Background/Purpose: Polymyalgia Rheumatica (PMR) is the commonest rheumatic condition affecting older people. 35% of newly diagnosed patients report anxiety, (Muller et al., 2016) which, with other symptoms, may significantly impact daily functioning and quality of life. International PMR guidelines (Dejaco et al., 2015) promote an exercise role to maintain independence. This qualitative study explored factors impacting physiotherapy management for people with PMR, including exercise prescription.

Methods: Following ethical approval and piloting, 17 semi-structured telephone interviews were conducted. UK physiotherapists were purposively sampled from consenting survey respondents (aged 25-57 years, mean 20.2 years (SD 10.4) post-qualification) who had varied experience of treating people with PMR. Interviews lasted between 44-87 minutes. The topic guide explored typical clinical presentations, participants’ treatment priorities and the physiotherapists’ role in PMR. Interviews were recorded, transcribed verbatim and analysed inductively using thematic analysis.

Results: Five themes were identified: Patient anxiety; individualised care; treatment inconsistency; physiotherapists’ uncertainty; and their perception of PMR complexity. Physiotherapists reported that patients’ fears of exacerbating symptoms often engendered kinesiophobia and dominated management priorities. Physiotherapists potential explanations for patients’ fear included a learnt mistrust of health professionals; aggravated by provisional diagnoses before getting a definitive PMR diagnosis; anxiety about reliance on glucocorticoid therapy; and sudden onset of disabling PMR symptoms. Physiotherapists reported that patients often lacked the knowledge and confidence to self-manage symptoms.

However, physiotherapists also lacked knowledge and experience. Infrequent PMR referrals, together with patient anxiety, led many participants to conclude PMR can be a complex condition to manage. In particular, physiotherapists were particularly concerned about exacerbating symptoms and distinguishing PMR symptoms from existing comorbid musculoskeletal conditions. Fearing triggering relapse, especially as glucocorticoid dosage was reduced, physiotherapists reported prescribing and progressing exercise cautiously, emphasising the need for individualised advice. Three particular responsibilities for physiotherapists in PMR were reported: discerning and treating underlying musculoskeletal impairments distinguished from inflammatory PMR presentations; integrating psychological and physical findings in holistic assessments; and using exercise therapy to educate and empower people to self-manage.

Conclusion: Both physiotherapists and people with PMR seem to report anxiety, especially around movement exacerbating symptoms. Physiotherapists reported fear of inducing relapse dominating physiotherapy management in people with PMR. Tailored graduated exercise programmes and patient education may, however, successfully address kinesiophobia and empower people to regain function and independence. Further evaluation relating to anxiety in PMR is needed.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-anxiety-fear-and-kinesiophobia-challenges-shared-by-uk-physiotherapists-in-managing-polymyalgia-rheumatica-findings-from-a-qualitative-study/