Background Exercise therapy is recommended for people with axSpA . In the Netherlands GET specifically for patients with axSpA is usually organized by local rheumatology patient organizations. New scientific insights into the delivery of GET have emerged over the past years and structural reimbursement from the basic health insurance was terminated. To ensure the quality and continuity of the delivery of GET it is necessary first to determine their current structure and processes.
Objectives To describe the structure and processes of group exercise therapy specifically for patients with axSpA in the Netherlands.
Methods Using the database of the Dutch Arthritis Foundation in 2016 a pen-and-paper questionnaire was sent to the coordinators of all 82 local patient organizations who could potentially be involved in the delivery of AxSpA GET. The questionnaire comprised 18 questions on the numbers of groups and participating patients, organizational and financial responsibilities, recruitment methods for participants and supervisors, the type of exercise therapy provided (land based, hydrotherapy or a combination of both) and the perceived threats for future continuation.
Results The questionnaire was returned by 66 of the 82 coordinators of whom17 stated their organization was involved in the delivery of axSpA specific GET (45 group therapy classes: 1 only land exercises; 13 only hydrotherapy; 31 combination) for 496 patients (estimated number of patients with axSpA in the Netherlands in 2016: 61.200 ). 15/17 local patient organisations have organisational as well as financial responsibilities. The most often used recruitment methods for participants were: via the rheumatologist/rheumatology nurses (n=17), physical therapists (n=8), or advertisement in local patient organisations' own media (n=8). Recruitment of supervisors was most often done by asking around within their own network (n=14) or asking the leaving supervisor for replacement (n=8). Regular evaluation of the delivery of care with the supervisors and participants was performed by 10 and 12 local patient organizations, respectively. Three had an agreement with health insurance companies regarding reimbursement of GET. In 6 regions the number of participants had been declining over the past 5 years. The most mentioned threats for continuity by coordinators were financial difficulties (n=7) and recruiting participants (n=9).
Conclusions 17 local rheumatology patient organizations involved in the delivery of GET specifically for patients with axSpA in the Netherlands were identified. The large majority played an active role in the organization and reimbursement and regular evaluation of care delivery was done by two-thirds of them. Future challenges are the recruitment of new participants and reimbursement. As only a small minority of AxSpA patients appears to take part in group exercise therapy, more insight into the needs and preferences among the larger population is needed.
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Acknowledgements This study was funded by the Dutch Arthritis Foundation.
Disclosure of Interest None declared