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Feldman DE, Orozco T, Bernatsky S, Desmeules F, El-Khoury J, Laliberté M, Légaré J, Perreault K, Woodhouse L, Zummer M. Do physical therapists follow evidence-based practices for treatment of inflammatory arthritis? Results from an online survey. Physiother Theory Pract 2024; 40:637-646. [PMID: 36238986 DOI: 10.1080/09593985.2022.2135150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Physical therapists (PTs) should know how to best treat patients with inflammatory arthritis. OBJECTIVE To document interventions chosen by PTs for patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and whether choices follow evidence-based practice. METHODS Licensed musculoskeletal PTs in Quebec, Canada responded to an online survey. Descriptive statistics illustrated proportions for each treatment choice and inferential statistics explored associations with demographic and practice-related factors. RESULTS There were 298 PTs who responded to the survey. For both RA and AS respectively, most common interventions were mobility exercises (91.0%; 98.3%) and patient education (90.1%; 92.8%). For both cases, slightly >60% selected strengthening exercises. Passive forms of therapy were chosen by 36% of PTs for RA and 58% for AS. Aerobic exercise was rarely selected. PTs working in the public sector were less likely to use manual therapy for both RA (Odds Ratio (OR) 0.43, 95% confidence interval (CI) 0.22,0.86) and AS (OR 0.46, 95% CI 0.22,0.97). CONCLUSIONS Most PTs chose mobility exercises and patient education, representing evidence-based approaches. Despite current recommendations, strengthening and especially aerobic exercises were not used as much. There is a need to increase awareness regarding the benefits of strengthening and aerobic exercise for these patients.
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Affiliation(s)
- Debbie Ehrmann Feldman
- Physiotherapy Program, Université de Montréal École de Readaptation, Pavillon 7077 Avenue du Parc, C.P. 6128, Succ. Centre-Ville, H3C 3J7, Montreal, Qc, Canada
- Centre for Interdisciplinary Research in Rehabilitation, 6363, Hudson Road, Office 061, Lindsay Pavilion of the IURDPM, H3S 1M9, Montreal, QC, Canada
- Center for Public Health Research, Université de Montréal, 7101 Av du Parc, H3N 1X9, Montréal, QC, Canada
| | - Tatiana Orozco
- Physiotherapy Program, Université de Montréal École de Readaptation, Pavillon 7077 Avenue du Parc, C.P. 6128, Succ. Centre-Ville, H3C 3J7, Montreal, Qc, Canada
| | - Sasha Bernatsky
- McGill University Department of Rheumatology and Clinical Epidemiology, McGill University Health Centre, 5252 de Maisonneuve O, H4A3S5, Montreal Qc, Canada
| | - François Desmeules
- Physiotherapy Program, Université de Montréal École de Readaptation, Pavillon 7077 Avenue du Parc, C.P. 6128, Succ. Centre-Ville, H3C 3J7, Montreal, Qc, Canada
- Research Institute of Hôpital Maisonneuve , Rosemont 5451 de l'Assomption, H1T2M4, Montreal, Qc, Canada
| | - Jonathan El-Khoury
- Université de Sherbrooke et Université du Québec à Chicoutimi Programme de Formation Médicale à Saguenay, Pavillon du Grand Séminaire, 555 Boul de l'Université, G7H2B1, Chicoutim Qc, Canada
| | - Maude Laliberté
- Physiotherapy Program, Université de Montréal École de Readaptation, Pavillon 7077 Avenue du Parc, C.P. 6128, Succ. Centre-Ville, H3C 3J7, Montreal, Qc, Canada
| | - Jean Légaré
- Patients Intéressés par la Recherche en Arthrite, CHU de Québec Université Laval, Arthritis Research, Qc, Canada
| | - Kadija Perreault
- School of Rehabilitation, Université Laval; Center for Interdisciplinary Research in Rehabilitation and Social Integration, 525 Bd Wilfrid-Hamel bureau H-1300, G1M 2S8, Québec, QC, Canada
| | - Linda Woodhouse
- Tufts University School of Medicine Department of Public Health and Community Medicine Doctorate of Physical Therapy Program, 101 E. Washington St., Suite 950, 85004, Phoenix, AZ, USA
| | - Michel Zummer
- Université de Montréal and Hôpital Maisonneuve Rosemont 5451 de l'Assomption, H1T2M4, Montréal, Qc, Canada
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Steen E, McCrum C, Cairns M. A UK survey evaluation of First Contact Practitioners' and musculoskeletal physiotherapists' confidence, recognition, and referral of suspected axial spondyloarthritis. Musculoskeletal Care 2023; 21:380-396. [PMID: 36411378 DOI: 10.1002/msc.1706] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Axial Spondyloarthritis is an inflammatory disease associated with significant diagnostic delays. Steen et al. (2021) found inadequate consideration of axial Spondyloarthritis (axSpA) in physiotherapists back pain assessments. Since the previous survey, increased professional education on axSpA has occurred and First Contact Practitioners (FCPs), now widely established in General Practice, are key in supporting earlier recognition. OBJECTIVES (1) To re-evaluate physiotherapists' and evaluate FCPs' awareness, knowledge, and confidence in screening for and recognising features of axSpA and criteria prompting referral to rheumatology. (2) To compare these results to previous research (Steen et al., 2021). DESIGN As per Steen et al. (2021), an online survey was undertaken combining back pain vignettes (reflecting axSpA, non-specific low back pain [NSLBP] and radicular syndrome) and questioning on features of suspected axSpA. RESULTS 165 surveys were analysed. Only 73% (n = 120/165) of respondents recognised the axSpA vignette compared to NSLBP 91% (n = 80/88) and radicular syndrome 88% (n = 68/77). An improvement in axSpA recognition was demonstrated compared with previous data. FCPs performed slightly better with 77% (n = 67/87) of respondents recognising the axSpA vignette. Adequate awareness of national referral guidance was evident in only 55% of 'clinical reasoning' and 6% of 'further subjective screening' responses. There was still misplaced confidence in recognising clinical features of axSpA compared to knowledge levels shown, including high importance given to inflammatory markers. CONCLUSION(S) Musculoskeletal physiotherapists demonstrate some improved knowledge and awareness of axSpA compared with previous study findings. Consideration of axSpA is still not universal in musculoskeletal physiotherapists' or FCPs' approaches to persistent back pain assessments and awareness of national referral guidance remains limited. This study highlights the continued need for professional education. Enhanced knowledge of screening and referral criteria in musculoskeletal clinical practice would support earlier diagnosis and better outcomes.
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Affiliation(s)
- Eliza Steen
- Manchester Local Care Organisation, Manchester, UK
- University of Hertfordshire, Hatfield, UK
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Knowledge and appropriateness of care of family physicians and physiotherapists in the management of shoulder pain: a survey study in the province of Quebec, Canada. BMC PRIMARY CARE 2023; 24:49. [PMID: 36797670 PMCID: PMC9933814 DOI: 10.1186/s12875-023-01999-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Shoulder pain is difficult to diagnose and treat with half of those affected still symptomatic six months after initial consultation. This may be explained by primary care management not conforming to evidence-based practice. This survey evaluated physiotherapists (PTs) and family physicians' (FPs) knowledge and appropriateness of care in shoulder pain management. METHODS A survey sent to PTs and FPs in the province of Quebec, Canada presented four clinical vignettes with cases of rotator cuff (RC) tendinopathy, acute full-thickness RC tear, adhesive capsulitis and traumatic anterior glenohumeral instability. Respondents indicated diagnosis, indications for imaging, specialists' referrals, and choice of treatments. Answers were compared to recommendations from clinical practice guidelines (CPGs). Participants' responses were compared between types of providers with Fisher's exact test. RESULTS Respondents (PTs = 175, FPs = 76) were mostly women with less than ten years of experience. More than 80% of PTs and 84% of FPs correctly diagnosed cases presented. Despite this practice not being recommended, more FPs than PTs recommended an imaging test in the initial management of RC tendinopathy (30% compared to 13%, p = 0.001) and adhesive capsulitis (51% compared to 22%, p = 0.02). For full-thickness RC tear and shoulder instability, up to 72% of FPs and 67% of PTs did not refer to a specialist for a surgical opinion, although recommended by CPGs. For RC tendinopathy, 26% of FPs and 2% of PTs (p < 0.001) would have prescribed a corticosteroid infiltration, which is not recommended in the initial management of this disorder. For adhesive capsulitis, significantly more FPs (76%) than PTs (62%) (p < 0.001) suggested an intra-articular corticosteroid infiltration, as recommended by CPGs. For all presented vignettes, up to 95% of family physicians adequately indicated they would refer patients for physiotherapy. In prioritizing rehabilitation interventions, up to 42% of PTs did not consider active exercises as a priority and up to 65% selected passive modalities that are not recommended for all shoulder pain vignettes. CONCLUSIONS Most FPs and PTs were able to make adequate diagnoses and select appropriate treatments for shoulder pain, but practices opposed to evidence-based recommendations were chosen by several respondents. Further training of FPs and PTs may be needed to optimize primary care management of different shoulder disorders.
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Orozco T, Feldman DE, Bernatsky S, Légaré J, Perreault K, Tawiah AK, Zummer M, Hudon A. Evaluating a new referral pathway from physical therapists to rheumatologists: A qualitative study. J Interprof Care 2022; 36:932-940. [DOI: 10.1080/13561820.2022.2044295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tatiana Orozco
- École de réadaptation, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Debbie Ehrmann Feldman
- School of Rehabilitation, Physiotherapy Program and School of Public Health, Department of Social and Preventive Medicine, Université de Montréal, Centre for Interdisciplinary Research in Rehabilitation, Institute of Public Health Research, Université de Montréal, Montreal, QC, Canada
| | - Sasha Bernatsky
- McGill University division of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada
| | - Jean Légaré
- Patient Partner Member of Pira, Chu de Québec Université Laval, Arthritis Research, Canada
| | - Kadija Perreault
- School of Rehabilitation, Université Laval; Center for Interdisciplinary Research in Rehabilitation and Social Integration, QC, Canada
| | | | - Michel Zummer
- Université de Montréal and Hôpital Maisonneuve Rosemont, QC, Canada
| | - Anne Hudon
- School of Rehabilitation, Université de Montréal, Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (Crir), Centre de Recherche En Éthique (Cré), Montreal, QC, Canada
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Feldman DE, Zummer M, Orozco T, El-Khoury J, Desmeules F, LalibertÉ M, Perreault K, Grad R, Woodhouse L, Bernatsky S. Rheumatologists' Acceptance of Patient Referrals from Physical Therapists. ACTA ACUST UNITED AC 2021; 16:101-110. [PMID: 33337317 DOI: 10.12927/hcpol.2020.26350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We surveyed Canadian rheumatologists regarding beliefs about physical therapists' (PTs) ability to refer patients appropriately to rheumatologists and whether they would accept such referrals. Most (86.9%) believed that PTs can appropriately refer to rheumatologists. However, only 48.2% of rheumatologists would be very or extremely likely to accept a referral from a PT they knew, and 23.5% would accept a referral from a PT they did not know. Conversely, 90.5% would accept a referral from a PT if they could bill it as a full consult. We conclude that being able to bill PT referrals as full consults may potentially enhance the acceptance of PT referrals.
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Affiliation(s)
- Debbie Ehrmann Feldman
- Professor, School of Rehabilitation, Physiotherapy Program and School of Public Health, Department of Social and Preventive Medicine, University of Montreal; Researcher, Centre for Interdisciplinary Research in Rehabilitation, Centre for Public Health Research, University of Montreal, Montreal, QC
| | - Michel Zummer
- Associate Clinical Professor, University of Montreal, Department of Rheumatology, Maisonneuve-Rosemont Hospital, Montreal, QC
| | - Tatiana Orozco
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC
| | - Jonathan El-Khoury
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC
| | - FranÇois Desmeules
- Associate Professor, School of Rehabilitation, Faculty of Medicine, University of Montreal, Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, Montreal, QC
| | - Maude LalibertÉ
- Assistant Clinical Professor, School of Rehabilitation, University of Montreal, Montreal, QC
| | - Kadija Perreault
- Associate Professor, Department of Rehabilitation, Centre for Interdisciplinary Research in Rehabilitation and Social Integration Laval University, Quebec, QC
| | - Roland Grad
- Associate Professor, Department of Family Medicine, McGill University, Herzl Family Practice Centre, Jewish General Hospital, Montreal, QC
| | - Linda Woodhouse
- Professor and Head of School, School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia; Adjunct Professor, Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB
| | - Sasha Bernatsky
- Professor, Department of Medicine, Faculty of Medicine, McGill University, Department of Medicine, Division of Rheumatology, McGill University Health Centre, Montreal, QC
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