Background The prevalence of spondyloarthritis (SpA) in patients with inflammatory bowel disease (IBD) is 3.1 - 10%, compared to <1% in the general population, defining IBD patients as high risk for developing SpA1. Traditional referral pathways to rheumatologists are associated with average wait times of up to 13 weeks2. A novel, non-physician based model of care was introduced with an advanced practice physiotherapist (APP) assessing patients for SpA.
Objectives To implement and evaluate a unique APP-led screening program for IBD patients with suspected SpA. The objectives were to measure: wait times from the day of referral to the day of APP screening, the clinical agreement of screening results between the APP and three Rheumatologists with expertise in SpA, assess the agreement for recommendation of MRI between the APP and Rheumatologists and compare the confidence of clinical judgment between the APP and Rheumatologists.
Methods Patients attending gastroenterology clinics with a diagnosis of IBD and ≥ 3 months of back pain were referred to the program. Patients demonstrating signs and symptoms of SpA were referred to the rheumatology clinic. Alternatively, patients who screened negative were provided with education on appropriate back care by the APP. Descriptive statistics, Kappa coefficient (k), Pearson’s Correlation and bivariate analyses were used for data analysis.
Results A total of 20 patients were referred to the screening program. Most patients were men (55%). Mean age was 40.9 years ±11.8. Average duration of back pain was 9.8 years; 65% reported insidious onset. Mean Oswestry disability index was 20.3 ±13.5, indicating minimal disability from back pain. The median wait time was 13 days. The APP agreed with the rheumatologists’ screening results an average of 71.4% (k=0.5; CI: 0.07-0.87). The APP agreed with the rheumatologists to recommend MRI for further assessment an average of 66.7% (k=0.6; CI: 0.23-0.94). Comparison of confidence of screening results was 6.8/10 (higher values indicating higher level of confidence) for the APP versus an average confidence level of 6.4/10 for the three rheumatologists (Pearson’s = 0.3).
Conclusions Utilizing an APP to screen SpA in patients with IBD demonstrates clinical judgement aligned with that of rheumatologists with expertise in SpA. Wait times to be screened by the APP are shorter than traditional referral pathways. This screening strategy has the potential to improve access to care and act as a care model for patients at high risk for SpA.
Palm O, Moum B, Ongre A, Gran JT. Prevalence of ankylosing spondylitis and other spondyloarthopathies among patients with inflammatory bowel disease: a population study (the IBSEN study) Journal of Rheumatology March 1, 2002 vol. 29 no. 3 511-515
Badley E, Veinot P, Ansari H, MacKay C. 2007 survey of rheumatologists in Ontario. Arthritis Community Research & Evaluation Unit (ACREU). Working Paper (08-03), 2008
Acknowledgements Funding for this research was made possible by a Canadian Initiative for Outcomes in Rheumatology Care (CIORA) grant received in 2011.
Disclosure of Interest None Declared