11 May 2023
In light of this month's eLearning Spotlight on Imaging, we spoke to Rebecca Adshead, a musculoskeletal and ankylosing spondylitis physiotherapist at Whipps Cross Hospital, about the changes and challenges she faced while setting up an early inflammatory back pain (IFB) service.
Can you tell me about your role?
My background was mainly musculoskeletal (MSK), I began my NHS career as a newly qualified physio in 2006 and entered the world of rheumatology as a band 7 physiotherapist over 10 years ago. A few consultants had an idea to set up an early inflammatory back pain service and my role was leading that service and setting it up from scratch.
I’ve been in this role since 2009 and not only has my role evolved but so has the service, as you learn what works and what doesn’t and how to improve things. My role mainly involves ensuring the service is running well, working with consultants, and providing education around inflammatory back pain and Axial SpA with the aim of getting the right patients into the right service.
Were any training opportunities available for you?
Physios sit comfortably in this role because of our MSK background and the skills we acquire at university as well as our postgraduate exposure in MSK. I didn’t attend any specific rheumatology courses prior to starting my role, however, I subsequently completed a postgraduate diploma in Advanced Physiotherapy over several years which supported my clinical assessment and reasoning.
We’re now expanding the service and recruiting another physiotherapist to work alongside me. We want them to be an experienced therapist, but they don’t need to have rheumatology-specific training. Once they’re in the post they’ll have support, training, and the competency framework set up and they’ll be good to go.
Can you tell me about your early back pain service?
The aim was to identify and triage patients with Axial SpA quickly and speed up their pathway as patients with this condition often experience diagnostic delay.
The buzz of starting a new role, setting up clinics, and trying to hit the ground running can make it hectic when you start something new. I visited other hospitals with specialist spondyloarthropathy services, as it was useful to gain insight to see how other services were run.
We published data on 200 patients around three years into starting the service. Roughly eight years in, we have around 600-700 patients and a lot more data. One thing I would advise is a baseline audit before setting up a new service.
What is the role of imaging in this service (X-ray and MRI)?
Our referral criteria are based on symptoms suggestive of inflammatory back pain. We do a lot of training around this, and I recently completed a document on this for first-contact practitioners (FCP), so they have more awareness of what to look out for.
We want GPs and FCPs to recognise IBP, so the right patient gets seen at the right time. Asking them for imaging is not always helpful, it’s best if patients are seen and fully assessed in a specialist rheumatology clinic.
After full assessment imaging is really useful and supports our diagnosis, We have a weekly radiology MDT to review images and discuss cases which is extremely helpful.
What do you think is the future of IBP?
It's exciting! There are a lot of expert clinicians and supportive patient charities and members of Parliament working hard to put IBP in focus and at the forefront of clinicians’ minds. The All-Party Parliamentary Group for axial spondylarthritis is campaigning to raise awareness and highlight the issues encountered in primary and secondary care and discuss strategies to improve outcomes in patient care.
We’re getting a lot more appropriate patients to come through the service locally with suitable referrals being written which is useful. The challenge is now continuing to educate and raise awareness at a local and national level.
Interested in learning more about Imaging? Why not enrol in our eLearning module or book for our upcoming imaging course taking place in December?