Diagnosis and management of rheumatic and musculoskeletal diseases in Dutch nursing homes: a qualitative study among healthcare professionals

BackgroundRheumatic and musculoskeletal diseases (RMDs) are common but often underrecognized in nursing home residents, potentially resulting in suboptimal management and reduced quality of life. This qualitative study explored experiences of health care professionals (HCPs), specifically lead clinicians (elderly care physicians, nurse practitioners, and physician assistants) and physiotherapists, related to diagnosing and managing RMDs in nursing homes.MethodsHCPs were purposively sampled for a semi-structured interview. An inductive thematic analysis was used to analyze the data systematically. Two researchers independently read and coded the interview transcripts. Important concepts were categorized and combined in overarching themes through multiple iterations by using Atlas.ti 24. Illustrative quotes made by HCPs were collected.ResultsTwenty HCPs (75% female; mean age 38.1 years; mean work experience 13.7 years) from five long-term care organizations were interviewed. Lead clinicians estimated RMDs as less prevalent among nursing home residents than physiotherapists. Clinicians considered musculoskeletal examination as complex and time-consuming, and therefore relied on the physiotherapist's judgement. Differentiating between types of RMDs was challenging for all HCPs.In the case of RMDs, HCPs reported setting individualized treatment goals focused on maintaining function, reducing pain, and preserving quality of life. NSAIDs were often avoided because of an increased risk of adverse effects and drug interactions. Systemic or intra-articular corticosteroids were also used infrequently, mainly due to lack of training in performing intra-articular injections or because their use was limited to specific conditions like gout. Physical and occupational therapy were often implemented. Care staff played a crucial role in identifying RMD symptoms through close observation of residents' behavior and mobility. Participants emphasized the need for enhanced training in RMDs and optimizing interdisciplinary collaboration with orthopedic surgeons and rheumatologists in order to improve early recognition, accurate diagnosis, and effective management of RMDs in nursing home residents.ResultsTwenty HCPs (75% female; mean age 38.1 years; mean work experience 13.7 years) from five long-term care organizations were interviewed. Lead clinicians estimated RMDs as less prevalent among nursing home residents than physiotherapists. Clinicians considered musculoskeletal examination as complex and time-consuming, and therefore relied on the physiotherapist's judgement. Differentiating between types of RMDs was challenging for all HCPs.In the case of RMDs, HCPs reported setting individualized treatment goals focused on maintaining function, reducing pain, and preserving quality of life. NSAIDs were often avoided because of an increased risk of adverse effects and drug interactions. Systemic or intra-articular corticosteroids were also used infrequently, mainly due to lack of training in performing intra-articular injections or because their use was limited to specific conditions like gout. Physical and occupational therapy were often implemented. Care staff played a crucial role in identifying RMD symptoms through close observation of residents' behavior and mobility. Participants emphasized the need for enhanced training in RMDs and optimizing interdisciplinary collaboration with orthopedic surgeons and rheumatologists in order to improve early recognition, accurate diagnosis, and effective management of RMDs in nursing home residents.ConclusionsLead clinicians experience challenges in diagnosing and managing RMDs in nursing home residents and therefore often rely on physiotherapists. Treatment is pragmatic and individualized with limited use of pharmacological options. Better education on RMDs and improved interdisciplinary collaboration are considered important for optimizing the management and care of nursing home residents.