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, Chancellor’s hotel, Manchester 1-2 nd May 2008

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 th April 2008 Initial feedback to CSG today

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

Stage 2: Consensus meeting Conducted th April 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)

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

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

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

Stage 2: Consensus meeting Unresolved tension- Podiatry Vs Foot care (complex interventions) (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

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

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)

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.