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Swart NM1, Peter WFH2,3, Meerhoff GA1, Vliet Vlieland TPM2
1Royal Dutch Society for Physical Therapy (KNGF), Amersfoort, Netherlands, 2Leiden University Medical Centre, Leiden, Netherlands, 3Amsterdam Rehabilitation Research Center Reade, Amsterdam, Netherlands
Background: The importance of exercise therapy in patients with rheumatoid arthritis (RA) is recognized in scientific evidence and clinical practice. The recommendations for physical therapists concerning the diagnostics and treatment of patients with RA are described in the Dutch guideline for physical therapy in patients with RA from 2008, conducted by the Royal Dutch Society for Physical Therapy (KNGF). Since 2008, new scientific evidence was published and the desire of guideline users towards a more easy to use guideline increased. Because an up to date guideline is indispensable for the applicability in daily clinical practice, the KNGF decided to revise the Dutch guideline for physical therapy in patients with RA.
Purpose: To revise the Dutch guideline for physical therapy in patients with RA using the approach developed by the Dutch Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group.
Methods: A guideline panel with representatives of relevant stakeholders (such as physical therapists, general practitioners, rheumatologists, specialized nurses, podiatrist and patients) was composed. Conform the GRADE approach, research questions for narrative or systematic reviews were formulated after focus groups with patients and physical therapists and consultation of experts. Evidence was synthesized by providing the estimates of the effect for each outcome and the quality of the evidence. A strong or conditional recommendation for or against an intervention was formulated by the panel, based on evidence together with additional considerations, as described in the GRADE evidence to decision framework.
Results: Three indications for physical therapy are distinguished, based on the patients' health status and abilities of self-management:
1) instructions for mainly unsupervised exercise therapy,
2) exercise therapy with short-term supervision and
3) exercise therapy with intensified supervision.
Exercise therapy is recommended for indication 2, and conditionally recommended for indication 1 and 3. The exercise therapy has to be provided in combination with information and advice on RA and promotion of self-management. Specific recommendations concerning the frequency, intensity, type and time of the exercise therapy are provided, based on studies performed in patients with RA, recommendations form The Health Council of the Netherlands and The American College of Sports Medicine guidelines for exercise testing and prescription. Behavioral interventions to promote physical activity in patients with RA are also recommended. The guideline obtains practical advices for applying tailored behavioral interventions.
Conclusion(s): The indication for physical therapy is divided in: instructions for mainly unsupervised exercise therapy, exercise therapy with short-term supervision and exercise therapy with intensified supervision. Based on scientific evidence and expert consensus on additional considerations among relevant stakeholders, exercise therapy with supervision of a physical therapist is recommended in patients with RA, together with information and advice and promotion of self-management. Specific recommendations on the content and form of the exercise therapy are provided. Behavioral interventions to promote physical activity are also recommended.
Implications: The Dutch guideline for physical therapy in patients with RA provides practical recommendations for physical therapists, based on scientific evidence and consensus among patients, physical therapists, general practitioners, medical specialists and other relevant stakeholders.
Keywords: rheumatoid arthritis, physical therapy, Guideline
Funding acknowledgements: The development of the guideline was funded by the KNGF.
Purpose: To revise the Dutch guideline for physical therapy in patients with RA using the approach developed by the Dutch Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group.
Methods: A guideline panel with representatives of relevant stakeholders (such as physical therapists, general practitioners, rheumatologists, specialized nurses, podiatrist and patients) was composed. Conform the GRADE approach, research questions for narrative or systematic reviews were formulated after focus groups with patients and physical therapists and consultation of experts. Evidence was synthesized by providing the estimates of the effect for each outcome and the quality of the evidence. A strong or conditional recommendation for or against an intervention was formulated by the panel, based on evidence together with additional considerations, as described in the GRADE evidence to decision framework.
Results: Three indications for physical therapy are distinguished, based on the patients' health status and abilities of self-management:
1) instructions for mainly unsupervised exercise therapy,
2) exercise therapy with short-term supervision and
3) exercise therapy with intensified supervision.
Exercise therapy is recommended for indication 2, and conditionally recommended for indication 1 and 3. The exercise therapy has to be provided in combination with information and advice on RA and promotion of self-management. Specific recommendations concerning the frequency, intensity, type and time of the exercise therapy are provided, based on studies performed in patients with RA, recommendations form The Health Council of the Netherlands and The American College of Sports Medicine guidelines for exercise testing and prescription. Behavioral interventions to promote physical activity in patients with RA are also recommended. The guideline obtains practical advices for applying tailored behavioral interventions.
Conclusion(s): The indication for physical therapy is divided in: instructions for mainly unsupervised exercise therapy, exercise therapy with short-term supervision and exercise therapy with intensified supervision. Based on scientific evidence and expert consensus on additional considerations among relevant stakeholders, exercise therapy with supervision of a physical therapist is recommended in patients with RA, together with information and advice and promotion of self-management. Specific recommendations on the content and form of the exercise therapy are provided. Behavioral interventions to promote physical activity are also recommended.
Implications: The Dutch guideline for physical therapy in patients with RA provides practical recommendations for physical therapists, based on scientific evidence and consensus among patients, physical therapists, general practitioners, medical specialists and other relevant stakeholders.
Keywords: rheumatoid arthritis, physical therapy, Guideline
Funding acknowledgements: The development of the guideline was funded by the KNGF.
Topic: Musculoskeletal
Ethics approval required: No
Institution: not applicable
Ethics committee: not applicable
Reason not required: no human subjects were involved
All authors, affiliations and abstracts have been published as submitted.
