Extending the scope of back care

Alison Moore meets East Kent physio Liz van Rossen, combating ankylosing spondylitis

Until the past 10 years, little could be done to stop patients with ankylosing spondylitis (AS) getting slowly worse. This painful condition often develops in early adulthood and can severely deform the spine.

But new drugs opposing tumour necrosis factor (TNF), which promotes inflammation, can slow its progress and ease symptoms if it’s diagnosed early enough.

Ensuring that early diagnosis takes place is the passion of Liz van Rossen, an extended scope practitioner (ESP) in rheumatology physiotherapy. She diagnoses and reviews patients at her clinic at Kent and Canterbury Hospital, and is working towards supplementary prescribing.

‘One man came in bent double looking at the floor, with his nephew who was a fit young builder,’ says James Murray, director of communications at East Kent Hospitals University Foundation Trust. ‘The younger man was starting to show signs of a back problem. But his uncle spotted what was happening and got him into the system in time. So he won’t follow his uncle’s footsteps.’

Liz educates local GPs and physiotherapists about the condition – which in the early stages can be hard to distinguish from ‘normal’ back pain. She was on the national working party that laid down best practice in diagnosis and treatment for the National AS Society (see www.nass.co.uk). And as well as helping people get a timely diagnosis and treatment, she has reduced pressure on the trust’s rheumatologists and kept waiting times down.

Liz, who trained in Belgium, was one of the first ESPs in the area – ‘a very exciting job but also a bit of a blank sheet of paper.’ At first, her role was to see diagnosed patients who needed physiotherapy. But the discovery of new drugs has changed the emphasis towards early diagnosis and intervention.

Around a third of her time is now spent on AS – the service is the first one in the country where an ESP reviews patients – and two thirds on other musculoskeletal conditions.

‘We have about 340 AS patients with 85 on anti-TNF treatments who are reviewed regularly,’ she says.

‘Physiotherapists are more and more the first line of contact for people with musculoskeletal problems and back pain. We need to get patients with inflammatory back pain diagnosed quicker. Yet physiotherapy students have very little contact with rheumatology and very few of them are in contact with it through rotations.’

The key to developing a successful service, she believes, is working closely with a multidisciplinary team. Access to a rheumatologist is essential, and she will refer or discuss cases she is uncertain about.

‘It is about working as a team,’ she says. ‘There are always barriers, but it is about how you overcome all the little hiccups along the line. The main thing is to have good communication and work very closely with the therapy department and the rheumatologists.’

ESPs can offer a cost-effective way of seeing patients, she says. And they can also take a holistic approach to patients, looking not just at clinical signs but at the impact the condition is having on their lives. fl

Alison Moore

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