Large Variability of Frequency and Type of Physical Therapy in Patients in the German Network for Systemic Sclerosis

Abstract

Objective. To determine the type and frequency of physical therapy (PT) prescribed by physicians for patients in the registry of the German Network for Systemic Sclerosis.Methods. The data for 4,252 patients were analyzed using descriptive statistics, chi-square tests, and odds ratios (ORs).Results. Overall, 37.4% of patients (1,590 of 4,252) received PT at the end of a yearly follow-up. The most frequently used type of PT was lymphatic drainage (n = 1,061, 36.8%), followed by exercise therapy (n = 1,047, 36.3%) and heat therapy (n = 689, 23.9%). More than three-fourths of treated patients (82%) received 1 or 2 different forms of PT simultaneously. The prescription of PT was associated with the extent of skin fibrosis as measured by the modified Rodnan skin thickness score (<10 [41.8% of patients], 11-20 [55.8% of patients], and >21 [63.9% of patients]; P < 0.001). Patients with musculoskeletal involvement (e.g., arthritis, muscle weakness, joint contractures, tendon friction rubs) had a higher chance of receiving PT than patients without these symptoms, with corresponding ORs ranging from 1.96 (95% confidence interval [95% CI] 1.69-2.28) for joint contractures to 3.83 (95% CI 2.89-5.08) for arthritis. When comparing the type of PT prescription across the initial and all follow-up visits from 2003 to 2017, significant alterations with a decreasing frequency of patients receiving PT could be observed (P = 0.001).Conclusion. To our knowledge, this is the first study reporting the use of PT in patients with systemic sclerosis (SSc) in a large cohort. Although SSc is characterized by considerable disability and restriction of motion, <40% of patients received PT.

Physical Therapy in Systemic Sclerosis: The Patient Perspective

“…Regarding the use of PT, the proportion of 63% over 2 years was somewhat higher than the percentages seen in previous studies, which reported proportions of SSc patients visiting PT during 1 year ranging from 37-58% (6)(7)(8). Firstly, our proportion covered 2 years, whereas for the previous studies (6-8) only 1 year was covered.…”

“…However, improving PT care for SSc patients remains challenging due to a lack of insight into current PT use and a lack of studies on the effectiveness and safety of PT in SSc. The few studies to date that have assessed the frequency of PT use in SSc patients have reported percentages ranging from 37% at the end of a yearly follow-up to between 53% and 58% in the last year (6)(7)(8). Only 1 study evaluated the content of PT as reported by physicians.…”

“…Only 1 study evaluated the content of PT as reported by physicians. The most often used treatment modalities were lymphatic drainage, exercise therapy, and heat therapy (8). In situations where evidence is lacking, the occurrence of practice variation and suboptimal care is likely.…”

Physical therapy in patients with systemic sclerosis: physical therapists’ perspectives on current delivery and educational needs

“…With respect to the content of physical therapy, our finding that exercise therapy was one of the most frequently used treatment modalities is in line with one German study (8). Our study adds to these results with a more detailed description of the treatment modalities employed.…”

“…This is also the case for systemic sclerosis (SSc), a rare, chronic autoimmune disease with multiorgan involvement (5). Physical therapists are among the most frequently visited health professionals in SSc, with the proportion of SSc patients visiting a physical therapist during 1 year ranging between 37% and 58% (6)(7)(8)(9). In the literature, SSc patients have expressed the need for improvement of non-pharmacological care, including physical therapy (10,11).…”