SAT0611-HPR LOW ADHERENCE TO RECOMMENDED PHYSICAL THERAPY IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS: A MIXED-METHOD CONTENT AND UTILIZATION ANALYSIS.
Authors: E. Vanautgaerden, M. Kaerts, W. Dankaerts, K. De Vlam, T. Swinnen
Journal: Annals of the Rheumatic Diseases (2020)

Background: Patients with axial spondyloarthritis (axSpA) encounter limitations during daily activities and societal participation which seriously impart health-related quality of life. Optimal management of axSpA consists of combined pharmacological and non-pharmacological treatment modalities, including the encouragement of exercise and the consideration of physical therapy given the latter’s superior efficacy 1 . Few studies investigated the use of physical therapy and the alignment of treatment content with practice recommendations among patients with axSpA. Objectives: 1) To estimate physical therapy use in patients with axSpA in a real life cohort; 2) to quantitatively and qualitatively describe the content of these physical therapy sessions; 3) explore possible determinants of physical therapy use and content. Methods: This cross-sectional study included 197 patients diagnosed with axSpA (Males/Females: 62.4/37.6%; mean±SD, age 42.6±12.0, BASDAI 3.7±2.1, BASFI 3.6±2.4, BASMI 3.1±1.8) and recruited during their routine consultation. The mixed-method approach included questionnaires (physical therapy use and content, medication, depression/anxiety (HADS), fear (TSK), physician global disease activity (PGDA)) and an in-depth qualitative interview (content of physical therapy). Interviews were analyzed using the Qualitative Analysis Guide of Leuven by two physical therapists. Spearman’s Rho correlations guided the exploration of determinants of physical therapy use and content. Results: Less than half (42.6%, n=84) of the axSpA of patients were in treatment with a physiotherapist. Most patients (40.0%) reported a physical therapy frequency of 1x/week. Session duration was typically 30 minutes (51.7% of the sample) and longer in fewer cases (30.0%). Exercise was in only 31.7% the cornerstone of their sessions. The majority of subjects (53.3%) were classified as receiving ‘passive therapy only’, with 10% of cases in the ‘exercise only’ and 36.7% in the ‘combination therapy’ groups. Interviews also revealed a lack of clear patient-centered treatment goals. We found moderate associations between physical therapy use/content parameters and medication, spinal mobility, fear, anxiety, depression, physician’s global disease activity versus (p&lt;.05), but no relationship with patient-reported pain or disease activity. Conclusion: Despite the importance of exercise and the added value of physical therapy in axSpA, few patients engaged in physical therapy sessions that include exercise training of adequate dosage. Remarkably, physical therapy utilization seems to be predominantly guided by psychological factors. Professional education for physical therapists should therefore include skills training in the management of complex clinical presentations 2 . Last, future research should prepare the evidence-based implementation of state-of-the-art physical therapy guidelines in axSpA. References: [1]van der Heijde D, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017 Jun;76(6):978-991. [2]Swinnen TW, et al. Widespread pain in axial spondyloarthritis: clinical importance and gender differences. Arthritis Res Ther. 2018 Jul 27;20(1):156. Disclosure of Interests: Evelyne Vanautgaerden: None declared, Marlies Kaerts: None declared, Wim Dankaerts: None declared, Kurt de Vlam Grant/research support from: Celgene, Eli Lilly, Pfizer Inc, Consultant of: AbbVie, Eli Lilly, Galapagos, Johnson &amp; Johnson, Novartis, Pfizer Inc, UCB, Thijs Swinnen: None declared