PT-led on par with rheumatologist triage of joint pain referrals

A triage led by a physiotherapist (PT) performs as reliably as a rheumatologist triage of referrals for joint pain, with significantly fewer patients with inflammatory arthritis (IA) needing an in-clinic visit, a recent study has shown.

A group of researchers conducted this single-centre, prospective, nonblinded, randomized, parallel-group feasibility study with referrals randomized 1:1 to either a PT-led or a rheumatologist triage. They collected standardized data at referral receipt, triage, and clinic visit. Currently, the gold standard for IA diagnosis was that done by a rheumatologist.

Overall, 102 referrals had been randomly assigned to the PT-led triage arm and 101 to the rheumatologist arm. Of the referrals, 65 percent in the PT-led arm and 60 percent in the rheumatologist arm were triaged as urgent (p=0.57). This finding suggested similar accuracy in detecting IA.

In addition, there were more referrals declined in the PT-led triage arm (24 vs 8; p=0.002), which led to fewer referrals triaged as semi-urgent (6 vs 23; p=0.003).

Notably, one case of IA in the rheumatologist arm was triaged incorrectly. This resulted in a significant delay in time to first assessment.

The results of this study have “implications for waitlist management and optimal rheumatology resource utilization,” according to the researchers.

“Given global shortages in the rheumatology workforce, the demand for rheumatology assessment often exceeds the capacity to provide timely access to care. Accurate triage of patient referrals is important to ensure appropriate utilization of finite resources,” they said.