Current provision of rheumatology education for undergraduate nursing, occupational therapy and physiotherapy students in the UK

Physical Therapists' Ability to Distinguish Between Inflammatory and Noninflammatory Arthritis and to Appropriately Refer Patients to a Rheumatologist

OBJECTIVE

To investigate whether physical therapists (PTs) can correctly identify new-onset inflammatory arthritis; to assess whether PTs are aware that cases of new-onset inflammatory arthritis should be referred to a rheumatologist; to explore the comfort level of PTs to refer to medical specialists; and to determine factors associated with correctly identifying inflammatory arthritis and referring to a rheumatologist.

METHODS

We sent a questionnaire to PTs in 2 Canadian provinces describing 4 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 medical diagnoses and indicate their plan of action. We described the frequencies of our outcomes and used logistic regression to explore associated factors.

RESULTS

A total of 352 PTs responded. The proportions who correctly identified each of the 4 cases were 90%, 83%, 77%, and 100%, respectively, for RA, OA, AS, and LBP. Among those, 77%, 30%, 73%, and 3%, respectively, indicated that it was "very important" or "extremely important" to refer to a rheumatologist. Approximately two-thirds felt "extremely comfortable" or "quite comfortable" to refer to a specialist. PTs working in rural areas were less likely to refer.

CONCLUSION

Most PTs correctly identified the clinical cases and were aware of the importance of prompt referral to a rheumatologist for inflammatory disease. Most indicated that it was not very important to refer those with OA and LBP. This implies that many PTs can distinguish between inflammatory and noninflammatory conditions and appropriately refer patients with suspected inflammatory arthritis to a rheumatologist.

Better arthritis care: Patients' expectations and priorities, the competencies that community-based health professionals need to improve their care of people with arthritis?

OBJECTIVE

The aim of the present study was to identify the competencies that patients think non-specialist community-based nurses and allied health professionals (AHPs) need to enable them to assess, care for and manage arthritis appropriately.

METHODS

Four face-to-face focus groups were held with a total of 16 women and nine men with arthritis, to discuss the care they received from community-based health professionals, the skills and knowledge they expected from community-based health professionals and what they prioritized.

RESULTS

People with arthritis wanted health providers to have an understanding of the difference between inflammatory arthritis (IA) and osteoarthritis (OA), of how serious OA can be, and of the unpredictability of IA and flares. They emphasized the need for nurses and AHPs to understand the psychosocial impact of arthritis on individuals, family and friends, and the psychological adjustment needed when diagnosed with IA. They wanted community-based health professionals to have some knowledge of the types of drug treatments that people with IA receive and the implications of taking immunosuppressive drugs. They also wanted them to understand the pain associated with arthritis, particularly OA, which participants felt was not taken seriously enough. They wanted nurses and AHPs in the community to be able to give basic advice on pacing and pain management, to make multidisciplinary referrals, to communicate effectively between referral points and to be able to signpost people to sources of help and good, reliable sources of education and information (especially for OA). They also wanted them to understand that patients who have had a diagnosis for a long time are the experts in their own disease. Other areas which were emphasized as being important were good communication skills and taking a holistic approach to caring for people with arthritis.

CONCLUSIONS

OA and IA differ significantly, both in their nature and their management. However, patients with arthritis want health professionals working in the community to be able to take a holistic approach to arthritis, with an understanding not just of the physical effects, but also their impact on the lives of patients, their family and their wider social circle, and on their ability to participate. People with OA want their condition to be taken seriously and to be offered appropriate management options, while people with IA want professionals to understand the unpredictability of their condition and to have a basic understanding of the drugs used for its treatment.

Assessing Implementation Readiness and Success of an e-Resource to Improve Prelicensure Physical Therapy Workforce Capacity to Manage Rheumatoid Arthritis

Study Design Prospective within-subject, cross-sectional, between-group, nested qualitative designs within an implementation science framework. Background Physical therapy is recommended for rheumatoid arthritis (RA) care, yet prelicensure RA curriculum time remains limited. Objectives To determine readiness for, and success of, implementing an e-learning tool, Rheumatoid Arthritis for Physiotherapists e-Learning (RAP-eL), within the prelicensure physical therapy curriculum. Methods All physical therapy students in a 1-year cohort in 2014 had RAP-eL embedded in their curriculum. Rheumatoid Arthritis for Physiotherapists e-Learning is an online platform that delivers RA disease information with translation to clinical practice. Implementation readiness, determined by acceptability of RAP-eL to students, was evaluated using focus groups (n = 23). Implementation success was measured using quantitative data from a previously validated questionnaire, including changes in students' self-reported confidence in knowledge (out of 45) and skills (out of 40) in managing RA after 4 weeks of access to RAP-eL, retention of learning over 14 months, and differences in workforce readiness between students in the cohort who had access to RAP-eL and a historical control cohort. Results Acceptability of RAP-eL was confirmed from qualitative data, demonstrating implementation readiness. Short-term improvements were observed in RA knowledge (mean difference, 16.6; 95% confidence interval [CI]: 15.7, 17.6) and RA skills (mean difference, 14.9; 95% CI: 13.9, 15.9; n = 137). Retention was demonstrated after 14 months (P<.001; n = 62). Students in the 1-year cohort who had RAP-eL embedded in the curriculum scored significantly higher on knowledge (mean difference, 3.6; 95% CI: 1.3, 5.9) and skills (mean difference, 3.3; 95% CI: 0.9, 5.7; n = 62) compared to those without RAP-eL (n = 36). Rheumatoid Arthritis for Physiotherapists e-Learning remains embedded in the curriculum. Conclusion This study demonstrated both readiness and success of the sustainable implementation of RAP-eL within a prelicensure physical therapy curriculum. J Orthop Sports Phys Ther 2017;47(9):652-663. doi:10.2519/jospt.2017.7281.

Better arthritis care: What training do community-based health professionals need to improve their care of people with arthritis? A Delphi study

OBJECTIVE

The aim of the present study was to identify the competencies that non-specialist community-based nurses and allied health professionals (AHPs) need to enable them to assess, care for and manage arthritis appropriately.

METHODS

A Delphi survey with an expert panel of 43 rheumatology specialists and expert patients was used to identify the competencies needed by community-based nurses and AHPs to enable them to improve their care of people with arthritis. The process was informed by feedback from focus groups with arthritis patients, community-based nurses and AHPs.

RESULTS

The core competencies in arthritis care needed by non-specialist community-based nurses and AHPs were identified. The key goals identified were to increase the understanding of arthritis and its impact on patients' lives, and to increase the ability to help patients to self-manage their condition and access support. Competencies included an understanding of the pathology underlying inflammatory and non-inflammatory arthritis, the ability to distinguish between the two and the ability to recognize early warning signs, with an emphasis on osteoarthritis (OA), rheumatoid arthritis, gout and septic arthritis. Essential competencies included the ability to engage in shared decision making, goal setting and signposting, to provide patients with education and information and to make appropriate referrals.

CONCLUSIONS

Health professionals working in the community commonly encounter arthritis as a presenting problem or as a co-morbidity. The quality of care provided to people with inflammatory arthritis and OA in the community is currently variable. The present study identified the core competencies that all community-based nurses and AHPs should have in relation to OA and inflammatory arthritis.

Educational needs of health professionals working in rheumatology in Europe

Objective

To explore the availability of postgraduate education for health professionals (HPs) working in rheumatology in Europe, and their perceived educational needs and barriers for participation in current educational offerings.

Methods

Structured interviews were conducted with national representatives of rheumatology HPs' organisations and an online survey among individual HPs was disseminated through existing European League Against Rheumatism (EULAR) networks (10 languages including English). These comprised questions on: availability of postgraduate education, familiarity with EULAR and its educational offerings, unmet needs regarding the contents and mode of delivery and potential barriers to participate in education (0–10 scales).

Results

According to 17 national representatives, postgraduate rheumatology education was most common for nurses, physical and occupational therapists. There were 1041 individuals responding to the survey, of whom 48% completed all questions. More than half (56%) were familiar with EULAR as an organisation, whereas <25% had attended the EULAR congress or were familiar with EULAR online courses. Educational needs regarding contents were highest for ‘inflammatory arthritis’ and ‘connective tissue diseases’ and regarding modes of delivery for ‘courses organised in own country’ and ‘online courses’. Important barriers to participation included lack of ‘resources’, ‘time’ and ‘English language skills’. Overall, there was considerable variation in needs and barriers among countries.

Conclusions

There is a lack of postgraduate rheumatology education for HPs in most countries. There are opportunities to raise awareness regarding EULAR educational offerings and to develop courses provided in HPs' own country, tailored to national needs and barriers and taking language barriers into consideration.

Understanding the information needs of women with rheumatoid arthritis concerning pregnancy, post-natal care and early parenting: A mixed-methods study

Background

Although women with rheumatoid arthritis (RA) face a number of challenges in negotiating the journey to parenthood, no studies have explored the information needs of women with RA in relation to their childbearing years. This study aimed to determine the need for (and preferred mode/s of delivery of) information regarding pregnancy, post-natal care and early parenting among women with RA.

Methods

Interviews and focus groups were conducted with 27 women with RA who were pregnant in the last 5 years, currently pregnant or planning pregnancy. Verbatim transcripts were analysed using both inductive and deductive approaches. Two validated instruments were used to quantify information needs and preferences: the Educational Needs Assessment Tool (ENAT, range 0-156, higher scores indicate higher educational needs) and the Autonomy Preference Index (API, range 0-100, higher scores indicate stronger preferences).

Results

Lack of information about medication safety, access to physical/emotional support services and practical strategies for coping with daily challenges related to parenting were the most prominent of the six key themes identified. Rheumatologists were the primary source for information regarding treatment decisions while arthritis consumer organisations were perceived as critical ‘resource hubs’. There was strong preference for information delivered electronically, especially among rural participants. Quantitative outcomes supported the qualitative findings; on average, participants reported high educational needs (mean ENAT score 97.2, SD 30.8) and API scores indicated that desire for information (mean 89.8, SD 5.6) was greater than the need for involvement in treatment decision-making (mean 68.4, SD 8.2).

Conclusions

Many women with RA struggle to find adequate information on pregnancy planning, pregnancy and early parenting in relation to their chronic condition, and there is a clear need to develop accessible information that is consumer-focused and evidence-based. Although most participants trusted their rheumatologist as their primary information source, there was consistent demand for more information, particularly regarding the safety of RA medications during pregnancy and breastfeeding, and the importance of learning from other women’s personal experiences was strongly emphasised.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-015-0657-4) contains supplementary material, which is available to authorized users.

The global challenges and opportunities in the practice of rheumatology: white paper by the World Forum on Rheumatic and Musculoskeletal Diseases

Rheumatic and musculoskeletal diseases (RMDs) represent a multitude of degenerative, inflammatory and auto-immune conditions affecting millions of people worldwide. Persons with these diseases may potentially experience severe chronic pain, joint damage, increasing disability and even death. With an increasingly ageing population, the prevalence and burden of RMDs are predicted to increase, placing greater demands on the global practice of rheumatology and related healthcare budgets. Effective treatment of RMDs currently faces a number of challenges in both the developed and developing world, and individual countries may face more specific local challenges. However, limited understanding of the burden of RMDs amongst public health professionals and policy-makers means that these diseases are often not considered a public health priority. The objective of this review is to increase awareness of the RMDs and to identify opportunities to address RMD challenges on both a local and global scale. On 26 September 2014, rheumatology experts from five different continents met at the World Forum on Rheumatic and Musculoskeletal Diseases (WFRMD) to discuss and identify some key challenges for the RMDs community today. The outcomes are presented in this review, focusing on access to rheumatology services, diagnostics and therapies, rheumatology education and training and on clinical trials, as well as investigator-initiated and epidemiological research. The long-term vision of the WFRMD is to increase perception of the RMDs as a major burden to society and to explore potential opportunities to improve global and local RMD care.

The educational needs of nurses and allied healthcare professionals caring for people with arthritis: results from a cross-sectional survey

AIM

The purpose of the present study was to identify the educational needs of rheumatology nurses and allied healthcare professionals (AHPs) working with people with osteoarthritis (OA) and rheumatoid arthritis (RA).

METHODS

A cross-sectional national online survey was carried out.

RESULTS

The survey was completed by 162 health care practitioners. Seventy-one per cent of respondents had the knowledge and skills to manage the care of a person with RA. The elements of care for which the respondents were either unsure or did not have the necessary knowledge and skills related to providing advice on exercise (37%) and pain medication (30%) to people with RA. There was a consistent tendency for respondents to be less confident in their knowledge and skills when caring for people with OA, with respondents reporting that they were either unsure or did not have the necessary knowledge and skills to advise on appropriate exercise (61%), or medication for the management of pain (45%) or the management of ongoing care (51%).

CONCLUSIONS

Current and future educational programmes on RA and OA management should provide nurses and AHPs with the opportunity to develop knowledge and skills in providing advice on exercise and pain medication.

Translating Policy into Practice for Community-Based Management of Rheumatoid Arthritis: Targeting Professional Development Needs among Physiotherapists

Introduction. Contemporary health policy promotes delivery of community-based health services to people with musculoskeletal conditions, including rheumatoid arthritis (RA). This emphasis requires a skilled workforce to deliver safe, effective care. We aimed to explore physiotherapy workforce readiness to co-manage consumers with RA by determining the RA-specific professional development (PD) needs in relation to work and educational characteristics of physiotherapists in Western Australia (WA). Methods. An e-survey was sent to physiotherapists regarding their confidence in co-managing people with RA and their PD needs. Data including years of clinical experience, current RA clinical caseload, professional qualifications, and primary clinical area of practice were collected. Results. 273 physiotherapists completed the survey. Overall confidence in managing people with RA was low (22.7-58.2%) and need for PD was high (45.1-95.2%). Physiotherapists with greater years of clinical experience, a caseload of consumers with RA, postgraduate qualifications in musculoskeletal physiotherapy, or who worked in the musculoskeletal area were more confident in managing people with RA and less likely to need PD. Online and face-to-face formats were preferred modes of PD delivery. Discussion. To enable community-based RA service delivery to be effectively established, subgroups within the current physiotherapy workforce require upskilling in the evidence-based management of consumers with RA.

Canadian physiotherapists' views on certification, specialisation, extended role practice, and entry-level training in rheumatology

Background

Since the last decade there has been a gradual change of boundaries of health professions in providing arthritis care. In Canada, some facilities have begun to adopt new arthritis care models, some of which involve physiotherapists (PT) working in extended roles. However, little is known about PTs' interests in these new roles. The primary objective of this survey was to determine the interests among orthopaedic physiotherapists (PTs) in being a certified arthritis therapist, a PT specialized in arthritis, or an extended scope practitioner in rheumatology, and to explore the associated factors, including the coverage of arthritis content in the entry-level physiotherapy training.

Methods

Six hundred PTs practicing in orthopaedics in Canada were randomly selected to receive a postal survey. The questionnaire covered areas related to clinical practice, perceptions of rheumatology training received, and attitudes toward PT roles in arthritis care. Logistic regression models were developed to explore the associations between PTs' interests in pursuing each of the three extended scope practice designations and the personal/professional/attitudinal variables.

Results

We received 286 questionnaires (response rate = 47.7%); 258 contained usable data. The average length of time in practice was 15.4 years (SD = 10.4). About 1 in 4 PTs agreed that they were interested in assuming advanced practice roles (being a certified arthritis therapist = 28.9%, being a PT specialized in rheumatology = 23.3%, being a PT practitioner = 20.9%). Having a caseload of ≥ 40% in arthritis, having a positive attitude toward advanced practice roles in arthritis care and toward the formal credentialing process, and recognizing the difference between certification and specialisation were associated with an interest in pursing advanced practice roles.

Conclusion

Orthopaedic PTs in Canada indicated a fair level of interest in pursuing certification, specialisation and extended scope practice roles in arthritis care. Future research should focus on the effectiveness and cost-effectiveness of the emerging health service delivery models involving certified, specialized or extended scope practice PTs in the management of arthritis.

Rheumatology education for undergraduate nursing, physiotherapy and occupational therapy students in the UK: standards, challenges and solutions

OBJECTIVES

Rheumatological conditions are common, thus nurses (Ns) occupational therapists (OTs) and physiotherapists (PTs) require at least basic rheumatology knowledge upon qualifying. The aim of this study was to develop a core set of teaching topics and potential ways of delivering them.

METHODS

A modified Delphi technique was used for clinicians to develop preliminary core sets of teaching topics for each profession. Telephone interviews with educationalists explored their views on these, and challenges and solutions for delivering them. Inter-professional workshops enabled clinicians and educationalists to finalize the core set together, and generate methods for delivery.

RESULTS

Thirty-nine rheumatology clinicians (12N, 14OT, 13PT) completed the Delphi consensus, proposing three preliminary core sets (N71 items, OT29, PT26). Nineteen educationalists (6N, 7OT, 6PT) participated in telephone interviews, raising concerns about disease-specific vs generic teaching and proposing many methods for delivery. Three inter-professional workshops involved 34 participants (clinicians: N12, OT9, PT5; educationalists: N2, OT3, PT2; Patient 1) who reached consensus on a single core set comprising six teaching units: Anatomy and Physiology; Assessment; Management and Intervention; Psychosocial Issues; Patient Education; and the Multi-disciplinary Team, recommending some topics within the units receive greater depth for some professions. An innovative range of delivery options was generated plus two brief interventions: a Rheumatology Chat Show and a Rheumatology Road Show.

CONCLUSIONS

Working together, clinicians and educationalists proposed a realistic core set of rheumatology topics for undergraduate health professionals. They proposed innovative delivery methods, with collaboration between educationalists, clinicians and patients strongly recommended. These potential interventions need testing.