***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Rheumatoid arthritis ( RA ) frequently causes  foot pain and swelling that affect ambulation . Pharmaceutical management of pain and disability is st and ard in clinical practice . The use of functional posted foot orthoses , as an adjunct to pharmaceutical treatment , is a promising treatment for managing  foot pain and disability in RA . Its effectiveness , however , has not been rigorously evaluated . We performed a double-blind clinical trial using foot orthoses vs. placebo orthoses in the management of the rheumatoid arthritic foot , while subjects continued customary treatment . On the basis of findings of no effect on disability and pain measures , this study indicates no benefit of functional posted foot orthoses over placebos Purpose . To compare the effectiveness of functional foot orthoses and unshaped ( flat ) orthotic material on plantar pressure redistribution , forefoot pain reduction and walking ability in rheumatoid arthritis ( RA ) patients . Methods . Forty patients with RA were r and omised  to receive unshaped material ( UM ) ( n = 20 ) or functional foot orthoses ( n = 20 ) . Plantar pressure measurement was performed with an F-scan system . Foot pain was assessed by the pain subscale of the Foot Function Index . Walking ability was assessed by the 6-min walking test . Investigations were performed at baseline , 1 week after the patient received shoes with orthoses and 6 months later . Results . Plantar pressures were significantly higher at painful than at non-painful foot areas . No differences in plantar pressure redistribution were found between the groups . Notable reduction of pain and improvement of activity ( walking ability ) was observed in both groups . Foot pain has moderate impact on the walking ability of RA patients . Conclusions . The study showed no clear advantage of functional foot orthoses over UM Abstract The objective of this study was to evaluate the long-term benefits of sharp scalpel debridement of painful forefoot plantar callosities in rheumatoid arthritis ( RA ) . The null hypothesis : sharp scalpel debridement would offer no additional long-term advantage in terms of pain and function .  Sixty-five people with RA were r and omised to receive regular sharp scalpel debridement of painful forefoot plantar callosities in conjunction with a combined therapeutic approach or a combined therapeutic approach alone . The primary outcome measure was change at 18 months in participant-reported forefoot plantar pain measured by a 100-mm visual analogue scale ( VAS ) . Secondary outcome measures were recorded at baseline and study exit and included revised Foot Function Index , Health Assessment Question naire , Foot Impact Scale and gait parameters . At 18 months , there were no differences between groups for the primary outcome VAS-measured forefoot plantar pain ( left foot ( F = 0.23 , p = 0.635 ) , right foot ( F = 2.14 , p = 0.148 ) ) . Within-group changes were highly significant ( treatment arm , difference = 16.9 ( 95 % confidence interval ( CI ) 9.4 , 24.4 ) , t = 4.6 , p < 0.0001 ; control arm , difference = 17.5 ( 95 % CI 9.4 , 25.5 ) , t = 4.4 , p < 0.0001 ) . There was little change in scores of overall function and foot impact in either group and there were no significant changes in gait parameters noted . The long-term effects of sharp scalpel debridement of painful forefoot plantar callosities in people with RA , when used in conjunction with a combined therapeutic approach , produced no additional benefit over the combined therapeutic approach alone . Trial registration http://www.controlled-trials.com/IS RCT A linear analogue for rating  pain with 10 , 15 and 20 cm lines is significantly less variable than a 5 cm line ( mean error of 15 cm line is 0 - 19 % , 95 % confidence limits for the group + /- 2 % and an inood correlation between repeated ratins of a recalled pain distant in time . The variance of the rating is significantly less than the repeated rating of a r and om mark . The linear analogue rating of a constant pain stimulus is reproducible and changes in rating are likely to be real changes of opinion . Pethidine 150 mg intramuscularly had no significant effect , tested 30 minutes after the administration , on the accuracy or reproducibility of the analogue rating . A linear analogue seems a suitable method of recording the patient 's opion of a severe pain such as that of labour Background Whilst evidence exists to support the use of single treatments such as orthoses and footwear , the effectiveness of podiatry-led care as a complex intervention for patients with rheumatoid arthritis ( RA ) related foot problems is unknown . The aim of this study was to undertake an exploratory r and omised controlled parallel arm clinical trial ( RheumAFooT ) to inform the design and implementation of a definitive trial and to underst and the potential benefits of this care . Methods Patients with a definite diagnosis of RA , stable drug management 3 months prior to entry , and a current history of foot problems ( pain , deformity , stiffness , skin or nail lesions , or footwear problems ) were recruited from a hospital outpatient rheumatology clinic and r and omised to receive 12 months of podiatry treatment or no care . The primary outcome was change in foot health status using the impairment/footwear ( LFISIF ) and activity limitation/participation restriction ( LFISAP ) subscales of the Leeds Foot Impact Scale . Disease Activity Score ( DAS ) , Health Assessment Question naire ( HAQ ) score and walking speed ( m/s ) were also recorded . Results Of the 80 patients identified , 64 patients were eligible to participate in the pilot and 34 were recruited . 16 patients were r and omised to receive podiatry led foot care and 18 received no care . Against a backdrop of stable disease ( DAS and HAQ scores ) , there was a statistically significant between group difference in the change in foot health status for foot impairment ( LFISIF ) but not activity/participation ( LFISAP ) or function ( walking speed ) over 12 months . In the podiatry arm , 1 patient declined treatment following r and omisation ( did not want additional hospital visits ) and 3 self-withdrew ( lost to follow-up ) . Patients received an average of 3 consultations for assessment and treatment comprising routine care for skin and nail lesions ( n = 3 ) , foot orthoses  ( n = 9 ) ,  footwear referral to the orthotist ( n = 5 ) , and ultrasound guided intra-articular steroid injection ( n = 1 ) . Conclusion In this exploratory trial patients were difficult to recruit ( stable drug management and co-morbid disease ) and retain ( lack of benefit/additional treatment burden ) but overall the intervention was safe ( no adverse reactions ) . Twelve months of podiatry care maintained but did not improve foot health status . These observations are important for the design and implementation of a definitive r and omised controlled trial . Trial Registration IS RCT N : Foot orthotic treatment is one of the major conservative methods used to h and le foot problems .  Total plantar contact foot orthoses are used to reduce and redistribute peak pressures . For the fabrication of a total plantar contact foot orthosis , the computer-aided design and computer-aided manufacturing ( CAD-CAM ) method has been applied . In this study , the plantar foot-orthosis interface pressure data during walking were collected by the Novel Pedar-mobile in-shoe plantar pressure measuring system . The data were collected under three conditions : ( i )  Flat insole  , ( ii )  foot orthosis  provided by the CAD-CAM method  , and ( iii )  foot orthosis provided by the foam impression method . The Swiss Comfort CAD-CAM foot orthotics system was used in this study . For conditions ( ii ) and ( iii ) , foot shapes were collected in partial weight bearing and subtalar neutral conditions . Thirty normal subjects were recruited for this study . The plantar foot surface was divided into eight plantar foot regions and then was investigated . These regions included the heel , the medial and lateral arches , the medial , mid and lateral forefoot , the hallux , and the lateral toes . The results showed that the orthoses provided by both the CAD-CAM and foam impression methods could decrease the peak pressure and the maximum force in the heel region , and increase the peak pressure and the maximum force in the medial arch region . Both orthoses redistributed the peak pressure and the maximum force from the heel to the medial arch region . The peak pressure in the mid forefoot region was different between the orthoses provided by the CAD-CAM and foam impression methods Background : We examined four commonly used scores , the SF-36 , the  Ankle Osteoarthritis Scale ( AOS )  , the  American Orthopaedic Foot and Ankle Society ( AOFAS ) Ankle Hindfoot Score  , and the  Foot Function Index ( FFI )  to determine their responsiveness and validity . Methods : Patients with end stage ankle arthritis were recruited into a prospect i ve multicenter cohort study and baseline and one year outcome scores were compared . The St and ardized Response Mean and Effect Size for the AOS , AOFAS , and FFI were calculated and the three region- or disease-specific scores were compared with the SF-36 to determine their criterion validity . Results : All four scores showed acceptable responsiveness , and when using the vali date d SF-36 as the st and ard the three region or disease specific scores all showed similar criterion validity . Conclusion : All four scores are responsive and can be considered for use in this population . The objective component of the AOFAS Ankle Hindfoot Score may make it harder to perform than the other three scores which have subjective components only , and as yet its objective component has not been shown to demonstrate reliability . We recommend use of a purely subjective score such as the Ankle Osteoarthritis Scale or Foot Function Index as the region- or disease-specific score of choice in this population . As the SF-36 shows acceptable responsiveness , using it alone could also be considered . Level of Evidence : II , Prospect i ve Comparative Purpose This study examines the responsiveness of the Foot Functional Index ( FFI ) and Leeds Foot Impact Scale for Rheumatoid Arthritis ( LFIS-RA ) in rheumatoid arthritis ( RA ) patients receiving a forefoot or hindfoot reconstruction .  Methods This was a prospect i ve cohort study including 30 rheumatoid arthritis patients with severe rheumatoid foot deformities in need for surgical correction .  Responsiveness was measured using distribution-based methods ( st and ardized effect size , st and ardized response mean and Guyatt responsiveness ratio ) and anchor-based methods ( receiver operating characteristics curves and correlation analyses ) by making use of an anchor question . To examine the depth of the question naires we measured the floor and ceiling effects . Results The study population consisted of three males and 27 females , with a mean age of 62 years . The mean follow-up time was 38 months . Twenty-two feet received a forefoot reconstruction and eight feet a triple arthrodesis . For the FFI the SES was −0.80 , SRM was −0.85 and the GRR was −1.25 . For the LFIS-RA the SES was 0.58 , SRM was 0.58 and the GRR was 0.88 . The AUC was 0.741 and 0.645 for FFI and LFIS , respectively . Contrary to the LFIS-RA , the FFI showed a significant correlation between change score and the anchor question . Both question naires did not show a significant floor or ceiling effect . Conclusion The FFI showed a large responsiveness and the LFIS- RA showed moderate responsiveness in rheumatoid arthritis patients receiving forefoot or hindfoot surgery , without floor or ceiling effects in both question naires BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . OBJECTIVE To investigate the clinical effectiveness of early foot orthosis intervention for painful correctable valgus deformity of the rearfoot in rheumatoid arthritis ( RA ) . METHODS Patients with RA were r and omized to receive custom manufactured rigid foot orthoses under podiatry supervision ( n = 50 ) or enter a control group ( n = 48 ) . The control group received foot orthoses only when prescribed under normal medical care . Foot pain and disability , using the Foot Function Index ( FFI ) , along with disease activity , tolerance , 
    Output:
    
Although the use of orthoses seems to alleviate foot pain , our meta- analysis did not reveal statistically significant differences between control and intervention groups regarding long- and short-term pain relief and /or reduced disability .
Conclusions Foot orthoses can relieve pain and disability and enhance patients , but no significant differences were found between control and intervention groups