AUT - Musculoskeletal Arthritis

AUT

Musculoskeletal Arthritis

OVERVIEW

The Musculoskeletal Arthritis Cluster group consists of a wide range of academic and clinical experts in the field of musculoskeletal arthritis and includes: Dr Sandra Bassett, Dr Richard Ellis, AP Paula Kirsten, Matthew Carroll, Dr Valerie-Wright-St Clair, Bromyn Harman, Edel Kelly, Heather Clark, Angela Brenton-Rule and AP Duncan Reid. The group has strong links to Arthritis NZ and is intended to form stronger links in years to come. For example, Arthritis NZ seminars running at AUT will run again being co-ordinated by one of the members of the group: Daniel O’Brien.

The aims of the cluster group are to provide a network for researchers in the field of musculoskeletal arthritis, to encourage and support research in the area of arthritis and to promote arthritis within rheumatology. A key objective of the cluster group is to fulfil the objectives of the HRRI by conducting high-quality research in the field of musculoskeletal arthritis; and to develop and optimize interventions that are in-line with professional and national standards for people with musculoskeletal arthritis. A future direction is to build research capacity (postgraduate and post-doctoral students) and support clinicians and service leaders in arthritis management based on best current evidence.

The group was officially recognised by HRRI in August 2012, and held its first quarterly meeting in February 2012. To initiate the cluster group a summer studentship grant (funded by HRRI) was awarded to Dr Peter Larmer for his work on NZ guidelines relating to arthritis.  The study will involve an extensive literature search to identify international guidelines on the management of osteoarthritis. These will then be summarised to provide guidance for the establishment of guidelines that could be implemented in New Zealand. In 2013 the group intends to review grant applications specifically relating arthritis, collaborate with other groups within the faculty and to develop strong links with key strake-holders within the field of arthritis.

 

CURRENT RESEARCH THEMES

  • Foot characteristics of patients with acute and chronic gout.
  • Maori diabetic foot problems. 
  • Development and implementation of podiatry within a rheumatology multidisciplinary team. 
  • Assessment of footwear problems in gout and rheumatoid arthritis. 
  • Evaluation of foot pain, impairment and disability in rheumatic diseases.
  • The long term effects of foot orthoses in chronic foot conditions.

We welcome collaboration with others interested in these fields. 

ACTIVE RESEARCH PROJECTS

Projects Currently Recruiting Participants:

1. Title: An evaluation of a three-dimensional foot model for studying children with flatfeet
Investigators: Angela McKenzie A, Mark Boocock, Keith Rome
Funding: AUT University
Research Co-ordinator: Mark Boocock

This project aims to use three-dimensional (3D) gait analysis to evaluate the differences in foot function of children (six – twelve years old) with normal and flatfeet.  A 3D foot model, previously used in a normal adult population, will be used to study its reliability when applied to children with flatfeet and normal feet.  The model will also test for differences in the mechanics of the foot between these two groups.

Contact: Mark Boocock

2. Title: Gout and footwear
Investigators: Keith Rome, Nicola Dalbeth, Peter McNair, Alain Vandal, Peter Gow
Funding: HRC: feasibility study

Gout displays a striking predilection to affect the feet, particularly the hallux (big toe), midfoot and ankle. Gout is major burden in New Zealand and Aotearoa New Zealand has the highest rates of disease worldwide. Poorly fitting shoes have been linked to foot pain in gout. To date, no clinical trials have addressed footwear as an intervention for patients with gout. In a recent study of footwear in patients with gout, we observed poor cushioning, lack of support, lack of stability and motion control. Based upon these findings, we concluded that footwear should be considered in the management plan of patients with gout, and future research should be focused on assessing the role of competitively priced footwear with adequate cushioning, motion control and sufficient width at the forefoot.
We are designing a randomised clinical trial on 36 patients to determine whether a specific footwear intervention can reduce foot pain and musculoskeletal disability in patients with gout.  The overall goal of this work is to identify a competitively priced shoe that is readily available in any retail store that is acceptable to patients and will address the foot problems we have previously observed in patients with gout.
Contact: Keith Rome

3. Title: Foot and ankle characteristics associated with falls and falls risk in people with rheumatoid arthritis.
Investigators: Angela Brenton-Rule, Keith Rome, Nicola Dalbeth, Hylton Menz, Sandra Bassett
Funding: Arthritis New Zealand

People with rheumatoid arthritis (RA) have an increased risk of falling. Foot deformity is common in RA and may be linked to falls. The research will assess the relationship between foot deformity and falls in people with RA. Falls can result in death, injury, loss of confidence and independence and increased risk of falling. The identification of modifiable falls risk factors, in the rheumatoid foot, may lead to the development of an intervention that prevents falls in people with RA and improves quality of life.
Contact: Angela Brenton-Rule

4. Title:
Evaluation of the Achilles tendon in gout using ultrasound and three-dimensional gait analysis.
Investigators: Matt Carroll, Keith Rome, Nicola Dalbeth, Mark Boocock
Funding: Arthritis New Zealand

Chronic gout places a significant economic burden on the health care system in New Zealand.  Chronic gout has a direct effect on the ability to work, work productivity and a reduced quality of life. There is little limited research assessing the influence of non-therapeutic factors such as biomechanical factors in chronic gout.  The mechanical efficacy of the AT could be significantly affected by tophus formation leading to significant alterations in the gait cycle function during everyday activities such as walking or participating in work.  Chronic gout is associated with the development of musculoskeletal foot pain, impairment and disability and has been linked to a reduced walking speed. Previous research has postulated that gait compensations in chronic gout may lead to reducing ankle plantarflexion creating disuse and weakness of the ankle plantarflexors.  This necessitates investigation of the relationship between impairment, clinical disease activity in the AT and gait function in chronic gout.    A better understanding of the role of AT in chronic gout may enhance our understanding of structural changes within the foot, ankle and lower limb.
Contact: Matt Carroll

5. Title: A comparison between Maori and non-Maori with diabetes of the anatomical and biomechanical parameters of the foot.
Investigators: Belinda Ihaka, Keith Rome, Wayne Hing
Funding: Podiatry New Zealand
Peripheral neuropathy is the main underlying feature in the development of foot ulcerations, although other co-founders such as limited joint mobility, increased plantar pressures, plantar fascia thickening, elevated blood glucose levels, BMI, age, footwear and ethnicity have also been postulated as risk factors to the development of foot ulceration. Previous studies have reported that the soft tissue properties of the foot may contribute to increased plantar pressures. A previous study suggested that increased thickening of the Achilles tendon and plantar fascia alters loading patterns, particularly during gait propulsion.  In another study, the authors suggest that the increased loading time during walking, was due to plantar fascial thickness. Anatomical and biomechanical parameters of the foot have not been addressed in Māori. The objective of this study is to evaluate anatomical and biomechanical parameters of the feet in Māori with diabetes. This study will be a part of future intervention studies to determine predictors of foot ulcerations to reduce the associated morbidity in Māori as a consequence. 
Contact: Belinda Ihaka

6. Title: An ultrasound investigation of the muscle characteristics of abductor hallucis in different stages of hallux valgus
Investigators: Sarah Stewart, Richard Ellis, Keith Rome
Funding: AUT University
Hallux valgus (HV), also referred to as a bunion, is a common deformity involving lateral deviation of the great toe. Crossing this joint is the abductor hallucis muscle, which has significant involvement in the pathomechanics of the deformity. The objective of the proposed study is to employ ultrasound imaging to investigate the abductor hallucis muscle characteristics, (defined as dorso-plantar thickness, medio-lateral width and cross-sectional area) in different stages of hallux valgus deformity which will be graded using the Manchester Scale. The study will involve 100 feet from participants recruited from the AUT School of Podiatry. 
Contact: Sarah Stewart

7. Title: Evaluation of a new and novel shoe insert
Investigators: Keith Rome, Peter McNair
Funding: ZIERA
From a commercial perspective, footwear, foot orthoses (FOs) and shoe inserts are commonly used to promote comfort.  Yet, the evidence to support their efficacy is not well established.  Of notable difficulty is what defines comfort.  Words such as pleasurable, sense of ease, enjoyment, well-being are often associated with the concept. These are thought to emanate from past-experiences which provide anchors for what might be perceived as either comfortable or not. In respect to comfort in shoes and shoes with FOs and inserts, one might intuitively perceive that it is related to decreasing forces and pressures, style and fit, warmth, and aesthetics.  The materials that are used in shoe construction, their amounts and their dimensions will influence these elements. Furthermore, there are likely to be anatomical and physiological parameters, such as the size and shape of a person’s foot together with its sensitivity to the materials of the shoe/FO/insert that could potentially influence the degree of perceived comfort.  It also seems likely that the interface between the foot and the insert or insole is a critical factor in determining what maximises comfort. The aim is to evaluate a new insole.
Contact: Keith Rome


8. Title: Clinical characteristics of foot ulceration in patients with chronic gout
Investigators: Keith Rome, Peter Gow, Kathryn Erikson, Anthony Ng, Hazra Hashid
Funding: New Zealand Wound Care Society
Research co-ordinator: Keith Rome
The aim of the study is to describe in depth the wound characteristics of a cohort of chronic gout patients at one participating centre. The prospective observational study will be conducted over 12 weeks. A group of 25 patients will be recruited from the rheumatology outpatient services based at CMDHB, Auckland, New Zealand. All patients will have a history of gout. All patients will have at least one foot ulcer. One examiner will conduct all the assessments at the same time point.

9. Title: The clinical and cost effectiveness of foot orthoses in the management of established rheumatoid arthritis

Investigators: Heidi Clark, John Dixon, Michael Plant, Keith Rome
Funding: University of Teesside Research Funding; Arthritis Research Campaign (UK).
Research Coordinator: Heidi Clark
The ankle and rearfoot are frequently identified as an area of the foot involved in rheumatoid arthritis (RA). To alleviate foot symptoms such as pain and to normalise the gait pattern associated with RA, health professionals commonly prescribe foot orthoses. The recent trend towards the prescription and supply of foot orthoses has resulted in many products being introduced and many more established products being used in new contexts. However, the selection and prescription of foot orthoses does not follow any set criteria, often based on consensus and opinion. Critical review of the literature has identified few well designed randomised controlled trials regarding the use of foot orthoses in the rheumatoid foot. Those identified are conflicting in their results, making clinical decision making based on current evidence difficult. Recent growing resource constraints have fostered awareness amongst clinicians of the importance of efficient practice patterns, and have sparked an interest in the methodology utilised to establish them. A few well-designed cost effectiveness analyses have been reported in the orthopaedic surgery literature. However much less is available for rheumatological disorders such as RA. The economic burden attributable to RA is not documented in the literature. However, since RA can result in considerable morbidity, there is a need to establish the most clinically and cost effective approach to the management of foot problems in RA. A gap in the literature has been identified relating to the use of foot orthoses in the established RA foot. This study proposes to address this gap by comparing two widely used types of foot orthoses in a randomised, controlled clinical trial. Participants will be blinded to the intervention. The type of foot orthoses used will be identified by surveying the current prescribing trends of health professionals working with the rheumatoid foot.   To help determine which strategy is more efficient, cost as well as effectiveness data will be collected. This crucial data will help to inform clinical decision making, building on previous work in the newly diagnosed rheumatoid foot, in that it will be supported by evidenced based guidance in order that quality standards will be raised.
Contact: Heidi Clark

 

Research Studentships

1. Title: An ultrasound investigation of the muscle characteristics of abductor hallucis in different stages of hallux valgus
Student (funding):  Sarah Stewart (AUT University)
Supervisors: Keith Rome, Richard Ellis
 
2. Title: Evaluation of the Achilles tendon in gout using ultrasound and three-dimensional gait analysis.
Student (funding):  Matt Carroll (AUT University)
Supervisors: Keith Rome, Nicola Dalbeth, Mark Boocock

3. Title: An evaluation of a three-dimensional foot model for studying children with flatfeet.
Student (funding):  Angela McKenzie (AUT University)
Supervisors: Keith Rome, Mark Boocock

4. Title: Foot and ankle characteristics associated with falls and falls risk in people with rheumatoid arthritis.
Student (funding): Arthritis NZ
Supervisors: Angela Brenton-Rule, Keith Rome, Nicola Dalbeth, Hylton Menz, Sandra Bassett

5. Title: The clinical and cost effectiveness of foot orthoses in the management of established rheumatoid arthritis
Student (funding):  Heidi Clark (University of Teesside, Arthritis Research Campaign)
Supervisors: John Dixon, Michael Plant, Keith Rome

6. Title: A comparison between Maori and non-Maori with diabetes of the anatomical and biomechanical parameters of the foot.
Student (funding):  Belinda Ihaka (Podiatry NZ)
Supervisors: Keith Rome, Wayne Hing

7. Title:
foot and ankle characteristics of patients with systemic sclerosis.
Student (funding):  Martin Kane, Nicola Dalbeth (Podiatry NZ)
Supervisors: Keith Rome, Wayne Hing

PUBLICATIONS & PRESENTATIONS

Keith Rome is an associate editor of the BMC Musculoskeletal Disorders Journal (http://www.biomedcentral.com/bmcmusculoskeletdisord/)

Peer reviewed publications 2012
Brenton-Rule A; Mattock J; Carroll M; Dalbeth N; Bassett S; Menz HB, Rome K. Reliability of the TekScan MatScan(R) system for the measurement of postural stability in older people with rheumatoid arthritis. J Foot Ankle Res 5: 21.

Carroll M, Yau J, Rome K, Wing W. Measurement of tibial nerve excursion during ankle joint dorsiflexion in a weight-bearing position with ultrasound imaging. J Foot Ankle Res 2012; 5: 5.

Dixon J, Gamesby H, Robinson J, Hodgson D, Hatton AL, Warnett R, Rome K, Martin D. The effect of textured insoles on gait in people with multiple sclerosis: an exploratory study. Physiotherapy Res Int Oct 28. doi: 10.1002/pri.521.

Evans AE, McKenzie, A, Rome K. The efficacy of non-surgical interventions for pediatric flexible flat foot: a critical review. J Ped Orthop [in press].

Evans M, Rome K, Peet L. The foot posture index, ankle lunge test, Beighton scale and the lower limb assessment score in healthy children: a reliability study. J Foot Ankle Res 2012; 5-1.

Hatton AL, Dixon J, Rome K, Newton J, Martin D. Altering gait by way of stimulation of the plantar surface of the foot: the immediate effect of wearing textured insoles in older fallers.  J Foot Ankle Res 2012; 5: 11.

Ihaka B, Bayley A, Rome K. Foot problems in Māori with diabetes. NZ Med J [in press].

Lewis GN, Heales L, Rice DA, Rome K, McNair PJ. Reliability of the conditioned pain modulation paradigm to assess endogenous inhibitory pain pathways. Pain Res Manag 2012; 17:98-102.

Rome K, Frecklington M, McNair PJ, Gow P, Dalbeth N. Foot pain, impairment and disability in patients with acute gout flares; a prospective observational study. Arthritis Care Res 2012; 64: 384-388.

Book Chapters
Rome K, Hatton AL; Oxford Desk Reference Geriatric Medicine: Chapter on Feet, Oxford University Press.

Hatton AL, Rome K (at review): Postural stability and footwear: Ergonomics.

Invitation as Key Note Speaker
Evidenced based practice in podiatric rheumatology. Podiatry NZ Conference, Auckland, 12-14th September 2012.

Professorial address Ko Awetea Series: Long term chronic foot conditions. Auckland, 12th July 2012.

The function of the foot in arthritic conditions. Arthritis NZ Conference, Auckland 16th May, 2012.

Assessing the rheumatoid foot. 3rd i-FAB conference, Sydney 10-14th April, 2012.

Oral Presentations [national and international]
Rome K, Hendry G. 3rd i-Fab Conference. Assessment of the rheumatoid foot workshop. Sydney 10-14th April 2012.

Peer reviewed publications 2011

Brenton-Rule A, Bassett S, Walsh A, Rome K. The evaluation of walking footwear on postural stability in healthy older adults: An exploratory study. Clin Biomech 2011; 26: 885-887.

Carroll M, Annabell ME, Rome K. Reliability of capturing foot parameters using digital scanning and the neutral suspension casting technique. J Foot Ankle Res 2011, 4:9

Dalbeth N, Doyle A, Boyer L, Rome K, Survepalli D, Sanders A, Sheehan T, Lobo M, Gamble G, McQueen FM. Development of a computed tomography (CT) method of scoring bone erosion in the foot and ankle of patients with gout: validation and clinical implications. Rheumatology 2011; 50: 410-416.

Evans AM, Rome K. A review of the evidence for non-surgical interventions for flexible pediatric flat feet. Eur J Phys Rehab Med. 2011; 47: 69-89.
Hatton AL, Dixon J, Martin D, Rome K. Standing on textured surfaces: immediate effects on standing balance in healthy older adults. Age Ageing 2011; 40: 363-66.

Rome K, Frecklington M, McNair PJ, Gow P, Dalbeth N. Footwear characteristics and factors influencing footwear choice in patients with gout. Arthritis Care Res 2011; 63: 1599-1604.

Rome K, Supervalli D, Sander S, Sanders A, McQueen FM, McNair P, Dalbeth N: Intra-tester reliability of manual testing of plantar pressure measurements in chronic gout. J Am Podiatr Med Ass 2011; 101: 424-429.

Rome K, Supervalli D, Sander S, Sanders A, McQueen FM, McNair P, Dalbeth N. Functional and biomechanical characteristics of foot disease in chronic gout: a case-control study. Clin Biomech 2011; 26: 90–94.

Invitation as Key Note Speaker
Developing and implementing a podiatric rheumatology service in Auckland, New Zealand: evidence based approach. NZ Rheumatology Conference, Auckland, August 6-8th August 2011.

Oral Presentations [national and international]
Rome K, Hendry G. 3rd i-Fab Conference. Assessment of the rheumatoid foot workshop. Sydney 10-14th April 2012.

Rome K. 2011. Foot problems in the rheumatoid population. New Zealand Rehabilitation Conference March 10-12th 2011, Auckland.

Martin D, Dixon J, Hatton A, Rome K, Hodgson D, Warnett R, et al.  Moderate/severe pain affects function in people with Multiple Sclerosis. Journal Pain 2011; 12 S1:P26.

Dixon J, Gamesby H, Robinson J, Hodgson D, Hatton AL, Warnett R, Rome K, Martin D. The immediate effects of textured insoles on postural stability in people with Multiple Sclerosis. Physiotherapy 2011; 97: S292-3.

Silvester R, Rome K, Dalbeth N, Gow P. Footwear issues in rheumatoid patients. 15th Australasian Podiatric Conference, Melbourne 26-30th April, 2011.

Frecklington M, Rome K, Dalbeth N, Gow P, McNair P. pain, disability and impairment in acute gout. 15th Australasian Podiatric Conference, Melbourne 26-30th April, 2011.

Brenton-Rule A, Rome K, Walsh A. Postural stability in footwear for older adults. 15th Australasian Podiatric Conference, Melbourne 26-30th April, 2011 

 

CONTACTS

Matt Carroll: School of Rehabilitation & Occupation Studies, Health & Rehabilitation Research Institute, Department of Podiatry, AUT University, Private Bag 92006, Auckland, 1142, New Zealand

E-mail: matthew.carroll@aut.ac.nz

Angela McKenzie: School of Rehabilitation & Occupation Studies, Health & Rehabilitation Research Institute, Department of Podiatry, AUT University, Private Bag 92006, Auckland, 1142, New Zealand.

E-mail: amackenz@aut.ac.nz

Belinda Ihaka: School of Rehabilitation & Occupation Studies, Health & Rehabilitation Research Institute, Department of Podiatry, AUT University, Private Bag 92006, Auckland, 1142, New Zealand

E-mail: bhaka@aut.ac.nz

Keith Rome: School of Rehabilitation & Occupation Studies, Health & Rehabilitation Research Institute, Department of Podiatry, AUT University, Private Bag 92006, Auckland, 1142, New Zealand.

E-mail: krome@aut.ac.nz

Mike Frecklington: School of Rehabilitation & Occupation Studies, Health & Rehabilitation Research Institute, Department of Podiatry, AUT University, Private Bag 92006, Auckland, 1142, New Zealand

E-mail: mike.frecklington@hotmail.com

Nicola Dalbeth: Auckland University,Department of Medicine, 85 Park Rd, Grafton, University of Auckland, Private Bag 92019, Auckland, New Zealand

E-mail: n.dalbeth@auckland.ac.nz

Peter Gow: Rheumatology Department, CMDHB, Otahuhu, Private Bag 93311, Auckland.

E-mail: peter.gow@middlemore.co.nz

Peter McNair: Director Health & Rehabilitation Research Institute, Department of Podiatry, AUT University, Private Bag 92006, Auckland, 1142, New Zealand

E-mail: pmcnair@aut.ac.nz


Last updated: 14-Feb-2014 8.01pm

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