One advantage of having more than three decades experience in rheumatology physiotherapy is that it offers perspective
One advantage of having more than three decades experience in rheumatology physiotherapy is that it offers perspective on where we have come from, and what the future directions might be.
Despite advances in drug management that, at the beginning of my career, would have seemed astounding, many challenges remain. In my view, the era of biologic medications has, inadvertently, shifted some emphasis in rheumatology away from multi-disciplinary and holistic care.
At the same time, there is a growing realisation that for some, biologics do not provide all the answers – and that issues such as managing pain, fatigue, sleep, mental health, physical activity, healthy body habitus et cetera remain.
In a future “ideal” rheumatology world, I’d like to see more innovative contribution from an engaged team of well-educated health professionals – so that ultimately patients receive more support to maintain lifelong self-management strategies, which complement their pharmacological care.
Such a future should, of course, be more evidence-based than in the past.
Allied health research has made huge strides in quality in those 30-plus years, and yet the available funding for well-designed and adequately powered studies remains pitiful.
At the same time, there is a growing realisation that lifestyle factors, particularly declining physical activity levels, are a major player in both the onset and expression of many rheumatological conditions.
For instance, new information about exercise in myositis points to a positive benefit for the right type of exercise in altering not only the disease course, but also the epigenetics.
Despite such examples, the interactions between exercise and inflammatory disease, and exercise and biologics, are poorly understood. This is surely one area that could reap significant rewards, in terms of a personalised approach that includes exercise and other components.
Education of allied health professionals, in order to see translation of evidence into practice, will be needed to underpin the future allied health role.
No doubt, established and emerging technology will be vital to engage more of the allied health workforce in rheumatology.
This is just one area where there may be great benefits in collaboration between rheumatologists and health professionals.
Hopefully, one outcome from the recent move by the Rheumatology Health Professionals Association to become a Special Interest Group within the ARA, will be the facilitation of future educational resource development.
Lastly, for any of this change to be realised, there needs to be a shift in understanding and culture by all stakeholders.
Many rheumatologists are supportive of these concepts, and have developed highly collaborative care models, with nurse practitioners and other specialised and engaged allied health professionals playing key roles.
However, such care models seem currently to be the exception rather than the norm, and more widespread change (including at a policy/ funding level) will require ongoing support from the rheumatology profession.
Hopefully we can work together on multi-disciplinary policy and funding advocacy, to drive evidence-based funding models that support a variety of care and which best addresses both the pharmacological and non-pharmacological needs of people with rheumatological conditions.
Janet Millner is a physiotherapist based in Tasmania and a member of Rheumatology Health Professionals Association
