Patient and Clinician Perspectives on Physical Therapy Use in Contemporary Rheumatology Care for Rheumatoid Arthritis in the US : A Qualitative Study

OBJECTIVE: Physical therapy (PT) can address functional limitations common in rheumatoid arthritis (RA) yet remains inconsistently utilized in rheumatology care. The purpose of this study was to explore how PT is used in routine RA care in the United States from the perspectives of patients, rheumatology clinicians, and physical therapists. METHODS: We conducted a qualitative study using semi-structured interviews with adults with RA (n=24), rheumatology clinicians (n=6), and physical therapists (n=6) with diverse experiences. Interviews were analyzed using reflexive thematic analysis to identify key themes related to PT use across the care pathway. RESULTS: Four themes emerged illustrating barriers to effective utilization of PT in RA care: Recognizing the Need for PT. Rheumatology clinicians often prioritized pharmacological management and reserved PT for later disease stages or severe functional decline, while patients described a desire for earlier, preventative PT. Discussion of PT. Clinicians and patients reported limited discussion of PT, with conversations often occurring late in disease management and PT seen as a "last resort." Interprofessional Collaboration and Training Challenges. Gaps in knowledge, interprofessional communication, and referral processes among rheumatology clinicians and limited rheumatology exposure among physical therapists impeded PT use. Utilization of PT. Logistical challenges (cost, travel, time), concerns about pain and adherence, and limited availability of rheumatology-focused PT clinics were barriers to utilization. CONCLUSIONS: Across participant accounts, PT was described as inconsistently utilized in routine RA care and often considered reactively. Participants described misalignment in clinician perspectives, limited communication, and inconsistent care processes as contributing to early breakdowns in the care pathway and delayed or unrealized PT access.