Axial SpA Referral Strategies in Edinburgh and the Lothians
Research type
Research Study
Full title
Axial Spondyloarthritis Referral Strategies in Edinburgh and the Lothians (AxREAL)
IRAS ID
350090
Contact name
Jordan Hepburn
Contact email
Sponsor organisation
Rachel Beaton
Duration of Study in the UK
5 years, 1 months, 26 days
Research summary
Axial Spondyloarthritis (AxSpA) is a progressive inflammatory disease which can have severe and complex impact on individuals. Individuals with AxSpA can experience chronic pain, health co-morbidities, poor quality of life and economic burden. There is a worldwide mean delay of 6.7 years from initial symptom presentation to healthcare and diagnosis by a Rheumatologist. Diagnostic delay is associated with more severe disease progression, structural spinal deformity, and potentially less efficacious medical treatment. AxSpA epidemiology, time to diagnosis and primary care referral strategy performance are empirically unknown in the Scottish GP population. This lack of insight extends to the impact of Advanced Practice Physiotherapists (APPs) on patient outcomes, who were introduced to General Practice as part of primary care redesign and integration. The AxREAL study aims to improve understanding of these phenomena within the Scottish Population. In so doing, the prior probability of AxSpA in General Practice will be determined, and optimal referral strategies will be identified based upon statistical modelling, health-economic analysis, and healthcare system feasibility. Thus findings are expected to have a tripartite of key outcomes: 1) support primary care clinicians’ in making decisions about referring patients for suspected AxSpA from GP, helping to reduce perceived uncertainty and the likelihood of patients experiencing diagnostic delay; 2) support design of effective primary care referral pathways to secondary care Rheumatology services, conducive to value based healthcare; 3) generate a quantifiable baseline in provision of care for people with symptoms associated with AxSpA in Scottish General Practice, providing a comparator for future healthcare service development and prospective research activity. These outcomes should ensure that the AxREAL study will positively impact patients, clinicians and healthcare services across NHS Scotland.
REC name
North of Scotland Research Ethics Committee 2
REC reference
25/NS/0062
Date of REC Opinion
14 Jul 2025
REC opinion
Further Information Favourable Opinion