Background/Purpose:

Early referral to rheumatology of persons with suspected inflammatory rheumatic disease is associated with better outcomes. Persons with undiagnosed rheumatic disease may directly consult a physical therapist (PT) in the Canadian private sector without physician referral.

Our objectives were:

1) To investigate whether PTs can correctly identify new-onset inflammatory arthritis and differentiate between these cases and other musculoskeletal problems;

2) To assess whether PTs are aware that persons with new-onset inflammatory arthritis should be seen promptly by a rheumatologist.

Methods:

We sent a questionnaire to PTs in two Canadian provinces (Quebec and Alberta, where PTs are permitted to refer patients directly to medical specialists) describing four case scenarios (new-onset rheumatoid arthritis – RA; knee osteoarthritis – OA; new-onset ankylosing spondylitis – AS; and low back pain- LBP). Participants were asked to identify probable diagnoses, and indicate their plan of action. Questionnaires were sent via professional licensing bodies and associations and completed through an online platform.

Results:

There were 303 PTs who responded to the survey (290 in Quebec and 13 in Alberta). Most PTs (67.6%) were between 18 and 45 years of age, 77.9% were female and 76.4% had more than 5 years experience. The proportions who correctly identified each of the four cases were: 87.7, 82.8, 73.4, 100% respectively for RA, OA, AS, and LBP. The majority (77%) of respondents who correctly identified the case as RA/inflammatory arthritis indicated that it was very important or extremely important to refer to a rheumatologist. Similarly, 70.4% of those who correctly identified the case of AS/inflammatory arthritis said it was very important or extremely important to refer the patient to a rheumatologist. Of those who correctly identified the case of OA, 29.9% said that it was very or extremely important to do so. For the case of LBP, only 0.5% said that it was at least very important to refer to a rheumatologist. In terms of comfort level to refer to a specialist, the majority of respondents (63.1%) felt extremely or quite comfortable.

Conclusion:

The majority of PTs correctly diagnosed the clinical cases and were aware of the importance of prompt referral to rheumatology of patients with suspected inflammatory disease. Most indicated that it was not very important to refer those with OA and the overwhelming majority would not refer those with LBP. The implications are that many PTs can distinguish between those with inflammatory and noninflammatory conditions and appropriately refer suspected inflammatory arthritis to rheumatology.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/physical-therapists-ability-to-recognize-inflammatory-arthritis-cases-and-awareness-of-importance-for-their-prompt-referral-to-rheumatology/