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. We have shown previously that a physiotherapist can diagnose inflammatory arthritis with an accuracy of 89% (Kirwan and Duffy, 2014).
Objectives This audit set out to ascertain whether a physiotherapist working in a rheumatology new patient clinic, as a first point of contact clinician, misses inflammatory arthritis.
Methods Data was collected consecutively on all patients assessed by the Physiotherapist at the Rheumatology New Patient Clinic from December 2010 to June 2014. Patients who were diagnosed with an inflammatory condition were omitted from this review. The remaining patients were given non-inflammatory diagnoses. Medical charts were reviewed to establish whether any of these patients subsequently developed an inflammatory arthritis.
Results A total of 294 patients were assessed over the time period. 233 patients were diagnosed with a non-inflammatory condition. Seven charts were unavailable at time of review. Of the 226 charts reviewed, none of these patients had developed an inflammatory arthritis. This review did not set out to establish if this group had resolution of their presenting complaint but instead focused on whether any patients presenting with non-inflammatory symptoms were misdiagnosed by the Physiotherapist.
Over a 3 and a half year period and upon completing assessments on 294 patients, our previous study (Kirwan and Duffy, 2014) revealed the Physiotherapist displayed high accuracy when diagnosing inflammatory joint disease. This review highlighted that the Physiotherapist did not miss inflammatory arthritis upon assessment and diagnosis of 226 patients with non-inflammatory conditions.
Conclusions This study highlights the high number of non-inflammatory conditions (79%) seen in a new patient rheumatology clinic. Patients presented with a wide spectrum of symptoms indicating a range of clinical assessments skills are required.
The data indicate that a physiotherapist with specialist training in rheumatology does not miss inflammatory arthritis, and can safely and effectively assess inflammatory (Kirwan and Duffy, 2014) and non-inflammatory conditions, while working in a new patient rheumatology clinic. The findings from this review confirm the value, and benefit, in having a physiotherapist present in rheumatology new patient clinics, to assist in diagnosing and managing the large number of mechanical/degenerative conditions seen.
Kirwan P, Duffy T. Physiotherapist's accuracy in recognizing and diagnosing inflammatory joint disease while working in a new patient rheumatology clinic. (Abstract). In: Ann Rheum Dis 2014;73(Suppl2); 2014 Jun 11-14; Paris, France.
Disclosure of Interest None declared
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