Table 3 Barriers to application of recommendations
Recomm.ItemArabian GulfBelgiumCzech R.FranceGermanyItalyNetherlandsNorwaySpainUKAll countries
1There is no barrier29 (32.6)37 (44.1)23 (31.5)234 (56.7)151 (50.2)66 (38.4)31 (42.5)31 (43.1)53 (44.5)22 (19.8)677 (44.9)
Consultation time to conduct assessment fully21 (23.6)22 (26.2)19 (26.0)55 (13.3)72 (23.9)47 (27.3)33 (45.2)20 (27.8)59 (49.6)45 (40.5)393 (26.1)
2There is no barrier16 (18.0)20 (23.8)17 (23.3)145 (35.1)140 (46.5)46 (26.7)16 (21.9)25 (34.7)18 (15.1)13 (11.7)456 (30.3)
Lack of time to conduct frequent monitoring33 (37.1)42 (50.0)33 (45.2)NA58 (19.3)68 (39.5)38 (52.1)29 (40.3)84 (70.6)79 (71.2)464 (42.4)*
3There is no barrier28 (31.5)33 (39.3)13 (17.8)138 (33.4)107 (35.6)32 (18.6)50 (68.5)30 (41.7)26 (21.9)25 (22.5)482 (32.0)
Insufficient number of qualified health professionals—eg, physiotherapists23 (25.8)11 (13.1)18 (24.7)70 (16.9)44 (14.6)97 (56.4)4 (5.5)12 (16.7)67 (56.3)45 (40.5)391 (25.9)
Lack of facilities for education19 (21.4)10 (11.9)19 (26.0)122 (29.5)59 (19.6)62 (36.1)2 (2.7)11 (15.3)60 (50.4)14 (12.6)378 (25.1)
4There is no barrier10 (11.2)16 (19.1)16 (21.9)72 (17.4)79 (26.25)14 (8.14)34 (46.6)23 (31.9)9 (7.6)24 (21.6)297 (19.7)
Lack of patient compliance with recommendations49 (55.1)51 (60.7)47 (64.4)214 (51.8)121 (40.2)74 (43.0)24 (32.9)28 (38.9)63 (52.9)39 (35.1)710 (47.1)
Lack of facilities for education36 (40.5)18 (21.4)21 (28.8)158 (38.3)99 (32.9)59 (34.3)4 (5.5)15 (20.8)60 (50.4)26 (23.4)496 (32.9)
Insufficient number of qualified health professionals—eg, physiotherapists35 (39.3)16 (19.1)28 (38.4)73 (17.7)55 (18.3)104 (60.5)4 (5.5)17 (23.6)67 (56.3)56 (50.5)455 (30.2)
5There is no barrier42 (47.2)10 (11.9)30 (41.1)223 (54.0)141 (46.8)44 (25.6)42 (57.5)12 (16.7)46 (38.7)38 (34.2)628 (41.7)
Concerns about the safety of long-term use of NSAIDs/COX-2 inhibitor34 (38.2)50 (59.5)37 (50.7)117 (28.3)95 (31.6)73 (42.4)17 (23.3)42 (58.3)48 (40.3)57 (51.4)570 (37.8)
6There is no barrier29 (32.6)17 (20.2)25 (34.3)223 (54.0)160 (53.2)79 (45.9)41 (56.2)11 (15.3)64 (53.8)65 (58.6)714 (47.4)
Fear of addiction/tolerance to opioids with long-term use38 (42.7)50 (59.5)35 (47.9)99 (24.0)61 (20.3)46 (26.7)14 (19.2)51 (70.8)25 (21.0)31 (27.9)450 (29.9)
7There is no barrier37 (41.6)37 (44.1)40 (54.8)182 (44.1)149 (49.5)64 (37.2)45 (61.6)29 (40.3)59 (49.6)66 (59.5)708 (47.0)
Patient concerns about use of corticosteroid injections43 (48.3)31 (36.9)27 (37.0)157 (38.0)78 (25.9)55 (32.0)11 (15.1)25 (34.7)36 (30.3)21 (18.9)484 (32.1)
8There is no barrier46 (51.7)42 (50.0)47 (64.4)255 (61.7)175 (58.1)97 (56.4)54 (74.0)35 (48.6)70 (58.8)66 (59.5)887 (58.9)
9There is no barrier21 (23.6)24 (28.6)5 (6.9)175 (42.4)119 (39.5)55 (32.0)43 (58.9)22 (30.6)49 (41.2)13 (11.7)526 (34.9)
Insufficient funding41 (46.1)6 (7.1)57 (78.1)32 (7.8)102 (33.9)38 (22.1)3 (4.1)19 (26.4)20 (16.8)73 (65.8)391 (25.9)
Administrative burden associated with anti-TNF treatment26 (29.2)24 (28.6)24 (32.9)101 (24.5)48 (16.0)74 (43.0)13 (17.8)9 (12.5)39 (32.8)28 (25.2)386 (25.6)
10There is no barrier27 (30.3)26 (30.9)23 (31.5)193 (46.7)184 (61.1)61 (35.5)48 (65.8)34 (47.2)44 (36.9)68 (61.3)708 (47.0)
  • Items ticked by more than 25% of rheumatologists are presented.

  • For each item: number (percentage) where the item was ticked.

  • *Percentage of available data.

  • NA, not available, NSAIDs, non-steroidal anti-inflammatory drugs; Recomm., recommendation; TNF, tumour necrosis factor.