SAT0733-HPR Dutch recommendations for physical therapy in axial spondyloartrhritis (AXSPA)
Authors: S. van Weely, F. van der Giesen, F. van Gaalen, I. van der Horst-Bruinsma, S. Ramiro, A. Weel, N. Lopuhaä, T. Vliet Vlieland
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> According to the ASAS/EULAR recommendations, physical therapy (PT), especially exercise therapy, is an essential element within the management of axSpA.<sup>1</sup> In the Netherlands considerable variation in the delivery of PT was observed,<sup>2</sup> suggesting suboptimal care delivery. This practice variation is likely to be related to the lack of specific recommendations regarding referral, assessment, content, and monitoring of its effectiveness and safety. <h3>Objectives</h3> To develop practice recommendations on PT in axSpA. <h3>Methods</h3> A taskforce of 31 experts was responsible for the recommendations. It consisted of patients(,<sup>2</sup> rheumatologists(,<sup>7</sup> physical therapists(,<sup>13</sup> policy makers(,<sup>3</sup> researchers(<sup>2</sup> and representatives of patient organisations(.<sup>4</sup> These were based on scientific evidence, expert opinion and patient values and were formulated following a combination of literature review and three expert-group meetings. Clinical questions were formulated in the first expert-group meeting. Then, a systematic literature review was performed to answer the clinical questions. It focused on systematic reviews, meta-analyses and (inter)national guidelines recommendations and consensus statements published after 2010 in English or Dutch. When this approach did not yield sufficient information, relevant RCTs or other types of research designs addressing (one of) the clinical questions were selected. Subsequently, draft recommendations based on the literature, expert opinion and patient values were formulated and discussed in a second meeting. In the third expert group meeting the recommendations were finalised and the level of agreement was determined by a written voting (rating from 1 (total disagreement) to 10 (total agreement)). We defined agreement if at least 80% voted ≥8. <h3>Results</h3> In the first meeting 18 clinical questions were formulated. Six questions pertaining to the content and safety of PT were merged and integrated. In total 12 practice recommendations were formulated on indication(,<sup>2</sup> referral(,<sup>2</sup> assessment/monitoring(,<sup>2</sup> treatment(,<sup>5</sup> reporting(<sup>1</sup> and safety(.<sup>2</sup> (Figure 1) Three recommendations were (partly) based on level 1 evidence (Dutch Evidence Based guidelines, EBRO); others were based on lower levels combined with the opinion of experts written in literature. Agreement was reached for 11 out of 12 recommendations. Mean levels of agreement were high and varied between 8,5–9,1. <h3>Conclusions</h3> Using a standardised process of professional guideline development, 12 practice recommendations for PT management of patients with axSpA were developed. They can guide clinicians and physiotherapists dealing with patients wiht axSpA, ultimately leading to a delivery of a better care. Next steps are the ratification by relevant professional societies as well as dissemination and implementation. <h3>References</h3> [1] Van der Heijde D, et al. 2016update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis2017;76(6):978–991. [2] Van der Giesen F, et al. Content and supervision of group exercise therapy (GET) for axial spondyloarthritis (axSpA) in the Netherlands; a nation wide survey, Ann Rheum Dis2017;76(2):1479. <h3>Acknowledgements</h3> This study was Funded by the Dutch Arthritis Foundation <h3>Disclosure of Interest</h3> None declared