OP0071-HPR PILOT IMPLEMENTATION OF ENHANCEMENTS IN SUPERVISED GROUP EXERCISE FOR PEOPLE WITH AXIAL SPONDYLOARTHRITIS (AXSPA) IN THE NETHERLANDS

Abstract

Background:Supervised group exercise (SGE) for people with axSpA is widely available in the Netherlands [1]. Its contents have barely changed over the past 30 years, despite new evidence-based insights to improve the quality of SGE [1,2].Objectives:To evaluate the process and effect of the implementation of enhancements in SGE for people with axSpA in the Netherlands.Methods:This implementation study was executed in four regions, organising nine axSpA-specific SGE classes. The implemented enhancements included: 1. Exercise personalisation based on periodic assessments, including the 6-Minute Walk Test (6MWT) and the Ankylosing Spondylitis Performance Index (ASPI; improved/not improved); 2. High intensity aerobic exercise including intensity monitoring (e.g. by heartrate or BORG-scale); 3. Group education on home exercise and physical activity (e.g. promotion of an app). The implementation strategy was executed over a period of one year and consisted of a one-day training for the supervisors and bimonthly telephone support.To evaluate the implementation effect, a survey was sent to 95 SGE participants, including two questions evaluating changes in the programme and in own functioning, as well as the ‘ASAS Health Index’ (ASAS HI) and the ‘Short Questionnaire to Assess Health-enhancing physical activity’ (SQUASH), which were also administered at baseline. In addition, the data from the periodic assessments (6MWT and ASPI) were used. Changes were analysed with the Wilcoxon Signed-Rank Test.To evaluate the implementation process, apart from specific questions in the patient survey, semi-structured interviews with supervisors from each region were conducted.Results:The survey was returned by 60/95 (63%) SGE participants (72% male, median age 60 years).Effects: As shown in Table 1, 33% experienced improved functioning, 37% improved performance on ASPI and the improvements on 6MWT were statistically significant, p < .05, whereas there were no significant changes in ASAS HI and SQUASH.Table 1.SGE Participants (n=60)Effect evaluationSelf-reported improvements in functioning, n (%)20/60 (33)Change in 6MWT score, median (IQR)10 (-20;62)*Improved on ASPI, n (%)20/54 (37)Change in ASAS HI score, median (IQR)0 (-1;1.9)Change in number of days with exercise (SQUASH), median (IQR)0 (-1;2)Evaluation of enhancementsSatisfied with overall programme changes, n (%)35/60 (58)Satisfied with amount of exercise personalisation, n (%)51/58 (88)Assessment is applied, n (%)50/58 (86)Assessment is favourable, n (%)47/50 (94)Satisfied with amount of aerobic exercise, n (%)39/56 (70)Satisfied with exercise intensity, n (%)44/57 (77)Heartrate monitoring is applied, n (%)29/59 (49)Heartrate monitoring is favourable, n (%)27/29 (93)Familiar with axSpA-specific home exercise app, n (%)12/56 (21)Exercises at home using the app, n (%)1/56 (2)*p < .05Process: The semi-structured interviews with the SGE supervisors (n=4, 25% male, aged 28-56 years, SGE experience 8-30 years) showed that: 1. exercise personalisation was difficult and periodic assessments were only maintained in two regions; 2. all regions increased focus on high intensity aerobic exercise and three monitored intensity; 3. none provided structural group education on home exercise. Table 1 shows that the majority of participants was satisfied with the overall programme changes, the personalisation, the assessments and the high intensity aerobic exercise and that heartrate monitoring and education on a home exercise app were applied in less than half of the participants.Conclusion:After a training for SGE supervisors and telephone support, a set of enhancements was only partially implemented. However, the majority of participants was satisfied with applied changes and about a third improved functioning. For a nationwide implementation, a more extensive strategy addressing specific barriers is warranted.