Axial Spondyloarthritis is an inflammatory disease associated with significant diagnostic delays. Steen et al. (2021) found inadequate consideration of axial Spondyloarthritis (axSpA) in physiotherapists back pain assessments. Since the previous survey, increased professional education on axSpA has occurred and First Contact Practitioners (FCPs), now widely established in General Practice, are key in supporting earlier recognition.
(1) To re-evaluate physiotherapists’ and evaluate FCPs’ awareness, knowledge, and confidence in screening for and recognising features of axSpA and criteria prompting referral to rheumatology. (2) To compare these results to previous research (Steen et al., 2021).
As per Steen et al. (2021), an online survey was undertaken combining back pain vignettes (reflecting axSpA, non-specific low back pain [NSLBP] and radicular syndrome) and questioning on features of suspected axSpA.
165 surveys were analysed. Only 73% (n = 120/165) of respondents recognised the axSpA vignette compared to NSLBP 91% (n = 80/88) and radicular syndrome 88% (n = 68/77). An improvement in axSpA recognition was demonstrated compared with previous data. FCPs performed slightly better with 77% (n = 67/87) of respondents recognising the axSpA vignette. Adequate awareness of national referral guidance was evident in only 55% of ‘clinical reasoning’ and 6% of ‘further subjective screening’ responses. There was still misplaced confidence in recognising clinical features of axSpA compared to knowledge levels shown, including high importance given to inflammatory markers.
Musculoskeletal physiotherapists demonstrate some improved knowledge and awareness of axSpA compared with previous study findings. Consideration of axSpA is still not universal in musculoskeletal physiotherapists’ or FCPs’ approaches to persistent back pain assessments and awareness of national referral guidance remains limited. This study highlights the continued need for professional education. Enhanced knowledge of screening and referral criteria in musculoskeletal clinical practice would support earlier diagnosis and better outcomes.
Demonstrated the importance of physiotherapists in early recognition and referral of axial SpA. Exploration of 263 people (age 17- 69 years) diagnosed with spondyloarthritis during the period 1990 – 2016, who had received outpatient physiotherapy care prior to their diagnosis. Average time from initial physiotherapy visit to diagnosis with SpA was 6.4 years. The most common clinical diagnostic codes assigned to these episodes of care included back pain (49.6%), shoulder (11.1%), knee (8.5%), neck (7.7%), ankle/foot (4.3%), tendonitis (4.2%), joint pain (3.4%), osteoarthritis (3.4%) and sacroiliac joint (2%). 44% received 3 or more physiotherapy episodes prior to diagnosis – number of contacts within each episode ranging from 3 (47 people) to 58 (1 person), a median of 11 contacts per episode (10 people).
Suggested that musculoskeletal physiotherapists may not be giving adequate consideration to axial SpA in back pain assessments. Awareness of national referral guidance was also limited. 132 survey responses were analysed. Only 67% (88/132) of respondents identified inflammatory pathologies as a possible cause of persistent back pain. Only 60% (79/132) recognised the axial SpA vignette compared to non-specific low back pain (94%) and radicular syndrome (80%). Most suspecting axial SpA would refer for specialist assessment (77/79; 92%). Awareness of national referral guidance was evident in only 50% of ‘clinical reasoning’ and 20% of ‘further subjective screening’ responses. There was misplaced confidence in recognising clinical features of axial SpA compared to knowledge levels shown, including high importance given to inflammatory markers and HLA-B27. Good awareness of the NICE 2017 guidance on SpA and continued professional development was associated with better awareness and knowledge of axial SpA features. Professional education on screening and referral for suspected axial SpA is needed to make axial SpA screening and referral criteria core knowledge in musculoskeletal clinical practice, to support earlier diagnosis and better outcomes for patients.
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