Patients with early and established inflammatory arthritis alike benefited from a 6-week PRT programme provided within a National Health Service setting. Although further work is needed to look at long-term effects, we suggest that this intervention should be more widely available.
BackgroundRheumatoid arthritis (RA) is associated with adverse changes in body composition and physical function that persist despite pharmaceutical treatment. Randomised control trial evidence has shown that Progressive Resistance Training (PRT) is safe and efficacious in restoring lean mass and function in patients with RA. We set up our own PRT programme for RA patients to explore whether similar results could be achieved in an NHS setting.MethodsRA patients were invited to attend a PRT programme of six, weekly class held under the supervision of a Senior Physiotherapist. Newly diagnosed and established RA were included. The exercises used within the circuit are: wall slides, chest press, leg extension, rowing, balance board work, triceps extensions, bicep curls, clam, bridging, standing calf raises and step ups. Classes included up to 10 patients at a time. Data collected at induction and after six weeks included demographics, BMI, percentage body fat, grip strength, 60 second Sit to Stand test, HAQ and FACIT (fatigue) scores. After the six-week PRT programme patients were encouraged to continue at home or referred to their local gym.ResultsOf 34 RA Patients invited, 27 started and 21 completed the 6 week PRT course. Mean age 54 (range 17–78) years; 71% F; 50% RF positive. 11 (32%) patients were diagnosed within 3 months of starting the class. There was no difference in results between recently diagnosed and established RA patients.After six weeks there was a significant improvement in: HAQ mean (range) 1 (0–2.9) vs 0.8 (0–2.5) p=0.03; Body Fat Composition mean (range) 38.0% (21.5%>51%) vs 36.9% (26.3%>48.2%) p=0.02; Sit to Stand mean (range) 20.0 (8–36) vs 23 (9–42) p=0.02. There was a trend towards improvement mean (range) in: handgrip strength 22.0 (2–54) vs 25.8 (5–54) p=0.21 and FACITF score 29.5 (18–49) vs 35.6 (19–49) p=0.05.BMISit to standGrip strength rightGrip strength leftFACITFBody fatHAQ(60 secs)(kg)(kg)%Baseline mean30.920.022.522.029.538.016 week mean30.323.027.325.835.636.90.8p0.490.020.080.210.050.020.03ConclusionsWe present an effective model for PRT workable in the NHS, which encourages patient to take control of their own exercise regimes. The class setting fosters motivation, confidence and a belief in exercise as part of effective treatment. This brief intervention was associated with significant improvement in various aspects of physical function, Grip strength, HAQ and Fatigue scores.Disclosure of InterestNone declared
Introduction Manipulation under anaesthetic (MUA) is a successful treatment for frozen shoulder (FS), and the recovery period and recurrence rates may be reduced by postoperative physiotherapy. This study evaluates two physiotherapy pathways for patients undergoing MUA for FS. Methods Between 2016 and 2018, 248 age- and sex-matched patients presented to either a NHS secondary care upper limb service or the lead author’s independent practice with a diagnosis of FS. The patients had differential access to postprocedure physiotherapy based on which service they presented to. In Group 1, physiotherapy advice only was given to the patient. In Group 2, supervised hydrotherapy and physiotherapy occurred postoperatively. Pre- and postprocedure Oxford Shoulder Scores (OSS) were collected for each group. Analysis of covariance (ANCOVA) was used to measure the effect of physiotherapy on postoperative OSS. Results Group 2 showed a significantly greater improvement in postprocedure OSS when compared with Group 1 (18.2 vs 16.7) p<0.001). The estimated maximum effect of physiotherapy on postoperative OSS was an increase of 3.2. Conclusion Following MUA for FS, a statistically significant increase in OSS was detected in patients receiving postprocedure physiotherapy compared with advice alone. There was no difference in recurrence rates. The increase in OSS (3.2) is below the minimal clinically important difference, raising questions regarding the relative importance of postprocedure physiotherapy in a resource-limited environment.
BackgroundWe introduced six week physiotherapy led progressive resistance training (PRT) programme for Rheumatoid arthritis (RA) patients to improve physical function and prevent the muscle loss (rheumatoid cachexia). Six week data showed improvement in body composition, physical function and fatigue scores1. There is little published data about the longer term benefits of short exercise interventions and therefore we wished to study longer term effects on exercise behaviour in our patient group.MethodsWe surveyed 79 RA patients who had completed the six weeks PRT programme between 2013 and 2016 using two methods: Anonymous postal questionnaire; Direct telephone questionnaire. Patients were asked the same following questions: 1. Describe the best you feel at present following the exercise programme? Same/ Better/ Worse. 2. Have you continued with progressive resistance exercises? Yes/ No. 3. Do you feel the programme was worthwhile? Yes/No. 4. Did you feel the programme was too long, just right or too short?ResultsPatientContinued PRTNot continued PRTContinued PRTNot continued PRT 75% (27/36)25% (9/36)51% (22/43)49% (21/43) (Postal)(Postal)(Telephone)(Telephone) Better81% (22/27) (p=0.006)33% (3/9)77% (17/22) (p=0.009)38% (8/21)Same15% (4/27)56% (5/9)18% (4/22)19% (4/21)Worse4% (1/27)11% (1/9)5% (1/22)43% (9/21)Postal questionnaire45% (36/79) patients returned the postal questionnaire. Time from PRT programme completion to postal questionnaire was: range (mean) 12–36 (26) months. 69% (25/36) still felt better; 25% (9/36) felt the same; 3% (1/36) worse since the programme. 91% (33/36) felt the programme was worthwhile. 75% (27/36) continued PRT exercises. 81% (22/27) of these still felt better, compared with 33% (3/9) who have not continued PRT (p=0.006). The duration of the programme was just right for 69% (25/36) and too short for 30% (11/36).Telephone questionnaire54% (43/79) patients were contactable by telephone. Time from PRT programme completion to telephone questionnaire was: range (mean) 14–38 (26) months. 58% (25/43) still felt better; 18% (8/43) felt the same; 23% (10/43) worse since the programme. 95% (41/43) felt the programme was worthwhile. 51% (22/43) continued PRT exercises. 77% (17/22) still felt better, compared with 38% (8/21) who have not continued PRT. (p=0.009). 49% (21/43) had not continued PRT exercises, of whom 43% feel worse at present. The duration of the programme was just right for 47% (20/43) and too short for 53% (23/43).ConclusionsOver 90% of patients who responded found the six week PRT programme worthwhile. More than half (51–75%) of the patients continued a PRT exercise programme. Patients who continued exercises felt better compared with those who did not continue exercises.References Berntzen et al A Six-Week Progressive Resistance Training Class Improves Function and Fatigue in RA Patients: Annals of the Rheumatic Diseases 75 (S2):254 2016. Disclosure of InterestNone declared
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