Measuring Health Outcomes for Economic Evaluation of Conservative Treatment for Foot Pain

  • Linda Fenocchi

Student thesis: Doctoral ThesisDoctor of Philosophy (PhD)


This study aimed to develop knowledge about how health outcomes (benefits) following conservative treatment for patients with common lower extremity musculoskeletal (MSK) conditions should be measured for use in economic evaluation. As prevalence of MSK conditions increases and health care resources are always constrained, there is an urgent need to generate a sufficiency of clinical and cost effectiveness evidence to inform policy and practice. Prior to undertaking the empirical work, a systematic review established that although there is evidence about conservative interventions for hip and knee osteoarthritis, this was lacking for other clinically important lower limb conditions such as foot and ankle. Using a mixed methods approach, the impact of foot pain on health-related quality of life (HRQoL)was explored to estimate the effect of MSK foot pain symptoms and comorbid conditions on measuring HRQoL following treatment. 115 adult patients with foot pain attending a first MSK biomechanics podiatry appointment completed EQ-5D-5L,SF-12v2, Foot Function Index, and Foot Health Status Questionnaire at 0, 3 and6 months. 25 participants were interviewed. Assessment of PROMs supported the validity and responsiveness of both EQ-5D-5L and SF-6D (using SF-12v2) for measuring HRQoL following podiatric treatment. Estimates for the interpretation of change for use in clinical trials were provided. Challenges for the measurement of health outcomes for chronic conditions were identified. Episodic symptoms and the presence of comorbid disease influenced perceptions of foot pain and HRQoL, as did comparisons with others’ health status. This has implications for collection of utility data if patients are unable to perceive and assess the value of treatment for a single condition independently within their health status. The usefulness of a mixed methods approach for health economics outcomes research has been demonstrated.The findings can inform other studies of conservative interventions for common foot and ankle MSK conditions.
Date of Award2020
Original languageEnglish
Awarding Institution
  • Glasgow Caledonian University
SupervisorGordon Hendry (Supervisor), Helen Mason (Supervisor) & Jody Riskowski (Supervisor)

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