Kate Carter

Online research methods have become increasingly common in podiatry, offering efficient, low cost and convenient data collection. Emerging evidence from online studies suggests that the integrity of online research is being compromised by participants who are not genuine: for example, they may not have the relevant health condition they are claiming to have or they may not be taking the trial medication as instructed. In health research, the consequences of non-genuine participants are significant, including unreliable data, wasted time and funding, researcher distress, loss of participant trust and, in some cases, cancelled projects. Growing awareness of fraudulent participation and reports of these challenges highlights the need for structured approaches designed to safeguard data integrity and the trustworthiness of results. In the United Kingdom, the University of Nottingham has recently published practical guidance for researchers and ethics committees on handling potential non-genuine participants. The aim of this commentary is to raise awareness of the risks posed by non-genuine participation in online research and to provide a summary of the recently published practical strategies for researchers to safeguard the integrity of their data.

Endorsement for scheduled medicines has been available to Australian podiatrists for over a decade. However, uptake and prescribing rates remain low. A key barrier is the limited number of endorsed prescribers, which restricts access to mentorship opportunities for podiatrists seeking endorsement. While existing literature explores practicing podiatrists' perspectives on endorsement, the views of students regarding prescribing remain underrepresented. This study aimed to explore final-year podiatry students' experiences with non-medical prescribing during clinical placements. This qualitative study purposively recruited final-year podiatry students from the University of Western Australia. Semi-structured interviews were undertaken to explore participants' experiences of non-medical prescribing during clinical placements, which were audio-recorded, transcribed verbatim and analysed using constant comparative analysis until data saturation was reached. Data recorded prior to interview included demographic information, academic characteristics were determined using self-reported questionnaires to describe motivation, self-efficacy and mental wellbeing and clinical logbook records were retrospectively reviewed for data on prescribing encounters recorded by students during clinical placements. Fifteen participants aged between 23 and 46 years were recruited. Retrospective clinical logs showed that 631 of 7613 cases (8.3%) involved prescription of a scheduled medicine, with most prescribing opportunities occurring in public health settings. Six global themes relating to prescribing experiences emerged: limited exposure, confidence, learning experiences, proposed improvements, pursuit of endorsement and future career impacts. Relationships between themes were developed based on key concepts, particularly scarcity of endorsed prescribers, and limited amount and variety of prescribing encounters. This study demonstrated that although podiatry students experienced limited exposure to endorsed prescribing and low self-confidence in prescribing ability, they continued to see value in non-medical prescribing with a willingness to pursue endorsement in the future. Future implications to address limited student exposure to prescribing due to shortage of endorsed podiatrists may facilitate the uptake of endorsement for scheduled medicines.

Online research methods have become increasingly common in podiatry, offering efficient, low cost and convenient data collection. Emerging evidence from online studies suggests that the integrity of online research is being compromised by participants who are not genuine: for example, they may not have the relevant health condition they are claiming to have or they may not be taking the trial medication as instructed. In health research, the consequences of non‐genuine participants are significant, including unreliable data, wasted time and funding, researcher distress, loss of participant trust and, in some cases, cancelled projects. Growing awareness of fraudulent participation and reports of these challenges highlights the need for structured approaches designed to safeguard data integrity and the trustworthiness of results. In the United Kingdom, the University of Nottingham has recently published practical guidance for researchers and ethics committees on handling potential non‐genuine participants. The aim of this commentary is to raise awareness of the risks posed by non‐genuine participation in online research and to provide a summary of the recently published practical strategies for researchers to safeguard the integrity of their data.

Background: Endorsement for scheduled medicines has been available to Australian podiatrists for over a decade. However, uptake and prescribing rates remain low. A key barrier is the limited number of endorsed prescribers, which restricts access to mentorship opportunities for podiatrists seeking endorsement. While existing literature explores practicing podiatrists' perspectives on endorsement, the views of students regarding prescribing remain underrepresented. This study aimed to explore final‐year podiatry students' experiences with non‐medical prescribing during clinical placements. Methods: This qualitative study purposively recruited final‐year podiatry students from the University of Western Australia. Semi‐structured interviews were undertaken to explore participants' experiences of non‐medical prescribing during clinical placements, which were audio‐recorded, transcribed verbatim and analysed using constant comparative analysis until data saturation was reached. Data recorded prior to interview included demographic information, academic characteristics were determined using self‐reported questionnaires to describe motivation, self‐efficacy and mental wellbeing and clinical logbook records were retrospectively reviewed for data on prescribing encounters recorded by students during clinical placements. Results: Fifteen participants aged between 23 and 46 years were recruited. Retrospective clinical logs showed that 631 of 7613 cases (8.3%) involved prescription of a scheduled medicine, with most prescribing opportunities occurring in public health settings. Six global themes relating to prescribing experiences emerged: limited exposure, confidence, learning experiences, proposed improvements, pursuit of endorsement and future career impacts. Relationships between themes were developed based on key concepts, particularly scarcity of endorsed prescribers, and limited amount and variety of prescribing encounters. Conclusion: This study demonstrated that although podiatry students experienced limited exposure to endorsed prescribing and low self‐confidence in prescribing ability, they continued to see value in non‐medical prescribing with a willingness to pursue endorsement in the future. Future implications to address limited student exposure to prescribing due to shortage of endorsed podiatrists may facilitate the uptake of endorsement for scheduled medicines.

Background: Psoriatic Arthritis (PsA)-related foot involvement has been shown to have a profound impact on daily functioning, with most studies having focused on predominantly Caucasian populations. The aim was to describe disabling foot pain (DFP) and its impact on daily living in PsA in Singapore. Methods: A cross-sectional, retrospective study was conducted using clinical data collected during a single-visit to a rheumatology clinic in Singapore. Records for adults with physician-diagnosed PsA were reviewed for sociodemographic information, disease characteristics, global disease activity and burden. Foot-specific measures included clinical assessment and the Manchester Foot Pain and Disability Index used to define DFP and evaluate between-group differences. Results: Forty-two participants with PsA (83% female, 57% Chinese, 31% Malay, 9.5% Indian, mean (SD) age 54-years (16)) attended the rheumatology clinic over the study-period. The median (IQR) disease duration was 2-years (11) and all were taking current DMARDs. Global disease measures demonstrated mild-to-moderate global disease activity and mild functional impairment, and were significantly higher in those with DFP. Despite 90% reporting to be coping well with their condition, self-care and having emotional support (n = 38), this study sample demonstrated high levels of anxiety/depression (29%), sleep disturbance (34%) and fatigue (24%), and a lack of disease- and drug-specific knowledge (64%). Further management was indicated for medication adherence counselling (48%), occupational therapy (43%), physiotherapy (36%) and podiatry (30%). Nearly half had current foot pain with 40% reporting DFP (n = 17), which caused significantly greater difficulty walking 3 km than those without DFP (p < 0.05). Rearfoot enthesitis (plantar fasciitis, Achilles enthesitis) was the most common cause of DFP (67%) with pain lasting longer than 1-year. 72% were overweight or obese, with a high proportion not engaging in any cardiovascular exercise (70%). Three of 42 participants had previously seen a podiatrist. Conclusions: People with DFP in PsA experience more severe global disease activity, reduced mobility and higher levels of negative impact on their daily lives in Singapore. In the absence of working in a multidisciplinary-team, there is value in comprehensive assessments that have potential to capture a holistic view of personal impact and improve person-centred care in PsA.

Background Limited research to date has defined the nature and extent of foot involvement in a psoriatic arthritis-specific population in Australia and the scale of the problem remains unclear. Survey research provides the ideal opportunity to sample a large population over a wide geographical area. Although quality criteria for survey research have been developed, research shows that adherence is low and that survey studies are poorly reported in peer-reviewed survey articles, which limits the ability to inform future survey design. The objective of this paper was to develop a national survey about foot involvement in people with psoriatic arthritis using a best practice approach. This is a methods paper for the development of survey research.Methods A systematic, multi-stage process of survey development was undertaken, which comprised 3 phases: 1) the generation of the conceptual framework and survey content; 2) the development of the survey and pre-testing and 3) development of the survey dissemination strategy. A survey best practice approach was adopted using iterative pre-testing techniques, which included; cognitive debriefing, cultural sensitivity review, survey design expert validation, subject expert validation and pilot testing. Targeted postal and online survey dissemination strategies were developed a priori to optimise the response rates anticipated.Results A 59-item survey with 8 sections was developed. Findings demonstrated a high survey response (n=649), high data completeness (83% of respondents reached the end of the survey) and low rates of missing data (below 5% for 95% of respondents). Extensive survey pre-testing among the target population, health professionals and experts improved the overall quality, content validity, functioning and representativeness of the survey instrument, which optimised potential response rates. Clear audit trails that mapped the analytical process at each stage substantiated the rigour of the survey development methods. Robust strategies for sampling, survey dissemination and community engagement were deemed to have made a powerful contribution to response rates and the scale of information collected.Conclusions Robust patient-centred methods in survey design were used to create a novel, high-quality survey to comprehensively evaluate psoriatic arthritis-related foot involvement. Transparent and precise description of the survey design and dissemination methods provides useful information to other researchers embarking on survey design in healthcare.

Background Previous research to describe the impact of foot involvement in psoriatic arthritis has used the Leeds Foot Impact Scale in Rheumatoid Arthritis (LFIS-RA) in the current absence of any psoriatic arthritis foot-specific tools. However, the LFIS-RA is a rheumatoid arthritis disease-specific outcome measure and its content validity for evaluating the experiences of people with psoriatic arthritis-related foot involvement is unknown. The study objective was to determine the content validity of the LFIS-RA for assessing people with psoriatic arthritis, using the International Classification of Functioning, Disability and Health (ICF) as the frame of reference.Method Concepts within each item of the LFIS-RA were linked to the best-matched ICF categories using established linking rules, which enable a systematic and standardised linking process. All concepts were independently linked to the ICF by 2 investigators with different professional backgrounds, which included occupational therapy and podiatry. The list of ICF categories derived from previous research that pertained to the foot in psoriatic arthritis was then compared with the ICF categories linked to the LFIS-RA. The comparison was undertaken in order to determine the extent to which concepts important and relevant to people with psoriatic arthritis-related foot involvement were addressed. Results Thirty-five distinct ICF categories were linked to the LFIS-RA, which related to body functions (44%), activities and participation (35%), environmental factors (16%) and body structure (5%). In comparison with the ICF categories derived from concepts of the foot in psoriatic arthritis previously defined, the LFIS-RA provided coverage of key constructs including pain, functioning, daily activities, footwear restrictions and psychological impact. Other concepts of importance in psoriatic arthritis such as skin and toenail involvement, self-management and paid employment were not addressed in the LFIS-RA. Conclusion Content validity of the LFIS-RA to determine the impact of foot functional impairments and disability in people with psoriatic arthritis was not supported by the results of this study. Future work should consider the development of a psoriatic arthritis foot-specific patient reported outcome measure, using the LFIS-RA as an important foundation.

Objective: The aim was to categorize the patient experience of PsA-related foot involvement by linking it to the International Classification of Functioning, Disability and Health (ICF) framework. Methods: Concepts, obtained from a previous qualitative investigation of people with PsA and health professionals into their perspective of PsA-related foot involvement, were linked to the full version of the ICF classification. Concepts were linked to the most appropriate ICF category using established linking rules, which enable a systematic and standardized linking process. All concepts were linked independently to the ICF by two investigators, followed by a third investigator for adjudication. The professional backgrounds of the investigators included occupational therapy and podiatry. Results: More than 100 distinct ICF categories were linked to the interview concepts. The most represented ICF category was body functions (35%), followed by environmental factors (31%), activities and participation (19%) and body structure (15%). Concepts that could not be linked to the ICF were related to coping, aspects of time and knowledge. Health professionals identified a greater proportion of body functions and fewer activity and participation categories compared with patients, indicating a possible mismatch of key concerns. Interdisciplinary group analysis demonstrated merit. Conclusion: A list of ICF categories was generated, defining aspects of functioning important and relevant to the impact of PsA-related foot involvement. Despite the localized anatomical focus of this study, the effect of foot problems in PsA was linked to all components of the ICF, confirming the profound impact on functioning and daily life.

Background: Previous research to describe the impact of foot involvement in psoriatic arthritis has used the Leeds Foot Impact Scale in Rheumatoid Arthritis (LFIS‐RA) in the current absence of any psoriatic arthritis foot‐specific tools. However, the LFIS‐RA is a rheumatoid arthritis disease‐specific outcome measure and its content validity for evaluating the experiences of people with psoriatic arthritis‐related foot involvement is unknown. The study objective was to determine the content validity of the LFIS‐RA for assessing people with psoriatic arthritis, using the International Classification of Functioning, Disability and Health (ICF) as the frame of reference.Method: Concepts within each item of the LFIS‐RA were linked to the best‐matched ICF categories using established linking rules, which enable a systematic and standardised linking process. All concepts were independently linked to the ICF by 2 investigators with different professional backgrounds, which included occupational therapy and podiatry. The list of ICF categories derived from previous research that pertained to the foot in psoriatic arthritis was then compared with the ICF categories linked to the LFIS‐RA. The comparison was undertaken in order to determine the extent to which concepts important and relevant to people with psoriatic arthritis‐related foot involvement were addressed.Results: Thirty‐five distinct ICF categories were linked to the LFIS‐RA, which related to body functions (44%), activities and participation (35%), environmental factors (16%) and body structure (5%). In comparison with the ICF categories derived from concepts of the foot in psoriatic arthritis previously defined, the LFIS‐RA provided coverage of key constructs including pain, functioning, daily activities, footwear restrictions and psychological impact. Other concepts of importance in psoriatic arthritis such as skin and toenail involvement, self‐management and paid employment were not addressed in the LFIS‐RA.Conclusion: Content validity of the LFIS‐RA to determine the impact of foot functional impairments and disability in people with psoriatic arthritis was not supported by the results of this study. Future work should consider the development of a psoriatic arthritis foot‐specific patient reported outcome measure, using the LFIS‐RA as an important foundation.