Background Physical inactivity contributes substantially to the increased risk for cardiovascular diseases in patients with ankylosing spondylitis (AS) (1). There is evidence that cardiovascular training (CVT) is effective, feasible and safe for AS patients (2). Therefore, CVT should be implemented in AS exercise classes. The attitudes of the target groups guide this implementation process (3).
Objectives To explore the perceived facilitators and barriers of performing and providing CVT among AS patients and physiotherapists (PTs) respectively.
Methods Three focus groups with AS patients (n=18) and four focused interviews with PTs (n=4) provided facilitators and barriers that were grouped in “categories”. The importance of these categories was ranked in subsequent online surveys among 1710 active members of the Swiss AS patient organisation (SVMB) and 84 PTs leading the SVMB exercise groups on a 4-point scale (from “not facilitating/hindering at all” to “very facilitating/hindering”).
Results Patients. Focus groups: Identified categories were: coping; disease-related symptoms; knowledge; motivation; outcome expectations; structural/environmental conditions; social support, and timing in daily routine. Survey: 704 patients responded (41.2%), 43% were women, 35.8% attended exercise groups; mean age was 51.9 (SD ±12.8) years. The three top ranked categories were both, facilitators and barriers: “high/low motivation” (facilitator for 47.1%, barrier for 59.5% of patients), “successful/unsuccessful timing in daily routine” (35.2% and 55%) and “disease-related symptoms” (39.5% and 51.4%).
PTs. Focused interviews : Identified categories were: group composition; knowledge; motivation; outcome expectations; structural/environmental conditions; support from SVMB, and timing in exercise group. Survey: 47 PTs responded (56%), 82.2% were women, mean age was 43.76 (SD ±11.84) years, mean experience with AS groups was 10.11 (SD ±7.96) years, 20.5% reported including CVT “always” in their exercise set. Two top ranked categories were both, facilitators and barriers: 'group composition' (facilitator “age homogeneity” for 58.3%, barrier “heterogeneous health/fitness status of participants” for 70.3%) and “high/low motivation” (45.9% and 51.4%). “Knowledge” (about design of CVT) was an important facilitator (54.1%). Another important barrier was “difficult structural/environmental conditions” (unsuitable facilities, missing equipment and outdoor possibilities) (51.4%). For over 90% of the patients and PTs “outcome expectations” was a facilitator.
Conclusions The facilitators and barriers perceived by AS patients and PTs are crucial when implementing CVT in AS-interventions. Facilitators suggest promising approaches, barriers anticipate challenges and request targeted solutions.
Kang J et al. Comorbidity profiles among patients with anylosing spondylitis: a nationwide population-based study. Annals of the rheumatic diseases. 2010;34(3):1165-8
Niedermann K et al. Cardiovascular training improves fitness in patients with ankylosing spondylitis. Arthritis Care Res (Hoboken). 2013 Jul 8. doi: 10.1002/acr.22062
Grol R, Wensing M, Eccles M. Improving patient care. The implementation of change in clinical practice. 2005. Elsevier
Disclosure of Interest : None declared
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