Background/Purpose: The prevalence of SpA in patients with inflammatory bowel disease (IBD) ranges from 3.1 – 10%, compared to <1% in the general population, defining IBD patients as high risk for developing SpA. Traditional referral pathways to rheumatologists are associated with lengthy wait times for patients with suspected inflammatory arthritis. In order to address the need to improve access to care, there has been interest in traditional role expansion using non-physician models of care. One such model has been to train advanced practice physiotherapists (APPs) in the assessment/treatment of patients with inflammatory arthritis. The purpose of this study was to implement and evaluate a unique screening program for IBD patients with suspected SpA, led by an APP. The objectives were to: measure wait times from the day of referral to the day of screening; measure a) the clinical agreement for screening results and b) agreed recommendation of MRI for further assessment between the APP and three rheumatologists with expertise in SpA, and, compare the confidence of clinical judgment between the APP and rheumatologists.
Methods: Patients attending gastroenterology clinics with a diagnosis of IBD and ≥ 3 months of back pain were referred to the program. Patients who demonstrated signs and symptoms indicative of inflammatory back pain (i.e. positive screen) were referred to the Rheumatology Clinic for diagnosis. Patients who screened negative, were provided with education on appropriate back care. Descriptive statistics described clinical characteristics and wait times. Kappa coefficient (k) measured interobserver agreement and Pearson’s Correlation compared confidence of the screening results of the APP and the rheumatologists. Bivariate analyses were based on “paper patients” reviewed by the rheumatologists that included clinical and investigative results of patients previously screened by the APP.
Results: A total of 20 patients were referred to the screening program. Most patients were men (55%), and the mean age was 40.9 years ±11.8. The average duration of back pain was 9.8 years; 65% reported insidious onset. The mean Oswestry disability index was 20.3 ±13.5, indicating minimal disability resulting from back pain. The median wait time was 13 days. The APP agreed with the rheumatologists’ screening results on an average of 71.4% (k=0.5; CI: 0.07-0.87) of patients. The APP agreed with the rheumatologists to recommend MRI for further assessment on an average of 66.7% (k=0.6; CI: 0.23-0.94) of patients screened. Comparison of confidence of screening results was 6.8/10 (higher values indicating higher level of confidence) for the APP versus an average confidence level of 6.4/10 for the three rheumatologists (Pearson’s = 0.3).
Conclusion: The utilization of the APP to screen for inflammatory back pain in patients with IBD demonstrates clinical judgement that is aligned with that of rheumatologists with expertise in SpA. The level of confidence of the APP was similar to the rheumatologists’. Wait times to be screened by the APP are shorter than traditional referral pathways. This screening strategy has the potential to improve access to care and act as a model of care for patients at high risk for SpA.
Disclosure:
L. A. Passalent,
None;
R. Morton,
None;
K. A. Alnaqbi,
None;
N. Haroon,
None;
S. Wolman,
None;
M. Silverberg,
None;
A. H. Steinhart,
None;
R. D. Inman,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-novel-approach-to-the-early-detection-of-axial-spondyloarthritis-in-patients-with-inflammatory-bowel-disease-the-implementation-of-an-advanced-practice-physiotherapist-led-screening-program/