James Lind Alliance

British orthopaedic Foot and Ankle Society (BOFAS) and James Lind Alliance Priority Setting partnerships joined forces to establish ‘Top-10’ Research Priorities in the UK. This project started in September 2019 and finished in July 2021.

Our partnership brought together those affected by foot and ankle problems including patients, carers, and clinicians to decide what research to focus on next. BOFAS and the James Lind Alliance are working together to establish a Priority Setting Partnership (PSP) following the methods set out by the James Lind Alliance.

The importance of involving those directly affected by a condition in identifying research priorities to ensure the findings are relevant is increasingly being recognised. The aim of this project was to determine a 'top ten' list of research priorities for patients with foot and ankle problems.

How the James Lind Alliance Process Works

STAGE 1 - ESTABLISHING THE FOOT AND ANKLE PARTNERSHIP

A Steering Group was formed, bringing together patients, carers, charities, healthcare professionals and research experts. The steering group agreed the protocol for the project, outlining what would happen and when. They also agreed on management arrangements and identified further partners to reach as wide an audience as possible.

STAGE 2 – SHARE YOUR VIEWS

No one understands foot and ankle problems better than the people who live with the condition or their families. The Steering Group created a survey click here to access the survey, using the James Lind Alliance guidance, to help understand which research questions these people as well as clinicians think are important to answer.

STAGE 3 - DATA MANAGEMENT

The project data management group collated all the survey results and sorted the answers into research questions and themes. These were reviewed against existing research that has already been done that might be able to answer some of the questions and prioritise questions where there is a lack of evidence.

STAGE 4 - INTERIM PRIORITISATION

To check we've got the right message, the research questions created went sent to survey respondents and partner organisations. Respondents were asked to rank their top 10 unanswered questions, and these were combined to create a final shortlist.

STAGE 5 - FINAL PRIORITISATION

At the end of the process a workshop was held for those who have taken part and partner organisations. The agreed final list of the top ten unanswered research questions was produced. These priorities can then be used by researchers to apply for funding to undertake projects which could improve care for patients with foot and ankle problems in the future.

The full protocol for the BOFAS James Lind Alliance can be found here.

The scope of the Foot & Ankle Surgery PSP is defined as:

Surgical treatments and injections for the treatment of foot & ankle conditions and injuries in adults (over 18 years).
Post-surgical rehabilitation or injection aftercare.

Steering Group

Jitendra MANGWANI – PSP Lead

Jitendra Mangwani is a Consultant Orthopaedic Foot and Ankle Surgeon at University Hospitals of Leicester. He graduated in India and completed his higher surgical training in trauma and orthopaedics in London with a specialist fellowship in foot and ankle surgery. He has a keen research interest. He is committed to medical education and is regularly invited as a faculty to courses and conferences. He runs both national and international foot and ankle surgery courses. He is a member of the Scientific Committee and in this role is co-opted on the Outcomes Committee.

Katherine COWAN – Senior Advisor James Lind Alliance

Katherine chairs the Steering Group. She is Senior Adviser to the JLA and has been a key contributor to the development of its methods and profile since 2008. Katherine co-wrote and edited the original JLA Guidebook. She has chaired over 40 PSPs and facilitated at almost 50 priority setting workshops internationally. Katherine’s professional background is in social research and she has a particular interest in public participation and inclusion. She has a Masters in Coaching and Mentoring Practice and has worked as an independent facilitator for 12 years..

Patricia ALLEN - Clinician

Patricia Allen is a Consultant Orthopaedic Foot and Ankle Surgeon at University Hospitals of Leicester and the Immediate President of British Orthopaedic Foot and Ankle Society. She trained in Birmingham and Bristol and undertook Fellowship training in Dublin before being appointed Consultant in Bristol in 2000. She moved to Leicester in 2003 to set up the Foot and Ankle unit there.

Noelene DAVEY - Clinician

BSc (Physiotherapy), University of Sydney (graduated 1995), HCPC registered and CSP Chartered Physiotherapist

Noelene and has gained a wide variety of experience in musculoskeletal physiotherapy both in Australia and the UK. She is currently an Advanced Physiotherapy Practitioner at Imperial College Healthcare NHS Trust, working alongside consultant orthopaedic surgeons and leads the physiotherapy department in delivering the best evidence based management of lower limb conditions. She is regularly invited to lecture at national and international conferences and is research active within her NHS role and is a Founding Trustee and Chair of educational charity Association of Foot & Ankle Physios & AHPs.

Mark B DAVIES - Clinician

Consultant Orthopaedic Foot & Ankle surgeon in Sheffield. Demonstrable commitment to research, audit and education. Honorary Secretary of BOFAS.

Nick GALLOGLY - Clinician

Nick Gallogly is a consultant orthotist and orthotic clinical lead for the Royal Berkshire Foundation Trust Hospital. His background includes a BEng in Medical Mechanical Engineering, a BSc in Prosthetics and Orthotics and an MSc in Clinical Biomechanics. Nick works within busy foot and ankle clinics and is a member of many MDT clinics including diabetic and both adult and paediatric neuromuscular clinics. He works with elite athletes which include premiership ruby and premier league football and GB rowing.

Douglas GRINDLAY - Information Specialist

Dr Douglas Grindlay is the information specialist in the Orthopaedics and Trauma Group at the University of Nottingham. Douglas is involved in systematic reviews and database searching, and compiles several current awareness services, including Foot and Ankle Evidence Updates: https://www.jiscmail.ac.uk/FOOT-AND-ANKLE-EVIDENCE-UPDATES. He has been a steering group member for several previous PSPs, including the PSP on Common Conditions of the Hand and Wrist, and has a particular interest in using systematic reviews and guidelines to identify research uncertainties.

Melinda HAU - Information Specialist

Miss Melinda Hau is a Trauma and Orthopaedics Trainee Registrar in East Midlands South. She graduated from University of Leicester in 2011 and did all her training in East Midlands. She has an interest in Foot and Ankle and Orthoplastic Surgery.

Steve INGRAM – Patient Carer

I am the main carer for my disabled wife. She had a Stroke in 2010 and was left with right sided paralysis and aphasia. I took early retirement in 2016 to look after her. I served in the RAF for six years, taught in secondary schools for sixteen years and was the Teaching Support Officer at Imperial College London for fourteen years.

Rebecca KEARNEY - Clinician

Dr Kearney is a clinical academic physiotherapist, senior NIHR Fellow award holder and Associate Director of Warwick Clinical Trials Unit. She leads the design and delivery of research programmes that evaluate the clinical and cost effectiveness of interventions in the area of trauma and orthopaedic rehabilitation.

Lyndon MASON - Clinician

Professor Mason is a consultant in foot and ankle, trauma, and major trauma at Aintree University Hospital, and as the musculoskeletal system lead at the school of medicine, University of Liverpool. He co-leads on foot and ankle research for which he has received both national and international recognition. He was involved in the JLA priority setting for Major Trauma in 2017.

Jo MILLARD – PSP Co-ordinator

Jo Millard is Secretariat for the British Orthopaedic Foot & Ankle Society. Her role is wide ranging and sees her working alongside the Education Committee, organising and running 5 UK training courses and 2 International training courses each year; with Scientific Committee, as PSP co-ordinator on the BOFAS Foot & Ankle Surgery PSP; and Outcome Committee, as Data Protection Officer. Jo also works closely with the BOFAS Treasurer on the society accounts in addition to organising the main Annual Scientific Meeting each year with the Society President.

Veena PATEL - Clinician

MBBS, MEd, MRCP(UK), MRCP(Rheum), FHEA

I work as a Consultant Rheumatologist at Leicester with a special interest in Osteoporosis and Metabolic Bone diseases. I have experience in managing wide range of patients with primary/secondary osteoporosis, osteomalacia, Paget’s disease, osteogenesis-imperfecta, hypophosphatasia etc. I have the experience of managing fracture liaison service and contributed in developing many related guidelines and pathways. My other interest is in medical education and have completed MEd from University of Birmingham. I am a Fellow of Higher Education Academy and contribute to UG/PG teaching locally as well at Royal College/Arthritis UK. I have experience in conducting qualitative research and have published in peer reviewed journals.

Amanda ROBERTS - Patient

Amanda is an experienced lay member of health related committees. She is passionate about patient and public involvement. She has been on a couple of JLA PSP steering groups before (eczema and retention). She has had foot surgery and two years ago she broke her ankle.

Brigitte SCAMMELL - Clinician

Brigitte Scammell is a Consultant Orthopaedic Surgeon in adult foot and ankle surgery at The City Hospital, Nottingham and Professor of Orthopaedic Sciences at the University of Nottingham. She heads the Academic Orthopaedic Unit and is the Admissions Sub-Dean for the Faculty of Medicine. Her clinical interests are in adult orthopaedics, especially of the foot and ankle, with a particular emphasis on the reconstruction of severe deformity and treatment of infection in patients with diabetic foot disorders.

Lauren THOMSON – Information Specialist

I am a current training registrar within the East Midlands South Deanery with an interest in foot and ankle surgery. A keen advocate for education I see the James Lind Alliance as an excellent conduit for understanding between both the professional and the patient.

BOFAS JLA PSP Results

Results from the Foot & Ankle surgery JLA process can be found here and the final ‘Top-10’ research priorities are outlined in this publication and below (infographic).

Next Steps - National Clinical Study Groups

For the year 2023/24, BOFAS has elected to concentrate on three out of these ‘Top-10’ priorities. These three priorities are:

How effective are steroid injections in improving pain from arthritis in foot and ankle?
What is the best time to start weight bearing after an ankle fusion/replacement surgery?
What is the best surgery for bone and cartilage defects in the talus?

BOFAS would like to thank patients and carers, members of the steering group and wider membership who participated and supported this process. If you have any queries, please get in touch with project lead Jitendra Mangwani via email honorarysecretary@bofas.org.uk.