Lessons learned from a pilot implementation of physical activity recommendations in axial spondyloarthritis exercise group therapy

BMC Rheumatology, vol. 6, pp. 12

Abstract

BACKGROUND: The Ankylosing Spondylitis Association of Switzerland (SVMB) aimed to implement physical activity recommendations (PAR) within their exercise groups (EGs). The PAR promote exercise in all fitness dimensions at the correct dose. To implement the PAR within EGs, they were translated into a new EG concept with five key activities: (a) training for supervising physiotherapists (PTs), (b) correctly dosed exercises in all fitness dimensions, (c) exercise counselling, (d) bi-annual fitness assessments, and (e) individual exercise training, in addition to EG. All these activities were realized in close coordination with SVMB management. OBJECTIVES: To analyse the implementation success by evaluating adherence/fidelity, feasibility, and satisfaction at the patient, PTs, and organisational level. METHODS: The five key activities of the new EG concept were developed, executed, and assessed after 6 months. The primary outcomes for implementation success were adherence of patients to the recommended exercise behaviour, self-reported by electronic diary; fidelity of PTs to the new concept, self-reported by diary; SVMB organisational changes. Secondary outcomes were feasibility and satisfaction with the new EG concept at all three levels. The tertiary outcome, to evaluate the effectiveness of PAR, was patient fitness, assessed through fitness assessments. RESULTS: 30 patients with axSpA (ten women, mean age 58 ± 9 years) and four PTs (three women, mean age 46 ± 9 years) participated. The patients' self-reporting of adherence to the PAR was insufficient (43%), possibly due to technical problems with the electronic dairy. The PTs' fidelity to the new EG concept was satisfactory. On all levels, the new concept was generally perceived as feasible and useful for supporting personalised exercise.The frequency of exercise counselling and the fitness assessments was found by patients and PTs to be too high and rigid. Patients' cardiorespiratory fitness [ES 1.21 (95%CI 0.59, 1.89)] and core strength [ES 0.61 (95%CI 0.18, 1.06)] improved over the 6 months. CONCLUSIONS: The pilot implementation of PAR showed acceptance and satisfaction to be sufficient, thus confirming the need for evidence-based EGs, provided by a patient organisation in order to support active PA behaviour. However, adaptations are necessary to increase its feasibility for nationwide implementation. TRIAL REGISTRATION: SNCTP, SNCTP000002880. Registered 31 May 2018, https://www.kofam.ch/en/snctp-portal/search/0/study/42491 .

Authors 9

1. Anne-Kathrin Rausch Osthoff corresponding Aachen Department of Orthopaedics, Rehabilitation and Physical Therapy

   Leiden University · Leiden University Medical Center · ZHAW Zurich University of Applied Sciences

   Affiliation as printed

   Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands. anne-kathrin.rausch@zhaw.ch

   ZHAW, School of Health Sciences, Institute of Physiotherapy, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland. anne-kathrin.rausch@zhaw.ch

   ZHAW, School of Health Sciences, Institute of Physiotherapy, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland

2. T. P. M. Vliet Vlieland Aachen Department of Orthopaedics, Rehabilitation and Physical Therapy

   Leiden University Medical Center

   Affiliation as printed

   Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands

3. André Meichtry

   ZHAW Zurich University of Applied Sciences

   Affiliation as printed

   ZHAW, School of Health Sciences, Institute of Physiotherapy, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland

4. Leti van Bodegom‐Vos Aachen Department of Biomedical Data Sciences

   Leiden University Medical Center

   Affiliation as printed

   Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands

5. Beatrice Topalidis

   Swiss Ankylosing Spondylitis Association

   Affiliation as printed

   Swiss Ankylosing Spondylitis Association, Zurich, Switzerland

6. Stefan Büchi
   Affiliation as printed

   Clinic for Psychotherapy and Psychosomatics Hohenegg, Meilen, Switzerland

7. Irina Nast

   ZHAW Zurich University of Applied Sciences

   Affiliation as printed

   ZHAW, School of Health Sciences, Institute of Physiotherapy, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland

8. Adrian Ciurea

   University Hospital Zurich

   Affiliation as printed

   Department of Rheumatology, Zurich University Hospital, 8091, Zurich, Switzerland

9. Karin Niedermann

   ZHAW Zurich University of Applied Sciences

   Affiliation as printed

   ZHAW, School of Health Sciences, Institute of Physiotherapy, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland