Introduction: The International Guidelines recommend exercise, education and weight management (if appropriate) as the first-line conservative treatment for patients with knee osteoarthritis (OA) to enhance their self-management. The aim of this study was to investigate the current state of conservative non-pharmacological management of patients with knee OA in Switzerland and to explore the perceived barriers and facilitators to the application of the guideline recommendations.Materials and methods: Eleven semi-structured interviews with selected general practitioners (GPs), rheumatologists and orthopaedic surgeons were performed. Based on these results, an online survey was developed and sent to the members of three scientific medical societies. Questions addressed the frequency of diagnostic measures, treatment options, reasons for referral to exercise and also barriers and facilitators.Results: A total of 234 members responded. They indicated that patients normally present due to pain (n = 222, 98.2%) and functional limitations of the knee (n = 151, 66.8%). In addition to clinical assessment, X-ray (n = 214, 95.5%) and MRI (n = 70, 31.3%) were the most frequently used diagnostic measures. Treatment options usually involved patient education for diagnosis (n = 223, 98.6%) and suitable activities (n = 217, 96%), pharmacological treatment (n = 203, 89.8%) and referral to physiotherapy (n = 188, 83.2%). The participants estimated that they had referred 54% of their patients with knee OA for a specific exercise. The referral to exercise was driven by “patient expectation/high level of suffering” (n = 73, 37.1%) and their “own clinical experience” (n = 49, 24.9%). The specialists rated the most important barriers to referral to exercise as “disinterest of patient” (n = 88, 46.3%) and “physically active patient” (n = 59, 31.1%). As the most important facilitators, they rated “importance to mention exercise despite the short time of consultation” (n = 170, 89.4%) and “insufficiently physically active patient” (n = 165, 86.9%).Discussion: A substantial evidence–performance gap in the management of patients with knee OA appears to exist in Switzerland. For the systematic referral to exercise as the first-line intervention, it might be useful for medical doctors to suggest a structured exercise programme to patients with knee OA, rather than just advising general exercise.
Objectives Physiotherapy is recommended in the management of people with axial Spondyloarthritis (axSpA), with new insights into its preferred content and dosage evolving. This study aimed to describe the use and preferences regarding individual and group physiotherapy among people with axSpA. Methods A cross-sectional survey was conducted among people with axSpA living in the Netherlands (NL) and Switzerland (CH). Results 713 people with axSpA participated (56.7% male, median age 55 years, median ASAS-Hi-score 4.2). Response rates were 45% (n = 206) in NL and 29% in CH (n = 507). 83.3% of participants were or had been using physiotherapy. Individual therapy only was or had been used by 36.7%, a combination of individual plus land- and water-based group therapy was or had been used by 29.1% and group therapy only by 5.3%. Only less than half participants attending individual therapy reported active therapy (like aerobic, muscle strength, flexibility exercises). Although the majority (75.9%) was not aware of the increased cardiovascular risk, participants showed an interest in cardiovascular training, either individually or in a supervised setting. If supervised, a majority, in CH (75.0%) more than in NL (55.7%), prefers supervision by a specialized physiotherapist. Conclusion The majority of people with axSpA uses or used physiotherapy, more often in an individual than in a group setting. The content of individual therapy should be more active; in both therapy settings aerobic exercises should be promoted. Especially, enabling people with axSpA to perform exercises independently would meet their needs and might enhance their daily physical activity.
BackgroundThe Ankylosing Spondylitis Association of Switzerland (SVMB) offers 68 exercise groups (EG) for people with axial Spondyloarthritis (axSpA). Participants exercise weekly with focus on strength and flexibility supervised by a physiotherapist (PT). Given the EULAR physical activity (PA) recommendations [1] and recent research [2, 3], the SVMB aims to further develop the concept of their EG by introducing: a) exercises in all dimensions, cardiorespiratory fitness, muscle strength, flexibility and neuromotor performance, according to the general PA recommendations [4]; b) individual exercise-coaching (three sessions in first six months) by the group PT, specifically trained in communication and action planning skills to support individual exercising, and c) bi-annual fitness-assessments for all exercise dimensions.ObjectivesTo evaluate the new EG concept among the participating people with axSpA and PTs across four pilot groups.MethodsAfter six months, a survey on the perception and satisfaction towards the new EG concept was sent to 30 people with axSpA, who rated the questions on a 0-10 numeric rating scale (0=not satisfied, 10=very satisfied). Semi-structured telephone-interviews were conducted with the PTs to explore their experiences with the new GE concept.ResultsPeople with axSpA:The survey’s response rate was 83% (25/30); of these, 15 (62%) participants were satisfied with the concept (mean 6.7±2.23) and 20 (80%) with the exercise-coaching (mean 7.7±2.92). 22 (88%) individuals defined a training goal and 15 (60%) achieved it. The exercise diary was used by 16 (64%) participants, five reported app-based. Reasons for not using the diary were the daily effort and problems with correctly allocating activities to exercise dimensions. A minority (n=7, 28%) reported to use a technical device for cardiovascular exercising. 17 (68%) were satisfied with the fitness-assessment (mean 7.5±1.78). PTs perceived the exercise-coaching as very useful for supporting individualised exercising. However, they emphasised that the frequency of the sessions should be flexibly based on the participant’s individual training goal and motivation. The PTs perceived controversial reactions to the fitness-assessments: increased but also decreased motivation towards exercising.ConclusionExercise-coaching and fitness-assessments were generally appreciated; however, the frequency was perceived as too high. The GE concept will be adapted accordingly to improve feasibility for national implementation: the exercise-coachings will be reduced to two in the first six months, the first one compulsory for all participants, then bi-annually, according to individual needs and training goals. The fitness-assessments will take place annually instead of bi-annually. There is a need for easy-to-use exercise diaries, covering all exercise dimensions.References[1] Rausch AK, et al. Ann Rheum Dis2018; 9(77):1251-1260.[2] Sveaas SH, et al. Br J Sports Med2017;51:1065-1072[3] Rausch AK, et al. RMD open, accepted[4] Garber CE, et al. Med Sci Sports Exerc...
BackgroundThe development of RA consists of different phases, including the phase of arthralgia without clinically apparent arthritis. This phase is not well defined in terms of symptom-content, hampering the appropriate delineation of patients eligible for trials. Clinical expertise is a valuable tool to delineate arthralgia patients at risk for RA. Variation in clinical expertise and practice exist. To employ clinical experience in a consensus-based approach, a EULAR task force consisting of 18 rheumatologists, 2 patients, 3 health professionals from different European countries and a research fellow are developing criteria for Clinically Suspect Arthralgia (CSA) with the clinical expertise as external standard.MethodsThe development consists of three phases. In phase 1, a list of clinical items considered as characteristic of CSA will be determined. In phase 2, 40 existing patients presented on paper with information on the items established in phase 1 will be classified by the participants. Candidate criteria will be based on the items discriminating between CSA and non-CSA. In phase 3 (validation) the criteria will be tested in patients referred to the participating centers. The expert opinion will be the reference in all phases; the final criteria will be established by voting. This abstract reports on the results of phase 1. Experts were asked to state all symptoms and signs relevant for considering an arthralgia patient as suspected for progression to RA. Then these items were evaluated in a modified Delphi approach.ResultsThe experts made a list of 55 symptoms and signs that were considered relevant. Then in 3 rounds (modified Delphi) the items that were considered most relevant to identify CSA were selected. Based on consensus, 16 items were obtained. These were: symptoms of recent onset (duration <1 year), symptoms located in MCPs, symptoms located in MTPs, symptoms located in several small joint regions, symmetric symptoms, 4-10 joints with symptoms, morning stiffness ≥60 minutes, most severe symptoms in early morning, improvement of symptoms during the day, increasing number of joints with symptoms over time, patient-experience of swollen small hand joints, difficulty with making a fist, presence of a first degree relative with RA, local tenderness involved joints at physical examination, positive squeeze-test of MCPs, positive squeeze-test of MTPs. These items will be evaluated in phase 2.ConclusionsAn ongoing EULAR task force has identified consensus-based criteria for arthralgia being clinically suspect for progression to RA that will be subjected to further validation.Disclosure of InterestNone declared
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