title: Management of early- and late-stage rheumatoid arthritis: are physiotherapy students' intended behaviours consistent with canadian best practice guidelines?
abstract: OBJECTIVE
  This study examined whether physiotherapy students in a problem-based learning (PBL) curriculum intend to implement best practices for management of clients with rheumatoid arthritis (RA).
  
  
  METHODS
  Physiotherapy students (n=49) completed a subsection of the ACREU Primary Care Survey to evaluate the concordance between intended behaviours and Canadian best practices for early- and late-stage RA, before and after completing the relevant PBL content. Changes in scores were assessed using McNemar's test for dependent proportions.
  
  
  RESULTS
  Most students indicated that they would recommend treatments or referrals for physiotherapy/exercise, education, and occupational therapy or joint protection pre- and post-PBL (>83% and >95%, respectively). Post-PBL, more students recommended referral to a rheumatologist and disease-modifying anti-rheumatic drugs (DMARDs) for both early and late RA; however, the increase was significant only for early RA (p=0.013 and 0.031 for referral to rheumatologist and DMARDs, respectively). More students recommended psychosocial support at both stages of RA post-PBL (early RA: p<0.001; late RA: p=0.031). Although more students recommended DMARDs post-PBL, only 8 students in total made this recommendation (16%), and fewer students considered use of non-steroidal anti-inflammatory drugs. Most students (94%) did not recommend referral to a surgeon for early or late RA.
  
  
  CONCLUSIONS
  Intended behaviour of physiotherapy students was more consistent with Canadian best practice guidelines for managing clients with early- and late-stage RA following the PBL curriculum. Further study is required to determine whether the students were less aware of best practices related to pharmacologic interventions and timely referral to appropriate specialists, or whether they considered these issues to be outside their scope of practice.
authors.affiliation: School of Rehabilitation Science, McMaster University, Hamilton.
authors.forename: Norma J
authors.initials: NJ
authors.lastname: Macintyre
authors.forename: Sydney C
authors.initials: SC
authors.lastname: Lineker
authors.forename: Christina
authors.initials: C
authors.lastname: Hallett
authors.forename: Jake
authors.initials: J
authors.lastname: Tumber
authors.forename: Nalin
authors.initials: N
authors.lastname: Fernando
authors.forename: Magdalena
authors.initials: M
authors.lastname: Hul
keywords: curriculum; evidence based practice; physical therapy specialty; primary health care; rheumatoid arthritis