Perspectives of UK Physiotherapists With Expertise in Rheumatology on the Barriers and Facilitators Influencing the Identification of Axial Spondyloarthritis by First Contact Practitioners in Primary Care: A Qualitative Study

Background: Axial spondyloarthritis (axSpA) poses a significant diagnostic challenge to health care professionals, with opportunities for early recognition often being missed in primary care. With musculoskeletal First Contact Practitioners (FCPs) rapidly becoming common place in primary care settings, the question is raised as to whether FCPs are adequately considering axSpA as a potential diagnosis. Swift recognition and timely referral are the antecedents to early diagnosis and better outcomes for people with suspected axSpA; therefore, it is imperative that FCPs can readily identify this condition. To date, no research has been conducted to thoroughly understand the determinants influencing axSpA identification by FCPs specifically. Aim: To explore perceived barriers and facilitators to axSpA identification by FCPs in primary care according to UK physiotherapists with rheumatology expertise. Method: A qualitative research design was undertaken using a constructivist methodological approach. Data were collected via virtual semi-structured interviews and analysed using a grounded theory coding strategy to identify key themes. Results: Ten physiotherapists with expertise in rheumatology were recruited using purposive sampling. Four themes pertaining to barriers were identified: (1) disease-specific factors, (2) patient factors, (3) clinician factors, and (4) system factors. Five themes relating to facilitators emerged: (1) education and training, (2) axSpA screening, (3) referral pathways, (4) clinical governance around the FCP role, and (5) peer support. Conclusion: Study findings highlight a multitude of barriers that may impede the identification of axSpA by FCPs. Participants also proposed several solutions to help overcome these obstacles, thereby facilitating earlier diagnosis for individuals with the condition.