Raising awareness of Axial Spondyloarthropathy

Purpose

The identification of patients with suspected Axial Spondyloarthropathy (AxSpA) came under the spotlight with the release of the NICE guideline NG65 in 2017.

This service evaluation focused the outcomes of a training and awareness campaign designed to improve the implementation of NG65 in screening for AxSpA.

Before the campaign 293 case notes were reviewed;
of which 23% (n=68) met the entry criteria...but only 2 (3%) had evidence of screening for EAM's.
Confidence in identifying suspected AxSpA was rated at 5.25/10
where 10 was totally confident and 0 was no confidence.

After the campaign 265 case notes were reviewed,
of which 18% (n= 48) met the entry criteria...however there was a substantial improvement in number of patients screened for EAM (28/48, 61%)...
The level of confidence in screening improved by 24%
to 7.63/10.

Approach

A self-reported questionnaire was delivered to all physiotherapists working in Nuffield Health asking them about their current knowledge base and confidence in screening for AxSpA.

Clinical case notes were reviewed between January and March 2018 from all patients who had a primary diagnosis of lower back pain, sacroiliac pain or multiple joint pains that included spinal related symptoms, and had been discharged recommending onward referral to specialists for further investigation. The notes were evaluated and compared against guidelines recommended in NG65 for AxSpA screening.

The awareness campaign was launched that included a webinar on screening for AxSpA, an infographic highlighting the key points and four real life case studies which were disseminated via email and an internal social and business media platform.

Finally, a clinical records software update was launched that gave physiotherapists a prompt if required to the appropriate screening questions.

The same data were then evaluated 1 year later.

Outcomes

Prior to the campaign 48% of Physiotherapists were aware of the entry criteria (age < 45 and 3/12 history of lower back pain), 90% were aware of the symptoms of inflammatory back pain (IBP) and 45% were aware of the extra-articular manifestations (EAM). Confidence in identifying suspected AxSpA was rated at 5.25/10 where 10 was totally confident and 0 was no confidence.

Both self-reported knowledge and confidence improved after the campaign with 100% of the respondents reporting an awareness of the entry criteria, symptoms IBP and EAM's. The level of confidence in screening improved by 24% to 7.63/10.

Before the campaign 293 case notes were reviewed; of which 23% (n=68) met the entry criteria. 64/68 (94%) had some evidence of screening for IBP but only 2 (3%) had evidence of screening for EAM's. 9/293 patients were referred specifically to Rheumatology.

After the campaign 265 case notes were reviewed, of which 18% (n= 48) met the entry criteria. The number of patients screened for IBP was consistent with the pre-campaign data (46/48, 95%), however there was a substantial improvement in number of patients screened for EAM (28/48, 61%) and the number of patients were referred to rheumatology (18/265).

This awareness campaign has helped develop Physiotherapist's self-reported knowledge and confidence in screening for AxSpA leading to improved implementation of NICE guideline NG65.

Further work could make the Webinar mandatory to all Physiotherapists, reaching a wider audience. It would also be useful to understand how many of the patients referred to Rheumatology resulted in a diagnosis of AxSpA.

Implications

This service development strategy has seen Physiotherapists increase the number of patients appropriately screened for AxSpA. In turn, this has helped manage the complexity of efficiently identifying patients with suspected AxSpA, potentially improving time-to-diagnosis delays and clinical outcomes.

 

Funding acknowledgements

No funding was provided for this service evaluation. 

Additional notes

This work was presented at Physiotherapy UK 2019