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O'Brien A.V.1,2, Liddle J.2, Muller S.2, Lawton S.3, Whittle R.2, Mason E.2, Mallen C.D.2
1University of Keele, School of Health and Rehabilitation, Keele, United Kingdom, 2University of Keele, Research Institute for Primary Care Health Sciences, Keele, United Kingdom, 3University of Keele, Keele Clinical Trials Unit, Keele, United Kingdom
Background: Polymyalgia Rheumatica (PMR) is the commonest inflammatory musculoskeletal disorder affecting older adults. Whilst physiotherapy interventions are recommended by international guidelines, the supporting evidence base is limited and of poor quality.
Purpose: This study aimed to describe UK based physiotherapists' current practice with PMR patients.
Methods: A UK cross-sectional survey of Health and Care Professions Council registered Physiotherapists working with musculoskeletal patients was undertaken in 2015. Participants were identified from professional (Special Interest) groups and the National Institute for Health Research regional Clinical Research Networks. University Ethical approval was given and UK-wide R&D permissions were granted. The survey questionnaire was developed for self-completion and mailed either by post or electronically, dependent upon available contact details. Questions centred around five key domains: respondent demographics; physiotherapy assessment inclusions; management strategies used (including exercise therapy and education advice); Physiotherapy outcome measures employed; and participant education in PMR. Descriptive statistics summarised anonymised data and response differences between work settings were calculated using the Chi Squared test.
Results: 1,056 physiotherapists participated; a response rate of 24.6%. The mean age of respondents was 44.5 years (SD 10.2); 81.9% of whom (n=891) were female. Participants worked in multiple work settings including: private practice (43%), primary care (36%) and secondary care (31%). Respondents (n=862, 80%) reported that a role exists for physiotherapists in the management of PMR and 197 (18.3%) of respondents reported having a specific interest in inflammatory musculoskeletal conditions. The majority of respondents (n=635; 58%) had assessed between 1-5 patients with PMR in the previous year with 85% (n=992), taking a minimum of 30 minutes to assess a patient with suspected PMR. Others (n=131, 12.5%) reported having autonomy to decide assessment duration depending upon patient need. Of 12 proposed suggestions, three priorities for assessment emerged:
1) to establish a patients knowledge about PMR;
2) perception of pain;
3) an ability to undertake activities of daily living.
Assessing pain was considered more of a priority for private practice physiotherapists (p=0.030), but less important in secondary care hospital workplaces (p≤0.001). Current steroid dosage questions were asked by 1,000 (96%) respondents; 593 (56.8%) of whom enquired in more detail about PMR medications. Accessing serology results was possible for 422 (40.6%) of participants, of these 377 (85%) reported these results always or sometimes impacted upon their subsequent physiotherapy management.
Conclusion(s): This survey is the first known appraisal of contemporary physiotherapy practice with PMR patients. These patients are being referred to UK therapists in all work settings. 80% of respondents believe there is a role for physiotherapy managing and prioritise patient understanding of PMR, pain and activities of daily living in their assessment. Further work is needed to generate best practice physiotherapy evidence to support international clinical guidelines.
Implications: UK Physiotherapists appear to have similar understandings of their role in the management of PMR; to educate, improve daily function and enhance quality of life. More research is however needed to establish which patients benefit optimally and which physiotherapy treatment strategies are most effective.
Funding acknowledgements: National Institute for Health Research UK (Clinical Doctoral Research Fellowship)
Topic: Rheumatology
Ethics approval: Keele University Ethics Committee, Staffordshire, UK
All authors, affiliations and abstracts have been published as submitted.
