Most physical therapists correctly identify inflammatory arthritis, refer to rheumatologists
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The majority of physical therapists can accurately distinguish between inflammatory and noninflammatory arthritis and understand the importance of correct and prompt referrals to a rheumatologist for suspected inflammatory conditions, according to survey results published in Arthritis Care & Research.
“Currently, the roles of allied health care practitioners are evolving with, for example, physical therapists (PTs) working as first contact clinicians for persons with musculoskeletal problems,” Debbie Ehrmann Feldman, PT, PhD, of the University of Montréal School of Rehabilitation, told Healio Rheumatology. “Furthermore, PTs are permitted to directly refer to specialists in some jurisdictions in Canada. PTs may encounter patients with new inflammatory arthritis. They should be able to correctly suspect such conditions and be aware of the importance of rapid referral to rheumatology for these patients.”
To determine whether physical therapists can correctly identify new onset inflammatory arthritis and are aware that these patients should be seen promptly by a rheumatologist, Feldman and colleagues conducted a cross-sectional survey of licensed physical therapists in Quebec and Alberta practicing in the musculoskeletal field. The survey, which was available online through SurveyMonkey between April 1 and Aug. 30, 2018, described four case scenarios — new-onset rheumatoid arthritis, knee osteoarthritis, new-onset ankylosing spondylitis and lower-back pain.
Participants were asked to identify probable diagnoses — up to three in an open question — and select an appropriate plan of action from the following choices: Electrotherapy, thermotherapy and/or cryotherapy, manual therapy, mobility exercises, strengthening exercises, education and “other, please specify.” Participants were also asked to gauge the degree of importance to refer to various clinicians, including a specialized physical therapist, occupational therapist, family physician, orthopedic surgeon, rheumatologist, neurologist, neurosurgeon or physiatrist. The researchers used logistic regression to analyze the survey results.
A total of 352 responded to the questions. According to the researchers, 90% of participants correctly identified RA, 83% accurately identified OA, 77% recognized AS and 100% were able to identify lower back pain. In addition, 77%, 30%, 73% and 3% of participants, for each respective condition, reported that they felt it was “very” or “extremely important to refer a patient to a rheumatologist for each of those condition respectively. Furthermore, approximately twothirds of participants felt “extremely” or “quite” comfortable in referring a patient to a specialist. However, those practicing in rural areas were less likely to refer.
“PTs can distinguish between inflammatory and noninflammatory conditions,” Feldman said. “They can appropriately refer cases with suspected inflammatory arthritis to rheumatology and feel comfortable to do so. This care pathway may improve clinical care of patients with inflammatory arthritis as it may expedite their trajectory to consult a rheumatologist sooner, which in turn optimizes outcomes for persons with inflammatory arthritis.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Carrie Beach, BSN, RN-BC
I think that most rheumatology health care professionals would agree that the sooner a patient is referred to rheumatology for inflammatory arthritis, such as RA, the better chance a patient has for achieving the best possible outcome due to prompt and proper treatment.
Including other health care professionals, such as physical therapists, to aid in the initial referral to rheumatology seems to be promising, as long as these professionals have proper and adequate training and education in identifying inflammatory arthritis. Our patients have often been treated by a physical therapist for a variety of musculoskeletal disorders or injuries prior to being referred to our office. If a physical therapist is able to effectively identify inflammatory arthritis, I think there can only be improved outcomes for our patients.
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David A. McLain, MD, FACP, FACR
These results were quite encouraging as the therapists were able to identify inflammatory arthritis correctly in the vast majority of cases and would have recommended these cases for referral to a rheumatologist. All physical therapists graduating in the United States will now be doctors of physical therapy, as all pharmacists and nurse practitioners are or will be doctors of their respective fields.
Physical therapists in the U.S. would like to see patients that are self-referred, for example, without the need for a physician or CRNP referral. Studies like this give support to the idea that physical therapy could be a ‘first stop’ for patients with inflammatory arthritis who self-refer to therapy, and are subsequently identified and referred early to rheumatology.
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