SAT0729-HPR REVISION OF THE DUTCH GUIDELINE FOR PHYSIOTHERAPY IN PATIENTS WITH RHEUMATOID ARTRITIS: RECOMMENDATIONS FOR DAILY PRACTICE

Abstract

Background The importance of exercise therapy in patients with rheumatoid arthritis (RA) is recognized in scientific evidence and clinical practice. The recommendations for physiotherapists concerning the diagnostics, treatment and evaluation of patients with RA are described in the Dutch guideline for physiotherapy (PT) in patients with RA from 2008. Since new scientific evidence was published and an up to date guideline is indispensable for the applicability in daily clinical PT practice, a revision is made. Objectives To revise the Dutch guideline for physiotherapy in patients with RA Methods A guideline panel with representatives of relevant stakeholders (such as PTs, general practitioners, rheumatologists, specialized nurses, a podiatrist and patients) was composed. Conform the Dutch Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, research questions for systematic or narrative reviews were formulated after focus groups with patients and PTs, 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 PT are distinguished, based on the patients’ health status and abilities of self-management: 1) patient education combined with instructions for mainly unsupervised exercise therapy, 2) patient education combined with exercise therapy with short-term supervision and 3) patient education combined with exercise therapy with intensified supervision. Exercise therapy is recommended for indication 2, and conditionally recommended for indication 1 and 3. Patient education consist of information and advice on RA and promotion of self-management. Specific recommendations concerning the frequency, intensity, type and time (FITT) of the exercise therapy are provided, based on studies performed in patients with RA, recommendations from The Dutch Health Council (2017), EULAR recommendation on Physical Activity (2018), and The American College of Sports Medicine guidelines for exercise testing and prescription (2018). Behavioral interventions to promote physical activity in patients with RA are also recommended. The guideline obtains practical advices for applying tailored behavioral interventions. Conclusion The indication for PT 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 PT is recommended in patients with RA, together with information and advice and promotion of self-management. Specific recommendations on dosage of exercise therapy (FITT) are provided. Behavioral interventions to promote physical activity are also recommended.