Physical Therapists’ Ability to Distinguish Between Inflammatory and Noninflammatory Arthritis and to Appropriately Refer to Rheumatology


1) To investigate whether physical therapists (PTs) can correctly identify new-onset inflammatory arthritis; 2) To assess whether PTs are aware that new-onset inflammatory arthritis cases should be referred to a rheumatologist; 3) To explore the comfort level of PTs to refer to medical specialists; 4) To determine factors associated with correctly identifying inflammatory arthritis and referring to a rheumatologist.


We sent a questionnaire to PTs in two Canadian provinces describing four case scenarios (new-onset rheumatoid arthritis – RA; knee osteoarthritis – OA; new-onset ankylosing spondylitis – AS; and low back pain- LBP). Participants were asked to identify probable medical diagnoses and indicate their plan of action. We describe the frequencies of our outcomes and use logistic regression to explore associated factors.


352 PTs responded. The proportions who correctly identified each of the four cases were: 90, 83, 77, 100% respectively for RA, OA, AS, and LBP. Among those, 77%, 30%, 73% and 3% respectively indicated that it was ‘very’ or ‘extremely’ important to refer to a rheumatologist. About two-thirds felt ‘extremely’ or ‘quite’ comfortable to refer to a specialist. PTs working in rural areas were less likely to refer.


Most PTs correctly identified the clinical cases and were aware of the importance of prompt referral to rheumatology for inflammatory disease. Most indicated that it was not very important to refer those with OA and LBP. This implies that many PTs can distinguish between inflammatory and non-inflammatory conditions and appropriately refer suspected inflammatory arthritis to rheumatology.

 2019 Sep 27. doi: 10.1002/acr.24081. [Epub ahead of print]