Background Physiotherapists working in triage roles are well established in orthopaedic and spinal clinics, but there is less literature available on their role in rheumatology. Physiotherapy clinical specialist posts were established in Ireland in 2012 to reduce waiting times to see a consultant rheumatologist. One such post had already been in existence in Connolly Hospital, Dublin, Ireland since December 2010.
Objectives The aim of this audit was to assess the accuracy of a physiotherapist in recognising and diagnosing inflammatory joint disease.
Methods Data was collected consecutively on all patients assessed by the Physiotherapist at the Rheumatology New Patient Clinic from December 2010 to July 2013. Patients with a suspected inflammatory diagnosis were assessed and appropriate initial diagnostic tests were ordered. These patients had follow up appointments scheduled with a consultant rheumatologist in order to confirm or refute the initial diagnosis. Medical charts were reviewed to ascertain if the Physiotherapist's initial diagnosis concurred with that of the Consultant Rheumatologist.
Results A total of 223 patients were assessed over the time period. Fifty two patients were suspected of having an inflammatory arthritis. Data was unavailable on 5 of these patients at time of audit as these patients were pending review and diagnosis by the Rheumatologist. Forty two of the remaining 47 patients (89%) were confirmed by the Rheumatologist as having an inflammatory arthritis. Five patients, accounting for 11% of the sample, were given alternative diagnoses upon review by the Consultant Rheumatologist. The Physiotherapist accurately diagnosed 42 of the 47 patients with inflammatory joint disease seen, accounting for an 89% accuracy, or alternatively a 11% error.
It is worth noting that the Rheumatologist had, at the follow up appointment, the results of all diagnostic tests which would have aided in making an accurate diagnosis, whereas the Physiotherapist's diagnoses were made based on the patients' clinical presentation and occasionally with accompanying test results.
Of the 223 patients assessed by the Physiotherapist in the Rheumatology New Patient clinic, 171 patients (77%) presented with non-inflammatory musculoskeletal pain. An audit of the diagnoses/outcomes of these patients is ongoing.
Conclusions The data indicate that a physiotherapist with specialist training in rheumatology can work effectively and safely in a rheumatology new patient clinic. It also highlights the high number of non-inflammatory conditions seen in a rheumatology new patient clinic, thereby confirming the importance of having a physiotherapist present to assist in managing the large number of mechanical and/or degenerative conditions that present to a rheumatology new patient clinic.
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Disclosure of Interest None declared
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