Highlights EULAR 2012

Health Professionals Sessions

John Verhoef MSc PT PhD

Professor of Physical Therapy

University of Applied Sciences Leiden

The Netherlands

Wednesday 06th of June 2012: Crossing boundaries of primary to

secondary care

Future demands for cooperation between

specialised care and primary care

Opportunities and challenges in a future primary health care for people with rheumatic

diseases

– Primary care is not the same all over Europe!

– Primary care could give opportunities regarding:• Early diagnosis, efficient referral, more future patients to treat

and follow, life long management, life style interventions, deal with comorbidities, some diseases are mainly treated in PC and organizing care.

– Primary care challenges: • Use and develop checklists, specific training of HP and

patients, IT support for communication, and teamwork

No abstract available; S. Bergman, Sweden

Collaboration across health service levels

– Need for health sector reform: develop integrated care and collaboration between primary and secondary specialist care

– In Norway treatment for OA is taken as a pilot for health sector reform, because there are no treatment pathways available

– Three projects were started to stimulate cooperation between PC and SC

– Key factors for succes: funding, changing behavior, and keep it simple, but structured!

SP0040: Nina Osteras, Norway

Hopes and real life experiences of communication between specialist health care

and primary health

–Real Life experiences:• In communication the responsibility is transferred to the

patient (unwanted by the patient)

• Survey-results: patients are frequently used as messenger between specialist care and primary care

–Hopes from the patient perspective:• Responsibility for transfer of information goes back to the HP

• Develop tools to enhance communication

• Patients themselves should ask for changes

SP0041: Connie R. Ziegler, Denmark

Future challenges for health professionals; communication across health care levels

– Literature overview from a health systems perspective

– Comparative institutional ethnographical (patient-centered) study routine care processes to RA patients in Austria, Sweden and the UK

– Despite the differences in the systems in principle it is possible to ensure continuity of care

– Getting insight into processes and structures of communication across care levels opens opportunities for changing daily practice

SP0042: B.Prodinger, Canada

Thursday 7th of June 2012: HPR abstract session

Progress in rehabilitation –

the future is bright

A MULTIDISCIPLINARY AND MULTIDIMENSIONAL PROGRAM FOR

HAND OSTEOARTHRITIS IS NOTEFFECTIVE:

–Single blinded randomized multicenter trial with patients with hand OA:

• Four weekly multidisciplinary intervention (goal setting, exercises, education, splinting): n=76

• 30 minutes education and 3 months on waiting list: n=75

• Outcome: pain, activity limitations, grip strength, self-efficacy, pain coping and QoL

–Conclusion:• No benefit on short term

• Future reseach focussed on effectiveness of single treatment elements targeted on patient characteristics and needs

OP0075-HPR: M.J. Stukstette et al, Netherlands

EFFECTS OF A SOFT THUMB BASE SPLINT

– Randomized controlled trial with patients with carpometacarpal OA:

• Splint-group: hand exercises (twice a day) and splint; n=30

• Control-group: hand exercises (twice a day); n=29

• Outcome: grip- and pinch strength, pain, thumb-webspace, joint mobility, self-reported hand function (two months follow-up)

– Conclusion:• No benefit on long term

• Only an immediate pain-relieving when worn

OP0076-HPR: M. Hermann et al, Norway

EFFECT OF INTERACTIVE WORKSHOP ON ADHERENCE WITH DUTCH PT

PRACTICE GUIDELINE HIP AND KNEE OA

– PT’s from 5 regions were randomly assigned to:• Interactive workshop (content guideline, 3 clinical cases with patient

partners and 3 regional experts, lasted 3 hours): n=141

• Control group (waiting list group): n=134

• Outcome: QIP-HKOA, knowledge questionnaire, guideline barriers questionnaire (before, after, 2 months later)

– Conclusion:• Statistical difference on all measures in favour for IW

• Effective strategy to improve adherence with the recommendations of the Dutch PT guideline on HKOA

OP0077-HPR: W.F. Peter et al, Netherlands

THREE WEEK REHAB PROGRAM HAD POSITIVE LONG TERM EFFECTS IN

PATIENTS WITH ANKYLOSING SPONDYLITIS

– Observer blinded randomized contolled trial with patients with ankylosing spondylitis:

• Three weeks inpatient rehab program: n=46

• Usual treatment: n=49

• Outcome: BASDAI (disease activity), BASFI (function), well-being, spinal and hip mobility, SF-36 QoL (4 and 12 months)

– Conclusion:• Significant benefit in favour for the rehab group regarding BASDAI,

well-being and some SF-36 variables.

• This 3-week inpatient program should be considered an important complement to medical disease management in patients with AS

OP0078-HPR: I. Kjeken et al, Norway

EFFECTS OF A ONE WEEK MULTIDISCIPLINARY INPATIENT SELF-

MANAGEMENT PROGRAMME FORPATIENTS WITH FIBROMYALGIA

– Randomized controlled two-armed assessor-blinded trial with patients with fibromyalgia:

• One week multidisciplinary inpatient SMP (psychological distress, health consumer skills, self-efficacy, information on FM): n=58

• Waiting list control group: n=60

• Outcome: General Health Questionnaire-20, Effective Musculoskeletal Consumer scale-17, Fibromyalgia Impact Questionnaire, Self-efficacy (ASES) (3-week follow-up)

– Conclusion:• Small short-term effect on skills and behavior important for managing

and participating in health care (EC-17)

• No others differences foundOP0079-HPR: B.Hamnes et al, Norway

Aerobic training in patients with ankylosing spondylitis

– Randomized controlled assessor-blinded trial with patients with ankylosing spondylitis:

• Intervention group: fifty minutes of walking in the individual anaerobic threshold associated with stretching exercises three times a week for twelve weeks: n=32

• Control group: only stretching exercises: n=32

• Outcome: BASFI, HAQ-S, BASMI, BASDAI, CRP, aerobic capacity treadmill-test and 6-minute walking test at T0, T6 and T12 weeks

– Conclusion:• The IG showed significant improvement in 6MWT compared to the

control group. There was an increased walking distance and cardiopulmonary capacity.

OP0080-HPR: F. Jennings et al, Brazil

Concepts important to patients with RA in rehab and their coverage by rehab tools

– Qualitative focus group study with patients with RA in combination with a systematic literature review:

• This study aimed to explore whether RA patients’ perspectives on rehabilitation are covered by current rehabilitation instruments (RAP, COPM, WHODAS-II, ICF Core sets)

• Outcome: Using the ICF as a common framework, the focus groups (19 patients in 4 groups) showed that personal characteristics, handling disease and limitation, self-confidence and maintaining independency was not at all covered within the rehab tools

– Conclusion:• Current rehabilitation tools poorly cover the concepts that patients

find essential during rehabilitation

• The ICF-CSRA best covered patients'’ perspective

OP0081-HPR: J. Meesters et al, Netherlands

Short term effect of 2-weeks rehab on disease activity and health status in patients with AS

– Descriptive retrospectively study for AS patients who participated in 2-week rehab program January 2007 to June 2011: n=87

• One week multidisciplinary inpatient SMP (psychological distress, health consumer skills, self-efficacy, information on FM): n=58

• Waiting list control group: n=60

• Outcome: BASDAI, BASFI), BASMI, Gait Velocity, Timed-Stands Test, Occiput-Wall Distance, Finger-Floor Distance, Chest Expansion, ESR and CRP

– Conclusion:• short term rehab improves disease activity and physical function.

• did not reduce ESR and CRP

OP0082-HPR: G. Haugeberg et al, Norway

Thursday 7th and Friday 8th of June 2012:

Guided Poster Tour HPR

Friday 8th of June 2012: HP Workshop Session

Challenges in HP’ practice:

how to develop and execute a treatment plan for a patient with rheumatic

conditions and comorbidities

Interactive presentation of two examples from daily practice regarding a patient with OA and

comorbidities

– Setting individual treatment goals in complex cases (T. Dager, Norway; SP0138)

– Exercise in case of multiple health problems (M. de Rooij, Netherlands; SP0139 together with a patient Mrs. Linderman)

Tutor: J.A.M. Linderman, Netherlands

Setting individual treat

ment

goals in complex cases

– Goal planning: essential part of rehab practice and is a collaborative process between the patient and the rehabilitation team

– Qualitative study of rehab outcomes emphasizes the need to understand and take into account the patients' own understanding of challenges when formulating individual rehabilitation goals

– At the work-shop, the goal-setting process was illustrated through patient cases, and factors facilitating or hampering the goal setting process was discussed.

SP0040: Nina Osteras, Norway

Exercise in case

of

multiple

health

problems

– OA: highest rates of comorbidity associated with more pain, greater limitations in daily activities, and worst functional prognosis

– Comorbidities in knee OA: coronary diseases, heart failure, hypertension, type 2 diabetic, obesity, copd, chronic pain, non-specific low back pain, depression, and visual and hearing impairments.

– Exercise therapy is one of the key recommendations lacking comorbidity-associated adaptations

– In this inter active session the adaptations that have been made in the diagnostic and intervention phase in a patient with OA of the knee and comorbidities (diabetic type 2, hypertension and obesity) was discussed

SP0040: Nina Osteras, Norway

Saterday 9th of June 2012: Joint Clinical-HPR-PARE Session

Move, groove and improve

exercise and RMD’s

How to ensure safety, quality and motivation in provision of exercise

Physical activity promotion in peolple with RMD’s:RheumaNet

– No physical activity estimates for patients with RMDs are available in Flanders.

– Initiated by patient organisations and Leuven University: ReumNet.

– Goal: research project for developing tailored PA intervention programs

– A web-based survey will start and will provide a good estimate of PA needs in Flanders

SP0183: P. Verschueren, Belgium

How to ensure quality in exercise groups organised by patient organisations

• In the state of North Rhine-Westfalia: 35.000 patients take part in hydrotherapy exercise groups, about 10.000 in other physiotherapy groups.

• Volunteers in about 100 local branches organize these therapy groups.

• How do we enable that the patient gets the right therapy? How is it made possible that the therapists working for us are doing a good job?

• “asking these questions is the start of the solution’

SP0184: D. Wiek, Germany

An early morning stretch: practical use of THERA band

No abstract: I. Kostas,Cyprus

Exercising safely – a PT perspective– Aerobic and strengthening exercises are recommended in

treatment guidelines in patients with rheumatic diseases, including rheumatoid arthritis and knee and/or hip osteoarthritis

– adverse events 9low incidence) have been reported: increase in pain, increase in joint inflammation, increased cartilage degeneration, musculoskeletal injuries and falls due to exercise

– There is a need to investigate adverse events resulting from exercising as part of the improvement of care for patients with rheumatic diseases

SP0185: M. van der Esch, Netherlands

Take Home Message

• Plan your next trip to the EULAR congress

• Give input to the EULAR HP Standing Committee regarding the program

• Take a look at the EULAR website regularly

• Have a save journey and see you next year!