The perspective of people with axial spondyloarthritis regarding physiotherapy: room for the implementation of a more active approach

Abstract

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.

Adequately dosed aerobic physical activity in people with axial spondyloarthritis: associations with physical therapy

“…This finding could be related to results from previous studies, showing that appropriately dosed aerobic PA is often not included in (PT) exercise programs [33,34]. A recent study on content of PT in axSpA patients found that in the Netherlands, aerobic exercises are only performed during individual PT in 22% of patients [32]. Hence, when implementing vigorous-intensity PA among people with axSpA, barriers and facilitators of both patients and therapists should be accounted for.…”

“…Another limitation of previous studies on aerobic PA among people with axSpA, besides not distinguishing between moderate-and vigorous-intensity PA and between leisure time and work-related aerobic PA, is that none of the studies so far took the role of physical therapy (PT) into account. This is striking as relatively many axSpA patients have PT treatment [32] and it is generally acknowledged that apart from other health professionals, physical therapists play an important role in the promotion of PA [15]. However, it appears that aerobic PA may not be included in PT treatments often [32] and that the aerobic PA employed in exercise programs for people with axSpA is often inadequately dosed [20,[33][34][35].…”

“…Due to the physical limitations for which axSpA patients seek PT treatment, it is not necessarily expected that patients with PT are more inclined to meet the aerobic PA recommendations. Moreover, PT programs may not include (advice on) aerobic PA [32]. Given the lack of knowledge on the association between having PT treatment and meeting aerobic PA recommendations among people with axSpA, the aim of the present study was to compare the engagement in moderate-and vigorous-intensity PA (during work and leisure time) in axSpA patients with and without PT treatment.…”

Organisation and content of supervised group exercise for people with axial spondyloarthritis in The Netherlands

“…No information is provided on the specific contents or organisational characteristics of SGE for people with axSpA. Regarding overall SGE use, a recently published crosssectional study on the engagement of people with axSpA in SGE found that, in the Netherlands and Switzerland, 9% and 30% of the respondents are attending SGE, respectively, and that these numbers are declining over time, while the average age of SGE participants is increasing [23].…”

Differences in characteristics, health status and fulfillment of exercise recommendations between axial spondyloarthritis patients with and without supervised group exercise

“…It is not entirely clear which axSpA patients participate in SGE, although this is useful information for future exercise promotion. Findings from previous studies suggest that only a small minority of axSpA patients engages in axSpA-specific SGE [12,16,17] and that this concerns relatively old axSpA patients [12,13]. This should be taken into account when providing personal exercise advice, as older axSpA patients, on average, have worse spinal mobility [18], slightly worse health status [19,20] and a higher risk of comorbidities [21].…”