BackgroundIn national and international management guidelines physical therapy (PT) is a recommended treatment for people with inflammatory arthritis (IA). Based on multiple systematic reviews, concluding that supervised exercise therapy and exercise promotion is an effective and safe PT treatment option in patients with IA, recommendations in particular endorse active PT treatment. In order to monitor and enhance the quality of PT in clinical practice, knowledge about its delivery, including its active content, is needed.ObjectivesTo assess the use, frequency, duration and content of PT in patients with IA.MethodsIn this cross-sectional, national study a link to an electronic questionnaire addressing people with rheumatic and musculoskeletal diseases was published between December 2020-July 2021 by the Dutch Arthritis Foundation via their website, newsletter and various social media. It comprised questions on demographic and health characteristics, the EuroQol 5-Dimensions 5-Levels (EQ5D5L) and 29 questions on the usage of PT currently and/or in the past 12 months and, if applicable, the duration, frequency and content of the PT treatment. The content of PT was categorized into exercises (active aerobic, muscle strengthening, range of motion and/or functional exercises), manual treatment, physical modalities and counseling/education. Only data from patients self-identifying as diagnosed with rheumatoid arthritis (RA) and/or axial spondyloarthritis (axSpA) were used for the current study.ResultsA total of 267 people with RA (mean (SD) age 54 (12) years, 96% female) and 104 people with axSpA (age 47 (13) years, 88% female) (10 patients with both diagnoses) completed the questionnaire. More than 90% were treated by a rheumatologist; the mean (SD) EQ5D5L of people with RA was 0.62 (0.2) and of axSpA 0.59 (0.2). 172 RA respondents (64%) reported the use of PT related to their RA (162 individual PT, 1 group PT, 9 both individual and group PT). In axSpA, the rate was 87 (84%; 77 individual PT, 2 group PT, 8 both individual and group PT).Of those reporting individual PT treatment, the duration was long-term (> 3 months) in 134 (89%) and 70 (89%) of the respondents with RA and axSpA respectively, with a duration of more than 2 years in 67 (44%) and 38 (48%). In all users of individual PT, the mean frequency was once per week or less in 116 (77%) of the RA and 63 (80%) of the axSpA patients. Proportions were based on number of respondents to questions on individual PT.Concerning the content of individual PT, and taking into account both short-term and long-term use, for active exercises, the proportion of patients reporting aerobic, muscle strengthening, range of motion or functional exercises ranged from 40-66% in RA and 24-73% in axSpA patients. Regarding manual treatment, the proportions were 61% and 58%, in RA and 73% and 72% in axSpA for massage and passive mobilizations, respectively. With respect to physical modalities (passive), the modality most frequently mentioned were kinesiotaping and dry needling (40 and 25% and 43 and 32% in RA and axSpA). For counseling/education, exercises to perform at home (70 and 78%) and physical activity (PA) promotion (48 and 49%) were most often reported in both RA and AxSpA.ConclusionLong-term use of PT is common in patients with RA and AxSpA. Apart from active treatment modalities (exercises) and promoting recommended PA, passive treatment options appear to be relatively often used. The results must be interpreted with caution, as the respondents may not constitute a representative sample of the IA population, yet warrant further research.Acknowledgements:This work was supported by the Dutch Arthritis Society [ReumaNederland], the Royal Dutch Society for Physical Therapy [KNGF] and The Netherlands Organisation for Health Research and Development [ZonMw].Disclosure of InterestsNone declared
BackgroundPhysical functioning in patients with inflammatory arthritis (IA) can be severely affected and is often measured using the disease-specific questionnaires Health Assessment Questionnaire-Disability Index (HAQ-DI) or Bath Ankylosing Spondylitis Functional Index (BASFI). Also, the Patient Reported Outcome Measurement Information System (PROMIS) Physical Function Item Bank1 has been increasingly used. This is a generic instrument to assess physical functioning and compare health status across conditions. Several short forms can be derived, including the PROMIS PF 10-Item Short Form (PROMIS PF-10). To date, experience with this PROMIS PF-10 in research with IA is limited and more insight is needed in its construct validity in specific IA populations.ObjectivesTo assess the construct validity of the PROMIS PF-10 in patients with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) and severe limitations in physical functioning.MethodsBaseline data from patients with RA or axSpA and severe limitations in physical functioning participating in two randomized controlled trials on the effectiveness of longstanding physical therapy2 were used. Patients completed the PROMIS PF-10 (score range 13.5-61.9 worst-best, standardized to the Dutch population) and several measures of physical functioning and quality of life: i.e. the 36-item Short Form Health Survey (SF-36) (Physical and Mental Component summary Scores (PCS and MCS) were calculated), the EuroQol 5-dimensions 5-levels (EQ5D5L; index and VAS) and the 6 Minute Walk Test (6MWT). In addition, RA patients completed the HAQ-DI and axSpA patients the BASFI. Spearman rho correlation coefficients were computed between the PROMIS PF-10 and the other measures. Correlations were considered 0.3<r<0.5 weak, 0.5 <r<0.75 moderate to good, r >0.75 good to excellent. The PROMIS PF-10 was expected to correlate moderately to good with instruments measuring physical functioning and weak with other instruments (e.g. SF-36 MCS). All analyses were stratified for RA and axSpA.ResultsData from 181 patients with RA and 139 with axSpA (92% and 48% female, mean (SD) age 59 (13.1) and 54 (11.4) years, respectively) were analyzed. The mean score of the measures of physical functioning and quality of life are summarized in the Table 1. The PROMIS PF-10 correlated moderately to good with HAQ-DI, BASFI, SF-36 PCS and EQ5D5L-index (Spearman r >0.5, all p-values <0.001). The PROMIS PF-10 correlated weak with the 6MWT, EQ-VAS and the SF-36 MCS (Spearman r <0.5).Table 1.Mean score and Spearman r correlation coefficients of PROMIS PF-10 with measures of physical functioning and quality of lifePROMIS PF-10HAQ-DI (RA) BASFI (axSpA)SF-36 PCSSF-36 MCSEQ5D5L indexEQ-VAS6MWTRA Mean(SD)34.1 (5.0)1.6 (0.5)39.4 (19.7)46.8 (12.0)0.5 (0.3)56.4 (18.7)300 (100)Spearman r--0.724*0.611*0.1010.617*0.450*0.469*AxSpA Mean(SD)35.4 (4.2)6.2 (1.8)44.4 (17.6)45.5 (11.6)0.5 (0.3)54.5 (19.0)390 (108)Spearman r--0.686*0.539*-0.0140.598*0.438*0.434**Correlation is significant at <0.001 levelConclusionThe moderately to good correlations of the PROMIS PF-10 with measures of physical functioning support the construct validity in RA and axSpA patients with severe limitations in physical functioning. However, the correlation of the quality of life questionnaire EQ5D5L was also moderately to good. Future research is needed to better understand this relatively high correlation. Also clinimetric properties (responsiveness to change and ability to discriminate between intervention and control conditions) in this population should be determined in future.References[1]Gershon RC, et al. J Appl Meas. 2010;11(3):304-314.[2]van Wissen MAT, et al. Physiother Res Int. 2021;e1933.Funding:The Netherlands Organisation for Health Research and Development [ZonMw: 852004018 and 852004019]; Ministry of Health, Welfare and Sport [VWS]; the Dutch Arthritis Society [ReumaNederland] and the Royal Dutch Society for Physical Therapy [KNGF].Disclosure of InterestsNone declared
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