Background Axial Spondyloarthritis (AS), a long-term sero-negative inflammatory arthritis is associated with inflammatory back pain, reduced spinal mobility, fatigue and work incapacity. Exercise and self-management education are key recommendations of the Assessment of Spondyloarthritis Society (ASAS) management guidelines. The Axial Spondyloarthritis Know-how (ASK) programme aims to increase knowledge, exercise participation and self-management and comprises a two hour group education, gym-based exercise and hydrotherapy session for up to six people, facilitated by a specialist physiotherapist and self-management education handbook.
Objectives The qualitative focus group study aims to explore the acceptability and benefit of a brief exercise and self-management group programme for adults with Axial Spondyloarthritis.
Methods A purposive sample of adults with AS (ASAS,2009) who attended the ASK group programme between April-June 2014 were enrolled into the study. Focus groups were facilitated by a rheumatology specialist physiotherapist not involved in the delivery of the ASK programme and followed a topic guide developed a priori. The focus groups were audio-recorded and transcribed verbatim. Manual coding was utilised to build categories (through naturalistic inquiry as a permutation of constructivist grounded theory) resulting in the identification of a thematic framework linking the theoretical concepts. The themes were checked for resonance with participants.
Results Two focus groups including nine participants (5 male) with mean age 43 years (21–74) and mean disease duration 12.2 years (1–44) were conducted. Overall, patients reported the ASK programme was an acceptable and beneficial experience. Four over-arching themes were identified: 1) Exercise Behaviours: Participants described increased knowledge and confidence to exercise following attendance. Three participants commenced exercising with local National Ankylosing Spondylitis Society groups and four adapted the content of a home exercise programme. 2) Disease Positioning: Participants reported comparing their mobility and posture with others in the ASK group and positioned themselves along a “disease severity spectrum” in relation to other group members. 3) Temporal Effects of Self-Management Education: The time between diagnosis and attending the ASK group influenced the extent of learning acquired. Newly diagnosed interviewees reported that the ASK group provided information and promoted self-management whereas those with longer disease duration, who considered themselves to be knowledgeable, reported gaining less benefit. 4) The Group Effect: Participants reported that they learned from their peers, particularly self-management strategies for dealing with flares.
Conclusions The ASK programme is an acceptable and beneficial experience for adults with AS. It promotes understanding of self-management, including exercise participation and flare-up management through learning from others. It may be easily implemented into clinical practice, however, may be more appropriate for those with early disease.
Rudwaleit M, van de Heijde D, Landewe R, Listing J, Akkoc N, Brandt J et al (2009); The development of Assessment of Spondyloarthritis International Society classification criteria for axial spondyloarthritis (part II):validation and final selection. Ann Rheum Dis; 68;777–83.
Disclosure of Interest None declared