To work together effectively, clinicians and rheumatology professionals need to understand the roles of every member of the interdisciplinary team. To enhance this understanding, the ARP Interprofessional Practice & Management Committee has undertaken a project to describe the modern roles of members of the interdisciplinary team in a series of fact sheets. The first three are available now, and clinics can use them to determine where their practices may be able to enhance the holistic care of patients.
Physician Rheumatologist (MD/DO)
Training
Medical School (four years) > Internal Medicine Residency (three years) > Rheumatology Fellowship (two to three years)
How/When to Refer
Patients can be referred to a rheumatologist by any healthcare professional who believes they would benefit from specialty care. Rheumatologists may also be recognized as clinical experts within specific disease areas and may receive requests from other rheumatologists to provide second opinions on patient cases.
Case Study
Rose, a single, 50-year-old woman, was diagnosed with rheumatoid arthritis one month ago. She just started methotrexate and prednisone to control inflammation. She reports a one-year history of general pain and swelling in her hands and feet, as well as morning stiffness lasting two hours, extreme fatigue and malaise. She says she often drops things held in her hands, particularly if they are heavy. She is having difficulty getting through her morning routine and getting to work. She does office work and finds it difficult to type, walk or stand for long periods due to pain and fatigue. She has two children in their middle teens.
What Can This Professional Do for Rose?
- Confirm the diagnosis of rheumatoid arthritis, provide additional or alternative diagnoses and consider individual aspects of the diagnosis in relation to Rose’s comorbidities, risk factors and personal circumstances;
- Equip Rose and her family with educational and other resources regarding the diagnosis and her treatment options;
- Monitor medication safety and adjust doses according to Rose’s treatment response;
- Monitor efficacy of the treatment plan and provide alternative recommendations if Rose’s response to therapy fails or is incomplete;
- Place referrals to other rheumatology professionals, including physical and occupational therapists, who can help Rose stay functional in performing her daily activities;
- Provide resources for pain and stress management, and offer corticosteroid injections for joint inflammation when appropriate;
- Offer support for any accommodations required during the course of Rose’s treatment, including completion of Family & Medical Leave Act (FMLA) paperwork; and
- Stay up to date on the latest clinical and research advances within the field of rheumatoid arthritis that could benefit Rose during the course of the patient-physician relationship.
The Profession’s National Organizations
Clinical Research Coordinator/Nurse
Training
Not mandatory but usually a bachelor’s degree, master’s degree and/or doctorate (PhD) is preferred.
License/Certification
Certified Clinical Research Coordinator (CCRC)/Certified Clinical Research Professional (CCRP)
General Description
A clinical research coordinator (CRC) and/or clinical research nurse (CRN) is the main point of contact for any possible research studies. These individuals are well versed in study activities and the personalized care patients will receive while in a particular study. The CRC/CRN will work/coordinate with multiple medical teams, as well as with the patient, to ensure the best possible outcome for the study and, more importantly, the patient. Because each research study is unique, the types of skill sets, education, experience and certifications/licenses the particular researcher needs can vary.
How/When to Refer
Often, the CRC/CRN educates clinical staff about current studies and what patients may qualify, and/or notifies clinical staff of a potential patient who may qualify for a study. Usually the CRC/CRN will meet directly with the patient to determine their research eligibility and coordinate all study activities/visits moving forward if they do qualify and participate.
Case Study
Rose, a 50-year-old single female, was diagnosed with rheumatoid arthritis one month ago. She just started methotrexate and prednisone to control inflammation. She reports a one-year history of general pain and swelling in her hands and feet, morning stiffness lasting two hours, extreme fatigue and malaise, and often drops things held in her hands, particularly if they are heavy. She is having difficulty getting through her morning routine and getting to work. She does office work and finds it difficult to type, walk or stand for long periods due to pain and fatigue. She has two children in their middle teens.
What Can This Professional Do for Rose?
The CRC/CRN can determine if Rose qualifies for a research study. If Rose does qualify, the CRC/CRN will help guide her from study beginning to end. Depending on the study, research staff can assist with study medication or devices, if applicable.
The Profession’s National Organizations
- CRC Certification: Association of Clinical Research Professionals (ACRP)
- CCRP Certification Program: Society of Clinical Research Associates (SOCRA)
Physical Therapist
Training
As a prerequisite to completing earning a Doctor of Physical Therapy (DPT) from a program accredited by the Commission on Accreditation in Physical Therapy Education, physical therapists (PT) must have earned a bachelor’s degree. The length of professional DPT programs is typically two to three years, with most of the programs extending approximately three years.
The PT curriculum includes courses and content across the continuum of care and across a patient’s lifespan. The didactic coursework consists of basic sciences, foundational sciences, behavioral sciences, patient/client management courses, behavioral sciences, differential diagnosis, clinical decision making and research. PT students are required to complete at least 30 weeks of full-time clinical experience (internship).
PTs are trained to be first-line, primary care practitioners. Patients have some direct access to physical therapy in every state, the particulars of which are governed by the state. In many states, patients don’t need a physician’s referral to see a PT. However, patients and practitioners should check their insurance coverage requirements.
License/Certification
To practice as a PT in the U.S., a DPT student must pass the National Physical Therapy Exam (NPTE). Each state regulates physical therapy licenses independently, so precise requirements for licensing and renewal on top of this exam vary by state.
General Description of the Role
Physical therapists are movement experts who improve quality of life and promote, maintain and/or restore health.
PTs improve health and quality of life through screening, physical examination, diagnosis, prognosis, physical interventions and rehabilitation, patient education, disease prevention, and health promotion and wellness.
PT treatment commonly includes specific exercise, manual therapy, hands-on care, assistive devices (e.g., cane, walker), prostheses, orthoses, physical modalities (e.g., heat, cold, electrical modalities) and patient education.
PTs diagnose and treat individuals across the continuum of care (i.e., acute care to chronic conditions and long-term disability) and across the lifespan (i.e., all ages, from newborns to people at the end of life).
PTs work in a variety of clinical settings, including acute care, hospitals, rehabilitation hospitals, outpatient rehabilitation, outpatient clinics, privately owned physical therapy clinics, sports training facilities, school systems, skilled nursing facilities (i.e., nursing homes), hospices, extended care facilities, private homes, health and wellness clinics/centers, education and research centers.
Rheumatology Skill Set
A PT’s education and training include working with individuals with rheumatic disorders. Typically, PT interventions focus on pain relief, maintaining and regaining joint mobility and motion, muscle flexibility, maintaining and increasing strength and endurance, and preventing secondary disorders and complications, such as deformities. PTs work on improving mobility, the ability to perform activities of daily living and independent functioning. PTs work on educating the patient and family/caregiver about the disease process, including the effects of pathology processes and secondary damage from rheumatic disorders.
How/When to Refer
- After a new rheumatic/musculoskeletal diagnosis, injury or surgery;
- To evaluate fall or other injury risk;
- Upon a decline in mobility;
- For chronic pain conditions;
- To establish a program to increase physical activity;
- For patient education/mobility intervention after any change in status;
- To evaluate and develop Americans with Disabilities Act (ADA) recommendation for the workplace; and
- To evaluate adaptive equipment needs.
Case Study
Rose, a 50-year-old single female, was diagnosed with rheumatoid arthritis one month ago. She just started methotrexate and prednisone to control inflammation. She reports a one-year history of general pain and swelling in her hands and feet, morning stiffness lasting two hours, extreme fatigue and malaise, and often drops things held in her hands, particularly if they are heavy. She is having difficulty getting through her morning routine and getting to work. She does office work and finds it difficult to type, walk or stand for long periods due to pain and fatigue. She has two children in their middle teens.
What Can This Professional Do for Rose?
The goals of PT treatment for Rose are to reduce pain, improve mobility, reduce joint stiffness, improve the ability to perform activities of daily living and prevent the development of deformities and complications. Treatment may include physical modalities to reduce pain, such as heat or cold, therapeutic exercise and hands-on/manual therapy to improve joint mobility and muscle strength, and aerobic exercise to address fatigue and improve endurance. PTs will train Rose on the ability to perform activities of daily living, as well as job tasks, to decrease her risk of injury. PTs will educate Rose about the disease process, including the effects of pathology processes and secondary damage from rheumatic disorders.
The Profession’s National Organization
Get Involved
If you have questions or would like to contribute to a fact sheet for your profession, contact ARP Interprofessional Practice and Management Committee Chair Annelle Reed.
Editor’s note: The above fact sheets were created by the ARP Interprofessional Practice and Management Committee.
Dr. Steinbarger
Kimberly Steinbarger, PT, MHS, DHSc, is an assistant professor at the Husson University College of Health & Pharmacy School of Physical Therapy, Bangor, Maine, and director of the Soaring Eagles Healthcare Pro Bono Clinic. She previously chaired the ARP Interprofessional Practice & Management Committee and is now a member of the ACR Committee on Quality of Care.
Ms. Losavio
Keri Losavio is the Wiley editor of The Rheumatologist.
