Diagnosis and management of standardised patients simulating peripheral SpA
| Educational group (n=19) | p Value (within group) | Control group (n=40) | p Value (within group) | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Round 1 (%) | Round 2 (%) | Change score (%) | Round 1 (%) | Round 2 (%) | Change score (%) | p Value (change scores, between groups) | |||
| Number 1 diagnosis | |||||||||
| Peripheral SpA | 2 (11) | 5 (26) | 3 (16) | 0.45 | 4 (10) | 4 (10) | 0 (0) | 1.00 | 0.21 |
| Reactive arthritis | 2 (11) | 1 (5) | −1 (−6) | 1.00 | 4 (10) | 3 (8) | −1 (−2) | 1.00 | 0.79 |
| SpA | 0 (0) | 3 (16) | 3 (16) | 0.25 | 0 (0) | 0 (0) | 0 (0) | NA | 0.01 |
| Psoriatic arthritis | 0 (0) | 1 (5) | 1 (5) | 1.00 | 0 (0) | 0 (0) | 0 (0) | NA | 0.15 |
| Tenosynovitis | 0 (0) | 0 (0) | 0 (0) | NA | 0 (0) | 1 (3) | 1 (3) | 1.00 | 0.49 |
| Arthritis, not otherwise specified | 5 (26) | 8 (42) | 3 (16) | 0.45 | 15 (38) | 16 (40) | 1 (2) | 1.00 | 0.44 |
| Rheumatoid arthritis | 5 (26) | 3 (16) | −2 (−10) | 0.69 | 2 (5) | 5 (13) | 3 (8) | 0.45 | 0.18 |
| Gout | 1 (5) | 1 (5) | 0 (0) | 1.00 | 8 (20) | 6 (15) | −2 (−5) | 0.77 | 0.70 |
| Sprain | 4 (21) | 1 (5) | −3 (−16) | 0.25 | 6 (15) | 5 (13) | −1 (−2) | 1.00 | 0.30 |
| Skin or nail infection/insect bite | 2 (11) | 0 (0) | −2 (−11) | 0.50 | 3 (8) | 1 (3) | −2 (−5) | 0.25 | 0.70 |
| Trauma | 0 (0) | 1 (5) | 1 (5) | 1.00 | 1 (3) | 1 (3) | 0 (0) | 1.00 | 0.49 |
| Other or no differential diagnosis | 0 (0) | 1 (5) | 1 (5) | 1.00 | 1 (3) | 2 (5) | 1 (2) | 1.00 | 0.71 |
| Additional diagnostic tests | |||||||||
| Laboratory tests (general) | 8 (42) | 5 (26) | −3 (−16) | 0.38 | 17 (43) | 18 (45) | 1 (3) | 1.00 | 0.18 |
| HLA-B27 test | 0 (0) | 0 (0) | 0 (0) | NA | 0 (0) | 0 (0) | 0 (0) | NA | 1.00 |
| IgM RF and/or ACPA test | 5 (26) | 2 (11) | −3 (−16) | 0.38 | 11 (28) | 7 (18) | −4 (−10) | 0.29 | 0.64 |
| Radiograph of the hand or foot | 0 (0) | 1 (5) | 1 (5) | 1.00 | 4 (10) | 8 (20) | 4 (10) | 0.22 | 0.59 |
| Management | |||||||||
| NSAIDs prescribed | 13 (68) | 13 (68) | 0 (0) | 1.00 | 21 (53) | 22 (55) | 1 (3) | 1.00 | 0.86 |
| Arranged follow-up consultation with GP (resident) | 10 (53) | 10 (53) | 0 (0) | 1.00 | 23 (58) | 25 (63) | 2 (5) | 0.82 | 0.82 |
Values are expressed as number (percentage) of participants. Numbers may not add up due to rounding. NcNemar tests were used within groups and Mann-Whitney U tests were used between groups.
ACPA, anticitrullinated protein antibody; GP, general practitioner; HLA-B27, human leukocyte antigen B27; NA, not assessed; NSAIDs, non-steroidal anti-inflammatory drugs; RF, rheumatoid factor; SpA, spondyloarthritis; SPs, standardised patients.