Lucie is an Extended Scope Practitioner (Specialist Physiotherapist, Young Adult Hip Service) at The Royal Orthopaedic Hospital in Birmingham. We spoke to her about the work Physiotherapists can do to help with earlier diagnosis, as well as their crucial role in rehabilitation.

Can you explain what kind of work you do as a Physiotherapist dealing with primary bone cancer patients?

From 2006-2013, I managed the Physiotherapy Gym at the Royal Orthopaedic Hospital, Birmingham and led the land based rehabilitation for patients who had had limb salvage surgery for primary bone tumours.

During my time working with patients with bone tumours, one of the main things that I found which caused significant distress for patients was the length of time they had waited to be diagnosed, and the numerous misdiagnoses they had received in the meantime. This led me to believe that we could do much more in terms of recognising symptoms earlier. Although I have moved out of the Physiotherapy Gym and work mainly with Consultants in the assessment of joint pain, I continue to feel passionate about this area of delayed/misdiagnosis.

Why is the role of a Physio so important?

Physiotherapy is obviously important in the post-operative role following limb salvage surgery, to strengthen muscles, improve movement and increase function. It is integral to achieve the most benefit from surgery.

However, I also feel there is another key role and that is Physiotherapists are now often the first Health Care Professional that patients will see with initial bone tumour symptoms. This has increased through self referral pathways where patients can refer themselves directly for Physiotherapy without seeing their GP. If we can educate all Physiotherapists and GPs who see patients at the first point of care for joint pains regarding early bone tumour symptoms, I feel we could improve early diagnosis.

Could you tell us a bit about your current research project and how you aim to incorporate your findings into your work with patients?

In 2015, I conducted a project where I interviewed patients with a primary bone tumour around the knee, about their symptoms. I also interviewed Consultants and Allied Health Care Professionals who have experience with patients with primary bone tumours about the symptoms they thought patients presented with.

The results showed that the guidelines we have about the symptoms patients experience are more in line with later symptoms, and that the early symptoms present more like normal joint pains and injuries. I feel that this is a key reason as to why we have not reduced delays in diagnosis over the last few decades as I feel the early symptoms are not known and are therefore being missed. I would therefore like to do a larger study to confirm these findings and to look at the symptoms of all lower limb primary bone tumours. I feel that finding out what the early symptoms are, and being able to distinguish them from normal joint pains and injuries, is a key way to reduce diagnostic delays for patients.