Background In national and international guidelines physical therapy, comprising exercise interventions and education, is recommended as a required treatment modality for the optimal treatment of axial spondyloarthritis (axSpA). [1–3]. However, specific details regarding referral for physical therapy and optimal content and dose of exercise interventions are lacking. Research showed large variation in the content of exercise therapy in axSpA patients, which reflects suboptimal care [4].

Objectives To develop practice recommendations on indications for referral, content, dose and safety aspects of exercise therapy for axSpA patients based on scientific evidence, expert opinion and patient values. The ultimate aim is improving the quality of exercise therapy care for people with axSpA.

Methods The recommendations are based on scientific evidence, expert opinion and patient values and were formulated following a combination of literature review and three expert-group meetings (consisting of patients, rheumatologists, physical and exercise therapists, policy makers, scientists and special interest groups). In three consecutive expert-meetings clinically relevant questions, draft recommendations based on systematic literature reviews, and final recommendations including level of agreement were generated. Lastly, a field consultation among physical and exercise therapists, rheumatologists, scientists and special interest groups will be scheduled and an implementation strategy, comprising of an information intervention and directives, will be developed.

Results In the first expert-group meeting 18 clinically relevant questions were formulated, on: indication and referral, assessment, content of treatment, evaluation and safety. In addition to recently published systematic reviews, additional literature reviews concerned assessment, safety and the dosage of exercise therapy. Related to the clinical questions, a framework for the therapeutic process and 12 draft recommendations were developed and discussed in the second meeting. In the third and last meeting the 12 recommendations regarding the delivery of physical therapy and exercise interventions were set and the level of agreement was determined.

Conclusions The expert-meetings and literature searches led to 12 practice recommendations and a clear starting point for the development of the implementation strategy. Twelve practice recommendations regarding the delivery of physical therapy for patients with axSpA were developed, based on scientific evidence, expert opinion patient values. The field testing and development and execution of a dissemination and implementation strategy will be done in 2017.

References

1. Dagfinrud H, et al. Physiotherapy interventions for ankylosing spondylitis. Cochrane Database Syst Rev. 2008.

2. van der Heijde D, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017.

3. Steeringgroup recommendations Spondyloartritis, Dutch Rheumatology Association, Guidelines for diagnosis and treatment of axial Spondyloartrtis, 2014.

4. Van der Giesen et al. Use and content of physical and (group)exercise therapy for people with axial spondylarthritis, NVR congress, posterpresentation, 2016.

References

Acknowledgements The Dutch Arthritis Foundation financially supported this project.

Disclosure of Interest None declared