An investigation into the scale and impact of self-reported foot problems associated with systemic lupus erythematosus. A study protocol and survey questionnaire development

Background Systemic lupus erythematosus (SLE) can manifest with arthralgia and myalgia, and in severe cases, disorganisation of the joints and tendon rupture. Further, Raynaud’s phenomenon and other circulatory problems such as vasculitis have been reported, and may be associated with loss of sensation and ulcers. Associated with impaired peripheral neurovascular function there is the potential for changes in tissue viability leading to thinning of the skin or callus formation. In addition, resistance to infections may be reduced, such as fungal infection of the skin and nails, bacterial infection associated with wounds and viral infections such as verruca. There is a dearth of evidence for the effects of SLE in the foot, the prevalence of foot problems in SLE and the impact of these on the individual. In addition, it is not known if people with SLE and foot problems have access to specialist care through foot health services. Method The first phase of the proposed study was to develop a survey questionnaire. This was achieved through a focus-group which comprised of patient advisers with SLE, consultants who specialised in SLE, specialist rheumatology podiatrists and specialist rheumatology nurses. From this consensus approach to the item generation the draft questionnaire was developed based on agreed themes, question format and overall structure. The Manchester Pain and Disability Questionnaire was included in order to capture levels of pain and associated disability. An iterative process followed with feedback from the focus group reducing the number of other items from 53 until the penultimate version of questionnaire was produced with 50 items. Following on from this, a process of cognitive debriefing was used with two people with SLE naïve to the questionnaire. Minor changes to two questions and the layout was required before a final version of the questionnaire was produced Discussion The questionnaire will be used for a study which aims to identify the frequency of patients’ reported foot problems, the impact of foot problems on their lives and the status of foot care provision. This will be achieved through a survey of people with SLE across six clinical sites and interviews with some people in order to explore their experience of foot problems. The results from this study will provide the information required to inform further research. In addition, it could potentially inform the design and delivery of foot health information and services to this patient group