Prevalence of severe functional limitations and physical therapy use in patients with rheumatoid arthritis or axial spondyloarthritis: a multicentre cross-sectional study in the Netherlands.

OBJECTIVE

To inform implementation of a long-standing, personalized exercise therapy programme in patients with rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) and severe functional limitations, we estimated the prevalence of severe functional limitations and described current physical therapy (PT) use.

METHOD: In a multicentre cross-sectional study, rheumatologists at 11 medical centres used a checklist to record severe functional limitations in consecutive outpatients with RA or axSpA. The same patients were invited to complete an online questionnaire on current or recent PT use, including duration where applicable.

RESULTS

Rheumatologists completed the checklist for 612 patients. Severe functional limitations were identified in 58/443 in RA (13%; 95% confidence interval 10-16) and 27/169 in axSpA (16%; 95% confidence interval 11-21). The online questionnaire was sent to 486 patients, of whom 251 (52%) responded (191 RA; 60 axSpA). Among respondents, 39/251 (16%) were classified by rheumatologists as having severe functional limitations. Among those who were severely limited, 13/39 (33%) reported individual long-term PT; among those without severe functional limitations, 46/212 (22%) reported individual long-term PT.

CONCLUSION

Our study shows a mismatch between eligibility and current PT use: long-term PT appeared underused among patients with severe functional limitations and potentially overused among those without them. Non-recommended passive modalities were frequently used. A systematic implementation strategy is needed to facilitate the uptake of the evidence-based PT in clinical practice for patients with RA or axSpA and severe functional limitations.