Nurses, physical therapists and occupational therapists should be knowledgeable about the clinical features; and diagnostic procedures of common rheumatic and musculoskeletal diseases, as well as provide advice on pharmacologic and surgical treatments; according to new EULAR recommendations published in the Annals of the Rheumatic Diseases.

“Health professionals in rheumatology (HPRs) play an important role in the care of people with rheumatic; and musculoskeletal diseases (RMDs),” Lisa Edelaar, MSc,of the Leiden University Medical Center; the Netherlands, and colleagues wrote. “Up-to-date knowledge and relevant skills are essential to provide safe and effective patient care. Although multiple educational offerings have developed for HPRs at postgraduate level; their availability and content vary largely among countries as well as by profession.”

“It is imperative that the definition or development of a curriculum for HPRs; harmonized across countries, has international consensus on the core competences needed for the management of people with RMDs,” they added. “A set of desirable competences already exists at European level for rheumatologists. For HPRs, relevant work done only at national level.”

Therapists in rheumatology

To develop recommendations for generic core competencies for nurses; physical therapists and occupational therapists in rheumatology, Edelaar and colleagues formed a task force that included representatives from all three groups, as well as rheumatologists, patient representatives, educators, methodologists and researchers from 12 European countries. Members met twice first to define 13 research questions, which then helped guide a systematic literature review that produced 79 full-text papers.

Of those, 20 papers addressed competences, knowledge, skills, attitudes and education needs of health professionals in rheumatology. In their second meeting, members discussed the results of the literature review and drafted recommendations. Each recommendation assigned a level of agreement based on a scale of 0 to 10. The task force developed a series of three overarching principles and 10 recommendations. The average level of agreement for each recommendation ranged from 9.42 to 9.79.

However, the overarching principles stress the utmost importance of “effective communication skills; and a biopsychosocial approach” in assessing and treating patients with rheumatic and musculoskeletal diseases, as well as a “person-centered care and patient advocacy.” In addition, health professional should use “an evidence-based approach, ethical conduct and reflective practice.”

Common pharmacological and surgical treatments

The 10 recommendations include: Nurses, physical therapists and occupational therapists should possess knowledge of the etiology, pathophysiology, epidemiology, clinical features and diagnostic procedures of common rheumatic and musculoskeletal diseases, as well as their impacts; Such health professionals should understand both the benefits and risks associated with common pharmacological and surgical treatments for these diseases; and Health professionals in rheumatology should provide advice on nonpharmacological therapies, and treat or refer as appropriate.

“These recommendations aim to provide a framework for the generic core competences of nurses, and for postgraduate education at international and national level,” Edelaar and colleagues wrote. Efforts will be made towards their implementation through dissemination across national societies, relevant websites and presentation of this work at key international and national conferences. It is advised that variation in health care systems and professions across countries is considered. For this purpose, the recommendations will be shared with a larger group of HPRs, clinicians, patients and service providers, for wider consensus and external validation.