Improving walking ability & early Rheumatoid Arthritis

Glasgow Caledonian University has been awarded a £1.8million grant from the National Institute of Health Research Health Technology Assessment Programme (NIHR HTA) for a 5-year project to evaluate gait rehabilitation as a new intervention for people with Rheumatoid Arthritis (RA) affecting the foot and ankle.

An estimated 645,000 people with RA in the UK and more than 90% of people with the disease develop symptoms in the foot and ankle, with resulting difficulties in walking. Many people with RA are unable to walk far or fast and often struggle with mobility tasks such as climbing stairs and walking on uneven ground.

The GREAT Study (Gait Rehabilitation in Early Arthritis Trial) will evaluate whether adding gait rehabilitation intervention to usual treatment results in any additional benefit compared to usual treatment alone in a randomised trial. Gait rehabilitation has been proven to help patients with mobility issues resulting from neurological conditions such as stroke, multiple sclerosis, and Parkinson’s disease but its effectiveness in RA remains unknown.

Gait rehabilitation

A team of researchers in musculoskeletal health, Professor Martijn Steultjens and Dr Gordon Hendry will work with experts in rehabilitation research for rheumatoid arthritis, musculoskeletal pain and disability, rheumatology, physiotherapy, podiatry, psychology, statistics, health economics, mixed-methods and qualitative research and patient representatives will be involved in the trial partners. The following universities are involved: Keele University, King's College London, the University of Salford and the University of Glasgow.

The technique involves undertaking repetitive tasks using a walking circuit, such as stepping over obstacles, combined with behavioural approaches, and aims to help improve posture, balance, and stability. The exercises will be done under supervision by a physiotherapist or podiatrist initially, with support for completion of the walking tasks at home.

The work will involve an initial feasibility study with patients from NHS regions in Scotland and England, followed by a large trial to investigate whether gait rehabilitation should be offered to all people in the early stages of the disease.  Gait rehabilitation has the potential to improve and maintain walking ability in early RA, prevent functional deterioration and promote more physically active lifestyles. The study will also increase awareness of the importance of preserving walking ability early in the disease course of RA.