Long diagnostic delays for patients with Axial Spondyloarthritis: Do Norwegian physiotherapists identify patients where this disease is probable? - A cross-sectional survey
Translated title
Lang diagnosetid for pasienter med Aksial Spondyloartritt: Gjenkjenner norske fysioterapeuter pasienter som bør utredes for sykdommen? - Et tverrsnittstudie
Author
Giladi, Jonathan
Term
4. Semester
Publication year
2022
Pages
56
Abstract
Baggrund: Mange mennesker med aksial spondylartrit (AxSpA) – en inflammatorisk gigtsygdom, der ofte viser sig som langvarige lænderygsmerter – oplever store diagnostiske forsinkelser. I Norge er den gennemsnitlige forsinkelse rapporteret til 10,6 år. Sen diagnose hænger sammen med mere alvorlig sygdom og dårligere forløb. En mulig årsag er begrænset kendskab i primærsektoren, herunder hos fysioterapeuter. Formål: At undersøge norske fysioterapeuters evne til at genkende mulig AxSpA og deres valg af henvisning. Vi så også på faktorer forbundet med korrekt identifikation og korrekt henvisning, samt hvor trygge fysioterapeuter er ved at henvise, og i hvilken grad de oplever, at læger tager deres henvendelser alvorligt. Metode: Et online spørgeskema blev distribueret via sociale medier og faglige netværk. Det omfattede demografiske spørgsmål og fire vignetter med patienter med lænderygsmerter; to vignetter repræsenterede mulig AxSpA. Data blev analyseret med deskriptiv statistik og odds ratio (OR) for at undersøge sammenhænge mellem demografiske faktorer og korrekt identifikation/henvisning. Resultater: 149 svar blev analyseret. 79% (95% KI 71–84%) identificerede AxSpA som en mulig diagnose i vignette 1, men kun 23% (95% KI 17–31%) i vignette 4. De fleste, men ikke alle, ville henvise disse patienter til videre udredning. Ret til at henvise (OR 5,30; 95% KI 2,15–13,07), at mere end halvdelen af patienterne havde lænderygsmerter (OR 4,92; 95% KI 2,11–11,46) og en kandidatgrad (master) (OR 2,49; 95% KI 1,08–5,74) var forbundet med korrekt identifikation og henvisning. Flertallet følte sig trygge ved at henvise patienter med mistanke om underliggende sygdom, og cirka halvdelen (49%) oplevede, at læger tog deres henvisninger/konferering alvorligt i høj eller meget høj grad. Konklusion: Fysioterapeuter i Norge spiller en nøglerolle i frontlinjen for patienter med lænderygsmerter og har ansvar for at opspore patienter med mulig underliggende sygdom som AxSpA. Da diagnostiske forsinkelser er lange, peger resultaterne på, at fysioterapeuter er en vigtig målgruppe for information om AxSpA, dets varierede symptombillede og klare henvisningsstrategier for at forsøge at forbedre situationen.
Background: Many people with axial spondyloarthritis (AxSpA)—an inflammatory arthritis that often presents as long‑lasting low back pain—face long delays before diagnosis. In Norway, the average delay has been reported as 10.6 years. Delayed diagnosis is linked to more severe disease and worse outcomes. One possible reason is limited awareness in primary care, including among physiotherapists. Objectives: To examine how well Norwegian physiotherapists recognize possible AxSpA and whether they would refer such patients for further assessment. We also assessed which factors were associated with correct identification and referral, and explored physiotherapists’ comfort with referring and whether they felt medical doctors took their referrals seriously. Method: An online survey was shared via social media and professional networks. It included demographic questions and four clinical vignettes about patients with low back pain; two vignettes represented possible AxSpA. We used descriptive statistics and odds ratios (OR) to examine links between demographic factors and correct identification/referral. Results: We analyzed 149 responses. In vignette 1, 79% (95% CI 71–84%) identified AxSpA as a possible diagnosis, but only 23% (95% CI 17–31%) did so in vignette 4. Most, but not all, said they would refer these patients for further diagnostic investigations. Having the right to refer (OR 5.30; 95% CI 2.15–13.07), having more than 50% of one’s caseload with low back pain (OR 4.92; 95% CI 2.11–11.46), and holding a master’s degree (OR 2.49; 95% CI 1.08–5.74) were associated with correct identification and referral. Most respondents felt comfortable referring patients with suspected underlying disease, and about half (49%) felt that doctors took their referrals/consultations seriously to a large or very large degree. Conclusion: Physiotherapists in Norway are key frontline providers for people with low back pain and play an important role in spotting patients who may have an underlying condition such as AxSpA. Given the long diagnostic delays, our findings suggest physiotherapists are an important audience for information on AxSpA, its varied clinical presentation, and clear referral strategies to help improve the situation.
[This summary has been rewritten with the help of AI based on the project's original abstract]
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