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    The experiences and non surgical management of people living with ankle osteoarthritis

    Yeowell, Gillian ORCID logoORCID: https://orcid.org/0000-0003-3872-9799, Samarji, Richard and Callaghan, Michael ORCID logoORCID: https://orcid.org/0000-0003-3540-2838 (2019) The experiences and non surgical management of people living with ankle osteoarthritis. In: 2019 OARSI World Congress on Osteoarthritis, 02 May 2019 - 05 May 2019, Sheraton Centre Toronto, Toronto, Canada.

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    Purpose: Osteoarthritis (OA) of the ankle joint is associated with lifelong joint pain and disability if not properly managed. This often impacts on an individual’s physical functioning and quality of life. Recent OARSI reviews of the year have emphasised the dearth of research in the treatment of painful ankle OA compared to knee and hip OA. The aim of this study was to explore the experiences of people living with painful OA ankle and their views about the non surgical management of this condition. Gaining an understanding of their experiences and the impact it has will help inform future research into the management of this condition. Methods: Design: A qualitative study, using semi-structured interviews. Sample: Nine participants were recruited from an orthopaedic clinic at a NHS (National Health Service) hospital in the UK and the general population. All participants had a clinical and radiographic diagnosis of OA ankle. All had either received non surgical treatments or were on a waiting list to receive surgical treatment. Data Analysis: Interviews were digitally recorded and transcribed verbatim. Thematic analysis was undertaken to identify emerging themes and concepts that surfaced across the transcripts of the participants. NHS and University ethical approval was obtained. Results: Nine semi-structured interviews were undertaken. Eight of the participants were male, median age = 55 years (IQR = 42.5 - 64.5). Mechanism of onset was due to trauma (falls, repeated inversion injuries or road traffic collisions) (n = 7), or the effects of haemophilia (n = 2). The median duration of symptoms was 2 years (IQR = 1.5 - 10). Data saturation was achieved. Four themes were identified: Symptoms; Impact on function, social activities and quality of life (QoL); Impact on mental wellbeing and self-identity; Management and treatment. Symptoms: The findings indicate that OA ankle pain had a substantial negative impact on a person’s physical and mental wellbeing, with many participants describing their pain in emotive terms such as ‘terrible’ and ‘horrendous’. Pain was the main issue for all participants in terms of the type, intensity and persistence of the pain. All participants reported symptoms of swelling and instability of the ankle. Impact on function, social activities and quality of life: The symptoms the participants experienced impacted on their function and social life. Additionally, the anticipation of these symptoms stopped them participating in social activities with friends and family, which adversely affected these relationships and had a negative impact on their QoL. Participants who also had concomitant painful OA hip or knee, felt that the greatest impact on their QoL was due to their ankle pain. Impact on mental wellbeing & self identity: The pain experienced from OA ankle appeared to affect the participants’ mental wellbeing, with most reporting feelings of anxiety and depression related to their pain and the impact on their function and social life. Participants discussed how living with OA ankle impacted on their self identity, perceiving this as a loss of self worth, which led to feelings of depression. Management and treatment: All participants had received various non surgical interventions including heat, exercise, external ankle supports, orthoses, medication and corticosteroid injections. Some found them helpful, whereas others had short lived benefit. Participants in this study, whose radiological changes were not substantial, felt that their condition was not taken seriously by their medical team and that this was the reason few treatment options were offered. They all highlighted the need for an effective non-surgical treatment. Conclusions: This is the first study to explore the experiences of people with symptomatic OA ankle. Our findings suggest that those with OA ankle suffer with severe pain, which has a substantial negative impacton a person’s physical and mental wellbeing. Although there is a wide range of conservative interventions available, they do not seem to be effective in the management of this condition. The participants’ mixed experience of the non-surgical management of their OA ankle was likely due to an absence of guidance on its treatment. The findings of this study should be used to inform future research.

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