Enhancing Access to Physiotherapy in Rheumatoid Arthritis Care: A Critical Examination and Extension of the Candidacy Framework

To critically examine the Candidacy Framework's application to RA care access, including physiotherapy services, and develop an enhanced model that better captures the complexities of chronic condition management in healthcare practice.

A Critical Interpretive Synthesis (CIS) of qualitative and mixed methods literature on access to RA care, including physiotherapy interventions, was conducted. This methodology allowed for the inclusion of diverse study types and encouraged critical engagement with the context and complexities of healthcare access and utilization.

The analysis revealed that while the Candidacy Framework's dimensions were identifiable, they did not fully explain how patients' identities and experiences of RA influenced their access to physiotherapy. The study highlighted the importance of understanding access as a dynamic process influenced by the intersectional nature of the embodied self, requiring consideration of how different parts of a person’s life connect and relate to each other. Person-centered physiotherapy interventions, tailored information, and flexible service configuration emerged as key factors in addressing access challenges for people living with RA.

An enhanced Candidacy Framework, termed Candidacy 2.0, places the intersectional relational self at the center, integrating concepts of recursivity and concordance. The framework provides a strong explanatory model for understanding access to physiotherapy and other care services for chronic conditions, emphasizing the iterative nature of establishing candidacy and the importance of person-centered approaches in physiotherapy practice.

Candidacy 2.0 offers a comprehensive framework to better understand and inform strategies to address access barriers for people with RA and other chronic conditions. It emphasizes the dynamic nature of patients' identities and experiences which can inform the design of more effective and equitable physiotherapy services, improving access and outcomes for people living with chronic conditions like RA. Physiotherapists can use this framework to tailor their interventions, communicate more effectively with patients, and advocate for system-level changes to improve access to care.