EULAR Defines Core Competences for Rheumatology Nurses, Physical Therapists and Occupational Therapists
Postgraduate education in rheumatology has often advanced unevenly across professions and countries, leaving health professionals to rely on local custom, variable training pathways, and fragmented expectations. The 2019 EULAR task force set out to replace that patchwork with a structured framework for the generic core competences of health professionals in rheumatology, with explicit relevance for nurses, physical therapists, and occupational therapists.
The effort was not a narrow technical exercise. It was a response to a practical problem in day-to-day care: if the professionals who help deliver chronic inflammatory disease management are trained to different standards, then the consistency of assessment, education, rehabilitation, self-management support, and follow-up can vary widely from one system to another.
The task force built its recommendations through EULAR standardised operating procedures. A multidisciplinary group of rheumatologists, nurses, physical therapists, occupational therapists, patient representatives, an educationalist, methodologists, and researchers from 12 countries met twice to shape the project. In the first meeting, the group defined 13 research questions to anchor a systematic literature review. In the second, the evidence was reviewed and transformed into recommendations, with levels of evidence, strength of recommendation, and level of agreement assigned on a 0 to 10 scale.
Evidence Base Centered on Professional Roles and Educational Needs
The systematic literature review was intentionally broad but clinically grounded. It included 79 full-text papers, and 20 of those addressed competences, knowledge, skills, attitudes, or educational needs across multiple professions. The available evidence was not abundant, but it was sufficient to support a consensus-driven framework rather than leave postgraduate training to informal tradition.
That scarcity of directly relevant studies matters because it reflects how little formal work has historically been devoted to defining the shared competencies of rheumatology health professionals. In practice, the group had to bridge evidence and expert judgment, using both to identify which skills are generic, which are profession-specific, and which support high-quality care across systems with different staffing models.
Three overarching principles emerged from the process, followed by 10 recommendations. The recommendations were built to support a common educational foundation rather than a rigid international curriculum. This distinction is important in rheumatology, where health professionals may work in settings ranging from specialist centers to community services, and where professional responsibilities differ across countries.
A single professional role cannot carry the entire burden of chronic rheumatic disease care.
The Competence Framework Reflects Shared Care Needs Across Disciplines
The recommendations focus on generic core competences, a phrase that signals shared essentials rather than exclusive tasks. In rheumatology, these essentials include the knowledge, clinical reasoning, communication skills, and professional attitudes needed to contribute safely and effectively to multidisciplinary care. Nurses, physical therapists, and occupational therapists do not perform identical work, but they do share a common educational substrate: understanding inflammatory and musculoskeletal disease, recognizing functional impact, supporting patient self-management, and working within an interdisciplinary team.
By grounding the framework in core competences, the task force created a structure that can be adapted to local education systems while preserving consistency in the fundamentals. That approach fits the reality of international rheumatology care, where titles, scope of practice, and service organization vary, but the need for reliable patient-centered support does not.
The recommendations also carry an implicit message for employers, educators, and professional bodies. Training should not be treated as an optional add-on to clinical service delivery. It should be a defined prerequisite for safe and effective contribution to rheumatology care, especially in settings where these professionals are central to longitudinal follow-up, patient education, and rehabilitation.
High Agreement Signals a Strong Professional Consensus
Agreement across the recommendations was consistently high. The average level of agreement for each recommendation ranged from 9.42 to 9.79 on the 0 to 10 scale, indicating strong consensus within the task force. High agreement does not eliminate variation in implementation, but it does show that the participating experts converged on the importance of a shared educational foundation.
The recommendations were also paired with a research agenda and an educational agenda. This dual output is clinically useful. On the one hand, it points to the need for more evidence on how competence-based education affects patient care and professional performance. On the other, it provides a practical structure for postgraduate programs that need clear goals now rather than waiting for perfect evidence.
The need for implementation is especially clear at the international and national levels, where variations in healthcare systems and professional roles can complicate direct adoption. A competence framework can travel across borders more easily than a fixed job description, but it still requires local translation. Educators will need to align the recommendations with national regulations, scope-of-practice rules, and the realities of service delivery.
Postgraduate Training in Rheumatology Gains a Common Foundation
This work gives rheumatology education a more coherent base. It does not erase the differences between professions, and it does not pretend that one template fits every country. Instead, it establishes a shared floor beneath specialized training, which is often the most useful place to begin when educational standards are inconsistent.
For patients, the value is indirect but meaningful. Better-defined training for nurses, physical therapists, and occupational therapists should support more reliable counseling, more coherent rehabilitation planning, and more consistent integration into multidisciplinary rheumatology care. For health systems, the framework offers a way to standardize expectations without flattening professional identity.
The remaining challenge is implementation. Health systems will need to decide how to incorporate the recommendations into postgraduate curricula, credentialing pathways, and local workforce planning, while accounting for differences in professional roles and service organization. The recommendations provide the map; local educational institutions still have to build the route.
The evidence base was sufficient to shape consensus, but still limited enough to leave room for further study on how best to teach, assess, and sustain these competences across countries and professions.