DEVELOPMENT OF THE UK RHEUMATOLOGY PHYSIOTHERAPY CAPABILITIES FRAMEWORK: SCREENING, ASSESSMENT AND SPECIALIST MANAGEMENT

C. McCrum^1,2, H. Chambers³, W. Gregory^4,5

¹University of Brighton, Centre for Health Professions Research, Eastbourne, United Kingdom, ²Canberra Health Service, Rheumatology Dept, Canberra, Australia, ³East Kent Hospitals University NHS Foundation Trust, Physiotherapy Department, Canterbury, United Kingdom, ⁴Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Rheumatology, Salford, United Kingdom, ⁵Manchester Metropolitan University, Department of Health Professions, Manchester, United Kingdom

Background: Rheumatology is a unique area of physiotherapy practice and the capabilities needed to work in this area require unique specialist knowledge and skills to be safe and effective. Physiotherapists are also key in triage, assessment and timely referral of suspected inflammatory conditions as well as their essential role in specialist rheumatology care delivery. There are published recommendations on generic health professional competencies for rheumatology. However, there was no profession-specific guidance on clinical capabilities and profession standards for recognition and referral in musculoskeletal settings or describing and defining rheumatology physiotherapy specialist capabilities across levels and settings.

Purpose: To describe the processes undertaken in developing and publishing a national physiotherapy capabilities framework that encompasses the clinical spectrum of screening, assessment and specialist management of rheumatology conditions and which covers the range of levels and settings of physiotherapy practice.

Methods: A national survey of rheumatology physiotherapy practice was completed in October 2019 which also invited respondents to be involved in development of a rheumatology physiotherapy capabilities framework (Gregory, Burchett & McCrum, 2021). Forty-seven physiotherapists expressed interest and were invited to comment, critique and feedback on a draft rheumatology specialist competency framework developed in parallel with the survey. A modified Delphi process and professional ratification was then undertaken by an expert group of 25 physiotherapists and the final document was informed by invited comment from key stakeholder groups, including higher education, service-users, commissioning, professional bodies, clinical networks, nation/region/clinical setting representation, and non-government/patient organisations. Endorsement was sought and given by the UK Chartered Society of Physiotherapy and British Society of Rheumatology.

Results: The Rheumatology Physiotherapy Capabilities Framework is designed to match the recognition, referral and care pathway of people presenting with symptoms in musculoskeletal and rheumatology specialist settings. The framework progresses through capabilities to support triage, investigations, diagnosis, specialist management, care delivery, quality assurance and improvement, research and practice innovation. Each section includes capabilities across physiotherapy professional levels from support worker, early career, specialist, through to advanced practice and consultant physiotherapy level. It includes non-clinical capabilities required to support provision of care and considered integral to the clinical capability domains. The Framework forms part of a community of other musculoskeletal, rheumatology and professional capability/competency documents, and aligns with EULAR generic core competency recommendations. The online version includes an interactive tool to identify capability levels and gaps to support individual evaluation, career pathways, service developments and accreditation/credentialling strategies.

Conclusions: The Rheumatology Physiotherapy Capabilities Framework is the first document to set physiotherapy-specific standards of knowledge, skill and attributes for assessment and care of people with rheumatology conditions, and essential capabilities for musculoskeletal triage settings to support recognition. Along with providing a professional standard for patient assessment and care, the Framework acts to support safe, effective service delivery, commissioning and guideline implementation, education curricula, career pathways, capability recognition and advances in physiotherapy practice.

Implications: This description of the unique specialist physiotherapy capabilities can be used worldwide to enable people with rheumatology conditions to receive the standard of care recommended across international guidance and to support our profession to provide and advance this care.

Funding acknowledgements: The project was unfunded

Keywords:
Competencies
Rheumatology
Musculoskeletal

Topics:
Rheumatology
Musculoskeletal
Professional practice: other

Did this work require ethics approval? No

Reason: Ethics approval was not required for the development of this professional guidance . The survey informing the competencies development process has been published in a peer-reviewed journal and was deemed to not require ethics approval for this professional survey. Involvement in the framework development was an opt-in process.
Gregory, W., Burchett, S., McCrum, C (2020) Survey of the current clinical practices of the UK rheumatology physiotherapist: A short report.Musculoskeletal Care, Sept, 1-6.