Rehabilitation Referral in Rheumatology: Insights From the RISE Registry

The aim was to describe the percentage of patients with axial spondyloarthritis (axSpA), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE) in the Rheumatology Informatics System for Effectiveness (RISE) Registry who received a rehabilitation referral.

Data were derived from RISE, an electronic health record enabled registry of approximately 30% of the US clinical rheumatology workforce. Practices were eligible if there was at least one patient record indicating a referral to rehabilitation (physical or occupational therapy) in any plan of care. Patients from eligible practices were included if they were ≥18 years old, had two or more qualifying International Classification of Disease (ICD) codes for axSpA, RA, or SLE at least 30 days apart, and had at least one visit in 2022. The primary outcome was percentage of patients with at least one rehabilitation referral documented in 2022 and at any time, reported by patient and practice characteristics.

A total of 20,574 adult patients with axSpA, 198,517 with RA, and 37,060 with SLE were identified. In 2022, 4.4%, 2.7%, and 2.6% of patients with axSpA, RA, and SLE were referred to rehabilitation at least once, whereas 11.8%, 9.2%, and 8.7% of these patients received a referral to rehabilitation at any time, respectively. Among practices, 52%, 61%, and 60% of practices referred <1% of patients with axSpA, RA, and SLE to rehabilitation in 2022.

Rehabilitation referral from rheumatology practices was low, with considerable variation across practices. The strength of recommendations for rehabilitation in treatment guidelines seem to have limited impact on referral practices.