiopathology; D006801:Humans; D011032:Podiatry / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods
keywords: Ankle; Clinical practice guidelines; Foot; Rheumatoid arthritis