The role of physiotherapy in polymyalgia rheumatica in the United Kingdom: a mixed method study

O'Brien, Anne Veronica

Abstract

Background: Polymyalgia Rheumatica (PMR) is the commonest rheumatic condition affecting older people, typically treated with glucocorticoids. However, the treatment side-effects including fatigue, anxiety and other alterations in mood, are frequent and unpopular. Patients desire guidance about maintaining physical function, independence, and self-management strategies. International guidelines, advocating patient education and individualised exercises for people with PMR, lack an evidence base to support physiotherapy practice. This study investigated a potential physiotherapy role to improve function in people with PMR.

Method: A systematic review and narrative synthesis of PMR physiotherapy literature was undertaken. Following ethical approval, UK physiotherapists were surveyed via a questionnaire to ascertain typical assessment and treatment practice and management priorities. Purposively sampled consenting respondents participated in subsequent in-depth telephone interviews, where opinions and experiences of physiotherapy roles in PMR were explored, clinical reasoning investigated, and treatment rationale clarified. Recordings were transcribed verbatim and thematic analysis used to code identify themes.

Results: No published physiotherapy evidence of quality was identified for the management of PMR. 1,072 physiotherapists responded to the self-completion questionnaire. Referrals into physiotherapy were infrequent; only 5.8% had treated more than 10 patients in the previous year, nonetheless 80% of respondents positively advocated a physiotherapy role in PMR management and only 1.3% of all respondents considered there was no specific role for physiotherapists in PMR. Rarely prioritised by physiotherapists as an inflammatory MSK condition, only 38.3% of respondents reported receiving any pre-registration education about PMR, fewer still (24.8%) since graduating.

97% of physiotherapists reported undertaking assessments lasting at least 30 minutes. Establishing patients’ knowledge and understanding of PMR, pain levels and ability to undertake activities of daily living (ADL) were physiotherapy assessment priorities. Patient education promoting self-management approaches was reported to be a component of physiotherapy treatment (90.1%), including pacing, activity modification, and individualised exercises (89%) which were targeted to improve ADL function, and dominated physiotherapy management.

Five interview themes were identified from 17 participant interviews. These were: bespoke individualised physiotherapy treatment; psychological influences (patient anxiety and kinesiophobia), impacting PMR management; perceived complexity and challenge of physiotherapy for PMR; physiotherapist uncertainty, and inconsistencies in UK physiotherapy practice.

Participants considered PMR especially complex and challenging to treat, exacerbated by physiotherapists’ lack of PMR education, concerns about glucocorticoid side-effects, easily exacerbated PMR symptoms and patient anxiety. Participants’ relative inexperience of PMR, and the absence of published physiotherapy guidelines relevant to PMR, engendered professional uncertainty. Treatment inconsistencies related to workplace logistics, appointment scheduling, differences in rehabilitation resource facilities and therapy manager caseload expectations.

Conclusion: UK physiotherapists reported a positive role in improving patient function in PMR management via personalised education and exercise therapy strategies but perceive complexity in managing these patients. Physiotherapy PMR education is inadequate. Gaining consensus about content of patient education in PMR is overdue and should include exercise advice. Focussing physiotherapy referrals via screening in primary care may be beneficial. Future research is recommended to provide a robust evidence base to improve holistic management of this neglected patient group.

Citation

O'Brien, A. V. (2023). The role of physiotherapy in polymyalgia rheumatica in the United Kingdom: a mixed method study. (Thesis). Keele University. Retrieved from https://keele-repository.worktribe.com/output/674475

• Thesis Type: Thesis
• Deposit Date: Dec 21, 2023
• Publicly Available Date: Dec 21, 2023
• Public URL: https://keele-repository.worktribe.com/output/674475
• Award Date: 2023-12