Physiotherapy is key to quality of life for people with all forms of arthritis, highlights Will Gregory
Osteoarthritis and inflammatory arthritis are the two most common types of arthritis. While they are different conditions – despite the name they have in common – both affect the joints. And their symptoms and outcomes can be improved by physiotherapy.
Inflammatory arthritis is when the body’s immune system mistakenly targets the body’s own tissues, including at the joints, which can lead to pain and stiffness. The inflammation can impact on many areas of the body, but it is the joint issues that give the “arthritis” part of the name.
A physiotherapist is a core part of the team supporting people with inflammatory arthritis. Physiotherapists are available from initial diagnosis, but current evidence suggests best response to formal support is starting around six months after diagnosis. Physiotherapy in rheumatology is patient-led, which means we work closely with each individual, delivering evidence-based treatments in accordance with what they want, as opposed to a predefined version of what we think is best for them.
When the patient is ready, we begin by exploring their previous, current and aspirational activity levels. After assessing the patient’s capabilities and thinking about goal setting around what our patient would like to (and needs to) achieve, we come up with a shared management plan. We establish how physiotherapy can support this and how our patient can implement physiotherapy in their daily life.
New medications means physiotherapists are more able to maintain and improve physical function for people with inflammatory arthritis. Guidelines and evidence are clear on the benefits of keeping physically active through cardiovascular fitness, muscle strengthening and balance activities.
Occasionally, we have a role when patients are unable to do their usual exercises due to disease flares. In this situation we support people to get the flare under control and allow them to return to exercise programmes once the flare settles.
Some people want just one physiotherapy appointment to talk through their goals and then they’re happy to undertake these independently. Others require more support. A usual package of care tends to be three to six appointments with an appointment every couple of weeks to assess progress, suggest and implement new exercises.
Osteoarthritis was historically thought to be a degenerative joint disease or “wear and tear” arthritis. Modern science has shown that “wear and repair” is a better description and degeneration is not a primary factor. Osteoarthritis initially affects the smooth cartilage lining of the joint, which makes movement increasingly difficult, leading to stiffness and pain. Often seen at the larger joints of the body, hips, knees and shoulders, osteoarthritis can affect any joint and is commonly first noticed at the small joints of the hands.
Physiotherapists see many people with osteoarthritis. There are fewer medications available for osteoarthritis than for inflammatory arthritis so there is not usually any delay in accessing physiotherapy support after diagnosis.
Care involves educating patients and offering supported self-management techniques. Because “wear” or degeneration are no longer thought to be major factors in osteoarthritis, physiotherapists have a stronger case to use exercise techniques to improve quality of life for people with osteoarthritis. Regular exercise and fitness work at appropriate levels has been shown to improve the symptoms of osteoarthritis.
Given that all forms of arthritis tend to be lifelong, physiotherapy has a continuous role. Self-referral means that people who are discharged can easily re-refer themselves if need be. At Salford Royal Hospital, most of our services are self-referral so our patients can contact any of the team to re-refer themselves. Equally, we as clinicians have a role in signposting and making those referrals when necessary.
Together is better
The charity sector plays a crucial role in the management of long-term arthritis diagnoses. Like many rheumatology teams, we are supported by the National Rheumatoid Arthritis Society, the National Axial Spondyloarthritis Society and Versus Arthritis amongst others. Their help enables us to give patients better support, education and online resources.
We are fortunate at Salford Royal Hospital to have an electronic patient records system that allows us to read each other’s notes instantaneously. Team meetings, discussions and informal opportunities to discuss cases ensure the right patient is seen at the right time in the right place.
Having the whole team involved in the care of someone living with inflammatory arthritis is crucial. Excellent communication channels between the team improves outcomes for patients… and that’s what we’re all aiming for.
The future of physiotherapy
We know that the application of the rheumatology physiotherapy role differs in services around the UK. This is an area that needs to be improved as we aim to ensure good practise is reflected throughout the country.
The “Rheumatology Physiotherapy Capabilities Framework” gives clear statements about the role that physiotherapists can have for people with arthritis. From being involved in diagnosis to long-term management in secondary care, evidence shows physiotherapists have a vital role to play.
The future for physiotherapy is exciting as see its role developed further in the management of inflammatory arthritis.
About the author: Will Gregory is a Consultant Physiotherapist and Clinical Governance Lead for the Rheumatology Directorate at Salford Royal Hospital
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