Going Above and Beyond

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Specially trained physiotherapists could help diagnose arthritis faster.
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Axial spondyloarthritis, a type of arthritis that affects the spine, typically begins before the age of 45. Symptoms can start appearing as early as the age of 15.

Up to 84% of Canadians will experience low back pain at some point in their life.

Back pain can be caused by many things, and patients sometimes have to wait a long time before they can see a specialist to have the cause of their back pain diagnosed—years in some cases. This is much too long for some back pain-causing conditions such as axial spondyloarthritis (SpA).

SpA is a form of arthritis that affects the spine and can produce back pain and stiffness. If left untreated, it can lead to severe pain, back deformities and significant disability.

One of the factors that delays diagnosis is the lack of access to rheumatologists, who are doctors specialized in the care of arthritis and other diseases that affect the musculoskeletal system.

A new study led by Krembil Clinician Investigator Laura Passalent examined whether an alternative model of care could help accelerate the detection of SpA for those living with back pain.

The alternative model involved using physiotherapists to supplement the role of rheumatologists. The physiotherapists were provided with additional training to determine whether back pain is likely to be caused by SpA. While physiotherapists typically diagnose and treat different types of injuries, diagnosing SpA is traditionally outside of the scope of their role.

As part of the study, the specially trained physiotherapists assessed 57 patients with back pain for SpA. The records of the same patients were also independently assessed by three rheumatologists.

Ms. Passalent and the other researchers involved in the study found that the diagnoses offered by the physiotherapists agreed with those provided by the rheumatologists up to 80% of the time. The assessment offered by each of the three rheumatologists also matched up to 80% of the time. These findings indicate that the specially trained physiotherapists are comparable to rheumatologists at diagnosing SpA.

“Our study suggests that health care practitioners extending their role, with suitable training, could help reduce bottlenecks in the health care system and improve access to care for SpA patients,” says Ms. Passalent.

This work was supported by the Canadian Initiative for Outcomes in Rheumatology cAre (CIORA).

Passalent L, Hawke C, Lawson D, Omar A, Alnaqbi K, Wallis D, Steinhart H, Silverberg M, Wolman S, Derzko-Dzulynsky L, Haroon N, Inman RD. Advancing early identification of axial spondyloarthritis: An interobserver comparison of extended role practitioners and rheumatologists. J Rheumatol. 2019 May 1. doi: 10.3899/jrheum.180787

Laura Passalent, Clinician Investigator, Krembil Research Institute.