Considering the well-established benefits of proper exercise and joint protection for patients with rheumatic diseases, physical therapists (PTs) and rheumatologists should be formidable allies in treating patients with chronic, inflammatory diseases, according to the 2016 recipient of the ARHP Addie Thomas Service Award, Carol Oatis, PT, PhD.
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Unfortunately, it’s not always easy to develop a good partnership between rheumatology and physical therapy. Access and cost are some of the most common issues facing providers, according to Dr. Oatis, who is a professor in the Department of Physical Therapy at Arcadia University in Glenside, Pa. Less common issues include ineffective communication and a dearth of face time between rheumatology and PT trainees.
“The relationship between [the] rheumatologist and [PT] is a very important one,” Dr. Oatis says. “One of the challenges is that there are about 6,400 practicing rheumatologists in the country and about 210,000 PTs.1,2 So there are a lot of PTs who don’t know a rheumatologist. I think rheumatologists and PTs have similar goals as they approach patients. PTs want to improve function and decrease pain in these patients. I think the collaboration is essential for optimal outcomes.”
Dr. Oatis, a past president of the ARHP who is best known for her textbook, Kinesiology: The Mechanics and Pathomechanics of Human Movement, explains the first step to improved patient care is recognizing PTs and rheumatologists have different points of view.
“In terms of diagnosis, a rheumatologist diagnoses patients medically. PTs diagnose patients functionally—to identify functional problems and movement disorders,” she says. “Those are very different roles in the diagnostic process. Medical diagnoses are often associated with or lead to movement disorders. And [the diagnosis of] movement disorders can often be based on [the presence of] medical disorders. And so, again, there is collaboration. They don’t necessarily diagnose the same thing, but they find diagnoses that are related to one another in the same patient.”
The second step is having PTs and rheumatologists form collaborative, working relationships. “Go meet the rheumatologists. [PTs] have lots to offer them. Rheumatologists have lots of patients you could help. Go find them, and get to know them,” Dr. Oatis says, emphasizing that rheumatologists should target working relationships with PTs who are familiar with rheumatologic diseases. “PTs have something to offer patients with fibromyalgia, lupus and ankylosing spondylitis. [PTs need] to know what those conditions are and recognize what we’ve got to offer those patients. We need to be familiar with the disease process and the literature.”
With regard to the evidence, a quick Google search of the terms benefits, exercise and rheumatic disease turns up hundreds of thousands of results. A systematic review of studies published in November 2016 in the Journal of Physical Therapy Science compared the effects of rehabilitation and rheumatology care for pain relief in patients with rheumatoid arthritis (RA). It showed that physical therapy and occupational therapy interventions “are effective for pain relief in people with RA.” The authors indicate the results were “consistent with those of previous systematic reviews.”3
“There is nothing new and startling [about the benefits of exercise],” says Dr. Oatis, who works closely with the Arthritis Foundation and the U.S. Bone and Joint Initiative. “[The literature] just keeps piling up and is pretty irrefutable.”
The American College of Rheumatology website outlines a number of ways PTs benefit RA patients: developing “shared treatment goals and an individualized treatment plan” and teaching self-management skills that “help patients decide on appropriate treatment options and encourage independence in daily activities, including self-care, transfers to and from toilet and bathtub, and using public and private transportation.”4
Access to care and rising costs of care are major issues in U.S. healthcare, and physical therapy could be hit especially hard by recent legislation. In a May 23 letter to U.S. Senators, American Physical Therapy Association (APTA) President Sharon Dunn, PT, PhD, wrote that the American Health Care Act “weakens the power of federally mandated essential health benefits [EHBs], which include physical therapy, by allowing states to apply for waivers to reduce the requirements or eliminate them entirely. We believe [these changes] could hinder access for millions of Americans.”5
Dr. Oatis agrees access and costs are serious issues. Example: She points to a recent conversation she had about rising co-pays and the affordability of physical therapy, even with insurance.
“The rheumatologist was so frustrated. His patients really lacked access to care and physical therapy because the co-pays are so high,” she says, noting PTs have had to become more efficient in the limited time they are allotted with their patients. “I think that’s an area [in which] the ACR, AHRP and APTA should be teaming up to advocate for patients. It’s one thing for a patient to have a co-pay seeing a rheumatologist every three months—having a significant co-pay of $40 to $70, trying to see the PT twice a week or even once a week. It really prevents a lot of patients from accessing [physical therapy],” she says.
Richard Quinn is a freelance writer in New Jersey.
References
- The American College of Rheumatology. 2015 workforce study of rheumatology specialists in the U.S. 2015.
- U.S. Department of Labor. U.S. Bureau of Labor Statistics: Occupational Outlook Handbook, 2016–2017 edition, physical therapists. 2015 Dec 17.
- Park Y, Chang M. Effects of rehabilitation for pain relief in patients with rheumatoid arthritis: a systematic review. J Phys Ther Sci. 2016 Jan;28(1):304–308. doi:10.1589/jpts.28.304.
- American College of Rheumatology. The role of the physical therapist in the management of rheumatic disease. 2015.
- American Physical Therapy Association. APTA to Senate: House version of AHCA would reduce access to care. PT in Motion News. 2017 May 23.