First Contact Physiotherapists (FCPs) Referral Practices to Rheumatology: A Scoping Review of the Evidence Base.

BACKGROUND: First Contact Physiotherapists (FCP) are central to musculoskeletal practice within UK primary care, supporting patients at the earliest point of their healthcare journey. Early recognition and referral of rheumatological conditions are critical aspects of the role, necessitating knowledge, skills and capability. OBJECTIVES: To explore and map existing literature on FCP rheumatology referral practices, identify gaps within the evidence base and inform future research. DESIGN: Scoping review following Joanna Briggs Institute guidelines. METHOD: Four bibliographic databases and grey literature were searched for sources published between 2015 and 2025. Study selection and data extraction were completed by the author and additional reviewers. Data were charted in extraction tables and synthesised inductively informing a narrative thematic summary. RESULTS: 29 sources were included, comprising 8 journal articles, 19 clinical guidelines and 2 frameworks. A paucity of evidence exists across the spectrum of rheumatological conditions, with dominance within axial spondyloarthritis (axSpA). FCPs have been shown to appropriately refer patients with axSpA, thereby reducing the time to diagnosis. Access to investigations is variable, but with ambiguities in interpreting results, clinical correlation is essential. Numerous referral guidelines support diagnosis and referral. Experience, training and effective relationships with rheumatology services were deemed of central importance. CONCLUSION: No included studies reported safety concerns related to FCP or a contribution to diagnostic delay; however, the limited evidence precludes conclusions on these outcomes. Studies support the value of FCP in rheumatology although they provide limited 'real world' evidence. Future research should evaluate referral practices across the spectrum of rheumatological disorders, the impact of FCP on diagnostic delays and conversion rates, and educational requirements to support rheumatology practice. TRIAL REGISTRATION: Open Science Framework (OSF) https://doi.org/10.17605/OSF.IO/ZV4Y6.