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New research reveals ‘significant breach of Rheumatoid Arthritis medical guidelines on the use of physiotherapy’

CSP press release published on 12 October 2011

One in three people with RA wait for more than a year for referral to a physiotherapist

The National Rheumatoid Arthritis Society (NRAS) and the Chartered Society of Physiotherapy (CSP) today (12 October) publish a new UK-wide report highlighting the medical evidence around the benefits of physiotherapy in the treatment of Rheumatoid Arthritis (RA), but also uncovering serious problems in the way physiotherapy services are being organized and accessed throughout the UK.

The report, the launch of which coincides with World Arthritis Day, calls for new measures to be introduced in England, Scotland, Wales and Northern Ireland to increase compliance with RA medical guidelines and to protect existing physiotherapy services. A survey of NRAS members with RA also uncovered shockingly low referral rates, despite clear evidence that physiotherapy improved their function and mobility (3).

Key survey findings include:

  • One in three (32 per cent) waited more than a year for referral, with a similar number having never been referred. Just one in ten waited less than a month.
  • Half the respondents said they could not self-refer; 24 per cent had to get permission from their GP; 22 per cent were able to self-refer.
  • About half of respondents (51 per cent) thought their physiotherapist was part of a consultant-led multidisciplinary team.
  • Just over half (52 per cent), saw their treatment as a ‘one off’, with the other half seeing it as part of their ongoing management.
  • Two in three (65 per cent) felt physiotherapy helped to improve their function; and well over half 58 per cent thought physiotherapy had improved their mobility.
  • Nearly three quarters (70 per cent) rated their physiotherapy treatment as good or very good.

Comprising a wide-ranging literature review and a UK-wide survey of NRAS members, the report uncovers evidence of a contravention of the leading medical guidelines on the treatment of RA produced by the British Society of Rheumatology and the British Health Professionals in Rheumatology, the National Institute for Health and Clinical Excellence, the Scottish Intercollegiate Guidelines Network, and the European League Against Rheumatism – which, although not mandatory, recommend giving all RA patients access to a physiotherapist, operating as part of a multidisciplinary team, with a regular review.

Although the survey of NRAS members found that patients who receive physiotherapy rate it highly, about one in three respondents had to wait more than a year for referral to see a physiotherapist – and even more shockingly almost as many had never been referred at all. The survey also found that an alarmingly high number of people reported that their physiotherapy treatment was a ‘one-off’ rather than being available as and when they needed it.  Just over half of respondents thought their physiotherapist was working as part of a multidisciplinary team – falling way short of the best practice envisaged in medical guidelines and government strategies on the management of long-term conditions.

The report also found that despite the introduction of a number of these government strategies on long-term conditions, which aim to increase patient involvement in decisions about their care, key issues such as referral are still largely being directed by medical professionals and that opportunities for self-referral, which piloting has shown to be successful and cost-saving, are still not widely available.

To improve the situation, NRAS and CSP are calling for governments in England, Scotland, Wales and Northern Ireland to publish more information to enable a more comprehensive assessment about the uptake of these services and referral practice; and to consider bringing forward new measures to encourage best practice in referral for physiotherapy, including more information for RA patients about self-referral and expansion of its availability, and appropriate training for medical practitioners. Given the current resourcing issues, we are also urging these governments to protect and, where possible, expand existing RA-related physiotherapy services to meet the evident needs of people with RA.

Ailsa Bosworth, Chief Executive, NRAS said:

“We have known for some time that people with RA have been having problems accessing multidisciplinary services like physiotherapy. However, the extent of the problems uncovered in this report is truly shocking. What is the point of having medical guidelines and government strategies for the management of long-term conditions, if they are going to be ignored to such an extent? More information needs to be made available about these services and I think there is now certainly a strong case for bringing forward new measures to boost compliance with the medical guidelines.”

Phil Gray, Chief Executive of the Chartered Society of Physiotherapy comments:

“People with RA regularly stress the important role that physiotherapy plays in supporting them to maintain their levels of movement and physical activity, reducing pain, fostering independence and in many cases allowing people to remain in work. It is of great concern that this survey reveals an unacceptable postcode lottery on whether people can access the physiotherapy support they need. Of particular concern is that some people are waiting so long – sometimes over a year - for a referral to physiotherapy. Delays such as this are costly – not only to the individual whose condition will worsen while they are waiting but also to the NHS, which will incur increased healthcare costs due to the patient needing greater support further down the line.”


For further media information, please contact:

Becca Bryant, Head of Press and PR, Chartered Society of Physiotherapy on 0207 306 1111, Email: or or out of hours: 079172 40819.

Jamie Hewitt, Government Affairs Manager, National Rheumatoid Arthritis Society

Tel: 0845 458 3969, Email:

Notes to editors

  1. The National Rheumatoid Arthritis Society (NRAS) was launched in October 2001 and in a relatively short time has become established as the campaigning voice in the UK for people with Rheumatoid Arthritis. NRAS provides a total one-stop-shop with support, information and advocacy for all people in the UK with RA, their carers and families. NRAS has a national volunteer network, a group of people with the disease who provide peer to peer support and provide additional resource to help NRAS in many different ways. 
  2. RA is a chronic, progressive and disabling autoimmune disease, which chiefly impacts upon joints but can also affect other organs such as the heart, eyes and lungs. RA is often confused with osteoarthritis, which is a different disease caused by wear and tear of the joints as we get older. RA impacts heavily on people of working age affecting around 690,000 of the UK adult population, with approximately 26,000 new diagnoses each year. 
  3. NRAS surveyed its members with RA about their experiences of physiotherapy services, sending out a total of 2,303 electronic questionnaires during August 2011 and a hardcopy of the questionnaire to a randomly selected NRAS community-based group in September 2011. The The organisation received a total of 245 useable responses to a series of 17 questions derived from a detailed literature review. Questions in the survey focused on benefits of the treatment, how long they waited for referral, how they were referred and how the service was configured locally. 
  4. The Chartered Society of Physiotherapy is the UK’s professional, educational and trade union body. We have more than 50,000 members, including chartered physiotherapists, physiotherapy students and assistants. Visit for more information.


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