Allied Health Professionals Show Similar Clinical Assessment Rates in axSpA

Investigators compared clinical impression and confidence of extended role practitioners with that of rheumatologists experienced in axial spondyloarthritis.

Allied health professionals (extended role practitioners) with specialty training showed similar clinical impression rates as rheumatologists in the clinical evaluation of patients with axial spondyloarthritis (axSpA), according to results from a study published in the Journal of Rheumatology.

Researchers conducted a clinical assessment study that compared the agreement of clinical impression among rheumatologists and extended role practitioners in the evaluation of 57 patients with chronic back pain. The practitioners assessed the patients for axSpA and offered a recommendation on the need for further magnetic resonance imaging (MRI). Subsequently, 3 rheumatologists assessed the patients using information provided by the extended role practitioner. Agreement was measured using percentage agreement and the κ coefficient.

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After analysis, the researchers found that interobserver agreement for all assessors was moderate (κ=0.52) with respect to clinical impression. Agreement between the rheumatologists and extended role practitioners ranged from 79.7% (κ=0.57) to 71.2% (κ=0.41), respectively.

With respect to MRI indication, all assessor agreement was fair (κ=0.37).

One key limitation of the study was the external validity of the results.

“Utilization of such extended practice roles, in collaboration with physician colleagues, may assist in improving the early detection of axSpA, thereby facilitating early treatment and improving overall outcomes in this patient population,” the researchers wrote.


Passalent L, Hawke C, Lawson D, et al. Advancing early identification of axial spondyloarthritis: an interobserver comparison of extended role practitioners and rheumatologists [published online May 1, 2019]. J Rheumatol. doi:10.3899/jrheum.180787