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, says, in a media release from 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 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 conditions, respectively. Furthermore, approximately two-thirds 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, the release explains.

“PTs can distinguish between inflammatory and noninflammatory conditions,” Feldman states. “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.”

[Source: Healio Rheumatology]