Soziale Teilhabe und Alltagsaktivitäten von Patienten mit entzündlich-rheumatischen Erkrankungen: Unterstützung durch Selbsthilfe, Bewegungstherapie und neue Medien

[Nonpharmacological treatment measures, rehabilitation services and membership in patient support groups in axial spondylarthritis (The ATTENTUS axSpA study)]

BACKGROUND

The treatment of axial spondylarthritis (axSpA) includes pharmacological treatment measures (PTM) and nonpharmacological treatment measures (NPTM) as well as supporting resources, such as rehabilitation services (RS) and membership in patient support groups (PSG). Nevertheless, there are significant participation restrictions in patients with axSpA in Germany.

OBJECTIVE

Investigation of functional deficits, participation restrictions and utilization of PTM, NPTM, RS and PSG membership in patients with axSpA.

MATERIAL AND METHODS

Multicentric, observational study of 770 axSpA patients in Germany (ATTENTUS-axSpA).

RESULTS

Substantial functional deficits and participation restrictions were observed in axSpA patients. Of the patients 39% did not receive treatment with biological disease-modifying antirheumatic drugs (bDMARD). In the NPTM 54% received physiotherapy less than once per week and 29% once per week. Physical activities were regularly performed by 86% of patients, mainly in the form of home exercises. Training in a gym (14%) or sports club (7%) was carried out much less frequently. Of the patients 54% received RS, one third had the last rehabilitation more than 5 years ago and 13% of the patients were members in a PSG. A significantly higher utilization of NPTM and rehabilitation was found in this group.

CONCLUSION

Treatment options and resources were often utilized to a small extent and/or in low intensity by axSpA patients, which could be a possible explanation for persisting restrictions of participation. Membership in a PSG was associated with an increased utilization of NPTM and RS.

[Therapeutic effects of complex multimodal rheumatologic treatment in the Rheumatology Center, Rhineland-Palatinate]

INTRODUCTION

The concept of complex multimodal rheumatologic treatment (CMRT) has been established for several years in German rheumatologic departments and aims at a multifaceted therapeutic approach to patients with rheumatic diseases. Objective of this study was to examine the therapeutic effect of CMRT in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) in an acute rheumatology center.

METHODS

The treatment success of CMRT was evaluated by epidemiologic data, patient questionnaires on visual analog scales (VAS) regarding morning stiffness, pain and disease activity (DA), as well as clinical scores (Disease Activity Score 28 [DAS28], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Bath Ankylosing Spondylitis Functional Index [BASFI]), laboratory inflammation markers (CRP, erythrocyte sedimentation rate) and medication in three visits: visit 1 = begin of CMRT; visit 2 = end of CMRT; visit 3 = 3 months after CMRT.

RESULTS

In this study 162 patients from the Rheumatology Center, Rhineland-Palatinate, Germany (96 (59.3%) RA, 30 (18.8%) AS, 36 (22.2%) PsA) were recruited. Statistical examinations revealed a significant improvement of VAS(DA) (visit 2 versus visit 1: RA: p = 0.02, AS: p < 0.001, PsA: p < 0.001), morning stiffness (RA: p < 0.001, AS: p = 0.03, PsA: p < 0.001) and patient reported pain (all; p < 0.001) in the context of CMRT. In the RA and AS subgroups improvements of DAS28 and BASDAI could also be observed (visit 2 versus visit 1: both; p < 0.001). Moreover, significant improvement of patient reported outcomes could be observed 3 months after CMRT regarding VAS(DA) (RA: p = 0.02 und AS: p = 0.03, morning stiffness (PsA: p = 0.02) and patient reported pain (RA: p = 0.01)). Interestingly, subgroup analyses showed that the therapeutic benefit was independent of the concomitant pharmacotherapy.

CONCLUSION

The results of this study suggest a therapeutic benefit for patients being treated by CMRT and highlight the high value of this therapeutic concept in patients with systemic-inflammatory rheumatic diseases.

[Appropriateness of physiotherapy care in Germany: a scoping review]

BACKGROUND

Physiotherapy is applied for various indications in practices, hospitals and rehabilitation facilities and should be delivered according to the patients' needs. Empirical knowledge on the appropriateness of physiotherapy care in Germany is scarce. This scoping review aims to give an overview over the evidence base, to describe the results of previous studies and to evaluate the appropriateness of physiotherapy care.

METHOD

A systematic literature search was conducted in the databases PubMed, CINAHL, LIVIO and SPOLIT. Results were synthesized in a quantitative and qualitative narrative review.

RESULTS

The screening of 1,517 publications yielded 30 studies eligible for inclusion. The included studies encompass 16 different indications. The number of patients with appropriate physiotherapy care varies between indications (from 3 % for urinary incontinence up to 72 % for osteoporosis).

DISCUSSION

The review shows a lack of empirical evidence since sufficient empirical findings regarding the appropriateness of physiotherapy care are missing for many of the indications, in particular on physiotherapy in hospitals and rehabilitation facilities. The results of single studies are limited by insufficient assessment of therapeutic needs or the therapy modalities applied. Analyses which encompass multiple settings and/or providers of care have not been conducted in all studies, even though respective approaches would have been suitable. Nevertheless, suggestions for targeted improvement of the appropriateness of physiotherapy care can be derived from the results.

Disease-related everyday communication of persons with rheumatic and musculoskeletal diseases-Results of a participatory research project

OBJECTIVE

The aim of the present study is to describe and analyse significant factors of disease-related everyday communication of persons with RMDs in a nationwide project in Germany funded by the Deutsche Rheumaliga Bundesverband e.V. (German League against Rheumatism).

METHODS

In this participatory research project four persons with RMDs are involved. An online questionnaire addressing context, difficulties, and burden of disease-related everyday communication was answered by 1.015 persons with RMDs. Social and communication skills were recorded by questionnaires to capture social insecurity and patient communication competence.

RESULTS

More than half of the participants reported difficulties in disease-related conversations across various situations. The majority of these persons suffer from this experience particularly in conversations at the work environment or with staff members of authorities. They feel unconfident especially in situations which require saying "no". Furthermore, compared to the general population persons with RMDs have more anxiety about contact with others.

CONCLUSION

Strengthening the social skills of persons with RMDs in conversations related to everyday situations can promote a self-determined life and contribute to the maintenance of social participation.

PRATICE IMPLICATIONS

Based on the results, a communication skills training for persons with RMDs will be developed.

[How does the German Association against Rheumatism and Arthritis convey health literacy?]

The German Association against Rheumatism and Arthritis considers the improvement of health literacy as one of their most important tasks. In local groups people with arthritis have the chance to exchange experiences and to benefit from consultation. Individual experiences are merged into a collective knowledge. Numerous printed media as well as information and exchange via the internet help to improve health literacy. Self-management courses and patient education courses are specific instruments to improve the competences of people with arthritis to manage their own condition. Through exercise programs, which are offered locally, the Association strives to improve self-efficacy regarding exercise. A survey of the members showed that the activities of the patient association are well accepted and valued. The empowered patient has more and more become a partner in the micro-level communication with their doctor. On the macro-level, patient representatives play an important role in the committees of the German self-administration of health insurance and physician organizations.