Orozco T1, El-Khoury J1, Feldman DE1,2
1Université de Montréal, École de Réadaptation, Montreal, Canada, 2School of Public Health, Université de Montréal, Social and Preventive Medicine, Montreal, Canada
Background: Physiotherapy plays an important role in the global management of rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Therapeutic exercises (mobility and strengthening) should be started as soon as the disease is diagnosed. Patient education is key and aerobic exercise is recommended in both RA and AS. Passive modalities such as electrotherapy are more controversial
Purpose: To document what type of interventions are used by physiotherapists (PTs) working in Quebec for patients with RA and AS, to assess whether intervention choices follow current practice guidelines, and to explore factors associated with such choices.
Methods: We sent an online survey to PTs in Quebec via licensing bodies and through social media contacts. Participants were asked about what kind of treatment they would provide for two patients showing typical signs and symptoms of RA and AS. Descriptive statistics were used to illustrate the proportions for each treatment chosen by PTs. We also explored associations between choice of treatments and PT demographic and practice related factors using inferential statistics and regression analyses.
Results: A total of 298 PTs from Quebec responded to the online survey. For both RA and AS respectively, the most common modalities were mobility exercises (94.0%; 98.9%) and patient education (93.1%; 93.3%). For RA, the next most common modalities were applying heat/cold (65.3%), strengthening exercises (65.3%), passive manual forms of therapy (manual therapy, soft tissue techniques, osteopathy) (37.5%), and electrotherapy (31.0%). Choosing electrotherapy (p= 0.006) and passive manual forms of therapy (p=0) were highly associated with working in the private sector. For AS, the next most common modalities were strengthening exercises (64.4%), passive manual forms of therapy (58.3%), applying heat/cold (57.8%) and electrotherapy (41.1%). Selecting passive manual forms of therapy were highly associated with working in the private sector (p=0) and having taken post-graduate related courses (p=0). In the literature, patient education, therapeutic exercises and aerobic exercise are recommended for both RA and AS. The results show that strengthening exercises are selected by about two-thirds of the participants whereas aerobic exercise was chosen by less than 3% of the PTs for both RA and AS.
Conclusion(s): The majority of PTs chose mobility exercises and patient education, which both represent important recommended treatment approaches for RA and AS. However strengthening exercises, which are part of therapeutic exercises, and aerobic exercise were not used as much as current practice guidelines recommend.
Implications: PTs in Quebec do not use strengthening and aerobic exercises enough with clienteles with RA and AS despite evidence recommending that type of treatment. There is a need for better knowledge translation to PTs regarding the importance of strengthening exercises and aerobic exercise for patients with RA and AS.
Keywords: Rheumatoid Arthritis, Ankylosing Spondylitis, Clinical Practice Guidelines
Funding acknowledgements: Canadian Initiative for Outcomes in Rheumatology Care (CIORA) and the PRogramme d'Excellence en Médecine pour l'Initiation En Recherche (PREMIER).
Purpose: To document what type of interventions are used by physiotherapists (PTs) working in Quebec for patients with RA and AS, to assess whether intervention choices follow current practice guidelines, and to explore factors associated with such choices.
Methods: We sent an online survey to PTs in Quebec via licensing bodies and through social media contacts. Participants were asked about what kind of treatment they would provide for two patients showing typical signs and symptoms of RA and AS. Descriptive statistics were used to illustrate the proportions for each treatment chosen by PTs. We also explored associations between choice of treatments and PT demographic and practice related factors using inferential statistics and regression analyses.
Results: A total of 298 PTs from Quebec responded to the online survey. For both RA and AS respectively, the most common modalities were mobility exercises (94.0%; 98.9%) and patient education (93.1%; 93.3%). For RA, the next most common modalities were applying heat/cold (65.3%), strengthening exercises (65.3%), passive manual forms of therapy (manual therapy, soft tissue techniques, osteopathy) (37.5%), and electrotherapy (31.0%). Choosing electrotherapy (p= 0.006) and passive manual forms of therapy (p=0) were highly associated with working in the private sector. For AS, the next most common modalities were strengthening exercises (64.4%), passive manual forms of therapy (58.3%), applying heat/cold (57.8%) and electrotherapy (41.1%). Selecting passive manual forms of therapy were highly associated with working in the private sector (p=0) and having taken post-graduate related courses (p=0). In the literature, patient education, therapeutic exercises and aerobic exercise are recommended for both RA and AS. The results show that strengthening exercises are selected by about two-thirds of the participants whereas aerobic exercise was chosen by less than 3% of the PTs for both RA and AS.
Conclusion(s): The majority of PTs chose mobility exercises and patient education, which both represent important recommended treatment approaches for RA and AS. However strengthening exercises, which are part of therapeutic exercises, and aerobic exercise were not used as much as current practice guidelines recommend.
Implications: PTs in Quebec do not use strengthening and aerobic exercises enough with clienteles with RA and AS despite evidence recommending that type of treatment. There is a need for better knowledge translation to PTs regarding the importance of strengthening exercises and aerobic exercise for patients with RA and AS.
Keywords: Rheumatoid Arthritis, Ankylosing Spondylitis, Clinical Practice Guidelines
Funding acknowledgements: Canadian Initiative for Outcomes in Rheumatology Care (CIORA) and the PRogramme d'Excellence en Médecine pour l'Initiation En Recherche (PREMIER).
Topic: Rheumatology
Ethics approval required: Yes
Institution: Université de Montréal
Ethics committee: Comité d'éthique de la recherche en santé (CERES)
Ethics number: 17-137-CERES-D
All authors, affiliations and abstracts have been published as submitted.
