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!
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