Abstract
Objective To compare clinical impression and confidence of extended role practitioners (ERPs) with rheumatologists experienced in axial spondyloarthritis (SpA) according to: 1) evaluation of patients with chronic back pain assessed for axial SpA; 2) MRI recommendation for further investigation of these patients.
Methods Patients with ≥3 months of back pain and age of onset < 45 years were referred for axial SpA evaluation. An ERP assessed consecutive patients and recorded standardized clinical information in written form. Three rheumatologists subsequently evaluated each patient based on the recorded information. Patients were classified as axial SpA or mechanical back pain based on clinical and investigative findings. Level of confidence was noted for classification and MRI indication. Agreement between assessors was evaluated using percent agreement and Kappa coefficient.
Results Fifty-seven patients were assessed. Inter-observer agreement of clinical impression for all raters was moderate (Κ=0.52). Agreement of clinical impression between ERPs and rheumatologists ranged between 71.2% (Κ=0.41) and 79.7% (Κ=0.57). Agreement of clinical impression amongst rheumatologists ranged from 74.1% (Κ=0.49) and 79.7% (Κ=0.58). All rater agreement for MRI indication was fair (Κ=0.37). ERP agreement with rheumatologist for MRI recommendation ranged from 64.2% (Κ=0.31) and 75% (Κ=0.48). Agreement for MRI indication amongst rheumatologists ranged from 62.9% (Κ=0.27) and 74% (Κ=0.47). Confidence in clinical impression was similar amongst all practitioners.
Conclusion ERPs with specialty training in inflammatory arthritis demonstrate comparable clinical impression with rheumatologists in the assessment of axial SpA. Incorporation of such roles into existing models of care may assist in early detection of axial SpA.
