Staggered steps: determining the impact of multiple sclerosis (MS) On lower limb health through scoping review and public and patient involvement

ABSTRACT

Introduction: Multiple Sclerosis (MS) is a complex disease which affects the central nervous system. The myelin sheath that protects the nerve fibres of the body is damaged by its own immune system (demyelination). Under NICE guidelines CG186, podiatrists are not currently included within the Multiple Sclerosis rehabilitation team, with access to podiatric treatment in secondary care available for those with a specific need. Aim(s) 1. To establish the impact of MS on lower limb health 2. To evaluate the benefit of Podiatric interventions, including foot health education, in the management and rehabilitation of lower limb health for increased mobility and ambulation Objectives: 1. Establish and facilitate a Patient and Public Involvement Advisory Panel 2. Undertake a scoping review under the PRISMA-ScR guidelines Methods: A scoping review of the effects of MS on the lower limb was undertaken to examine the extent, range and nature of any research activity that has already been completed in this area of podiatric medicine, subsequently identifying research gaps in existing literature. A PPI advisory panel was established, comprising of ten members, formed through social media recruitment, utilising Twitter as the primary platform. A search strategy was entered into the PubMed database which yielded the literature for our review in COVIDENCE. Result(s) The COM-B model has been used as a framework for analysis, along with keywords used as discussion strategy. The Guidance for Reporting Involvement of Patients and Public 2-GRIPP2 is the checklist that has been utilised to report the themes and initial findings of the PPI meetings. This guidance resembles the logic model, highlighting that evaluating participation is a complex activity, which provides the fundamental key to ensuring that public involvement and participation activities and programmes generate learning and results, and improve future participation practices. Full data extraction has been performed on the 128 articles with no indication of any podiatric involvement in studies. Discussion(s) The initial findings have identified that there is scope for further research of the utilisation of podiatrists in the management and rehabilitation of lower limb health in patients with MS. The dialogue of the panel is encouraging with a host of examples provided as evidence that podiatric interventions could facilitate meaningful change to the rehabilitation service and have a great impact on both patients and carers.