Background For axSpA patients exercise therapy is recommended in (inter)national treatment guidelines. Apart from mobility exercises, muscle strengthening and cardio vascular training are recommended therapeutic modalities [1,2]. In the Netherlands 45 therapy groups (land based exercises; 1, hydrotherapy; 13, combination groups; 31) are organized by 17 local patient organizations exclusively for AxSpA patients. It is unclear if the treatment recommendations are followed and what the nature of the supervision in these exercise programs is.
Objectives To describe the therapeutic modalities used and characteristics of the supervision in GET for patients with axSpA in the Netherlands.
Methods A questionnaire was sent to the coordinating supervisors of GET from the17 local patient organisations involved in GET for axSpA with questions regarding the frequency and duration of group exercise programs and treatment modalities (mobility, stregthening and/or cardio-vascular exercises) used in land-based and hydrotherapy parts of the programs. In addition the questionnaire included questions regarding the number of supervisors involved in the supervision of GET, their professional background (physical therapist, other), years of experience with GET (<1yr, 1–5 yrs, >5yrs) additional education related to rheumatic diseases (yes/no) and rheumatology network membership (yes/no).
Results All 17 coordinating supervisors of GET for axSpA returned the questionnaire. All exercise groups were performed once a week with a median (range) duration of 30 minutes (30–60) for the hydrotherapy and 105 minutes (45–180) for the combination therapy groups. Regarding land-based treatment modalities, active joint range of motion exercises and muscle strengthening exercises were used as stated by 15/17 and 14/16 coordinators respectively. In hydrotherapy this was 17/17 both. 13/16 coordinators stated that cardio-vascular training was used in land-based parts and in hydrotherapy parts in 14/17. Only 1/17 coordinator stated that hart rate monitoring (land-based) was used. A total of 64 supervisors were involved in GET for axSpA of whom 54/60 were physical therapists. 35/59 were involved for more than 5 years, 21/55 had post graduate rheumatology education and 10/54 were rheumatology network members.
Conclusions Mobility and strengthening exercises are used in the majority of GET programs, but hart rate monitoring is almost never used raising questions regarding the intensity of these programs. The duration of exercise sessions showed a wide variety, as did the program composition (water based/land and water based) identifying considerable practice variation. The majority of the supervisors were physical therapists with long standing experience but only a minority had postgraduate rheumatology education. To ensure the quality of GET for patients with axSpA, reducing practice variation is a future challenge. Education of GET supervisors might be important aspects and target of priority.
Van der Heijde D, Ramiro S, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Annals of the rheumatic diseases. 2017.
Dutch Arthritis Association, Guidelines for diagnostics and treatment in axial spondylitis. 2014.
Acknowledgements This study was funded by the Dutch Arthritis Foundation.
Disclosure of Interest None declared