[Lay version of the 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis : Translation into German and linguistic validation in German-speaking countries with people affected]

BACKGROUND

Physical activity and exercise are beneficial for people with rheumatic diseases; however, recommendations for the management of rheumatoid arthritis (RA), spondyloarthritis (SpA) and hip- and knee osteoarthritis (HOA/KOA) are usually unspecific with respect to mode and dose of exercise. This is why the 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis were formulated. The recommendations consist of 4 overarching principles and 10 recommendations. These were also published as a lay version in the English language.

AIM

Translation of the lay version into German and its linguistic validation in Austria, Germany and Switzerland.

METHODS

A professional translation was reviewed by the authors, including people with, RA, SpA, HOA/KOA from the three German-speaking countries, which provided a prefinal lay version. Subsequently, eight interviews with people with RA, SpA, HOA/KOA were conducted in each country to evaluate understandability, wording, completeness and feasibility of the prefinal lay version. Finally, the authors, i.e. those with RA, SpA, and osteoarthritis, anonymously rated their agreement to the final lay version on a 0-10 scale.

RESULTS

The professional translation was substantially revised by the authors and based on the interviews. Formulations were adapted to increase readability and understandability and specify statements. Comments that would have changed content or structure were not considered. Average agreement with the particular recommendations was between 10 (SD 0) and 7.6 (SD 1.67).

DISCUSSION

For people with RA/SpA/HOA/KOA the EULAR physical activity recommendations should be available in their mother language. The final German lay version is valid and accepted across all three German-speaking countries. Thus, the physical activity recommendations can be provided to people with rheumatic diseases in an understandable and feasible way.

POS0044-HPR FEASIBILITY OF FITNESS ASSESSMENTS IN GROUP EXERCISE THERAPY FOR INDIVIDUALS WITH AXIAL SPONDYLOARTHRITIS

Background

Assessments should be standard in individual as well as group physical therapy. The Ankylosing Spondylitis Association of Switzerland has translated the EULAR recommendations for physical activity (PA) in a concept for group exercise therapy, which, in addition to guidance on exercising in all four fitness dimensions (aerobic, strength, flexibility, neuromotor function), also includes PA counselling and regular fitness assessments for the planning and documentation of the individual therapy progress as well for quality monitoring of the exercise groups.

Objectives

To evaluate the feasibility of the selected assessments across all four fitness dimensions, rating the acceptance, practicability, and integration by physiotherapists (PTs) and people with axSpA.

Methods

A feasibility study was conducted in four pilot exercise therapy groups. PTs performed the assessment battery, consisting of a) the Chester Step Test (CST) for aerobic fitness; b) the modified Core Strength Test for core strength, c) the Bath Ankylosing Spondylitis Metrology Index (BASMI) for spinal mobility and d) the Single Leg Stance Test (SLST) for balance, with the participants of the exercise therapy groups. Subsequently, the PTs and the participants with axSpA rated the acceptance, practicability, and integration by means of questionnaires.

Acceptance was operationalised as satisfaction and perceived applicability, practicability was operationalised as feasibility and comprehensibility, and integration was operationalised as usefulness and repeatability. An ordinal scale with four answer options (very good, good, moderate, bad) and a free text field for comments was used. The categories ‘very good’ and ‘good’ were interpreted as ‘positive evaluation’. The feasibility of the assessments was defined based on three levels (I-III): with a positive evaluation of >80% (level I) a specific assessment was considered suitable, with a positive evaluation of 50-80% (level II) adjustments were necessary, with a positive evaluation of <50% (level III) a specific assessment was not considered suitable for group exercise therapy and a new choice had to be made.

Results

The BASMI was rated level I by people with axSpA and PTs, no adaptations were necessary. The CST was rated level I by people with axSpA and level II by PTs (too time consuming and failure-prone software), resulting in the adaptation that the test can now be performed without software, and a training will make the testing PTs more efficient. The modified Core Strength Test was rated level I by people with axSpA and level II by PTs (instructions unclear), leading to adaptations in the instruction manual. The SLST was rated level I by people with axSpA and level II by PTs (instruction “standing on one leg as long as possible” not useful for persons without balance deficit), leading to the adaptation that the test can be stopped after 60 seconds as the normal values are below that threshold.

Conclusion

From patient perspective, the feasibility of the tests was evaluated positive in terms of acceptance, practicability and integration (all level I). From PTs’ perspective some adaptations were necessary (level II, except BASMI). After the adaptations, the assessment battery can now be used in group exercise therapy for individuals with axSpA. In this way, the individual fitness status can be evaluated, and interventions can be adapted, and thus the quality of group exercise therapy can be continuously monitored and improved if necessary.

Acknowledgements

We thank all participants and the SVMB for their support.

Disclosure of Interests

None declared

Was machen die ersten in der Schweiz wissenschaftlich ausgebildeten Physiotherapeuten heute?

Hintergrund: Der Studiengang Physiotherapie Wissenschaften (PTW) wurde zwischen 2002 und 2008 dreimal durchgeführt und schloss mit einem Master in Physiotherapy Science (MPTSc) ab. Er qualifizierte 53 Physiotherapeuten zu Forschungstätigkeit oder zum Transfer von wissenschaftlichen Erkenntnissen in die klinische Praxis.

Ziel: Untersuchung der beruflichen Entwicklung, heutigen Funktionen und Tätigkeiten der PTW-Absolventen.

Methode: Online-Querschnitt-Befragung.

Ergebnisse: Von den 34 antwortenden Absolventen (Rücklaufquote: 64 %) sind alle berufstätig, 24 (71 %) innerhalb der Physiotherapie. Die meisten hatten eine Funktion als Führungsperson, wissenschaftliche Mitarbeiter, Physiotherapeuten oder Dozenten und hatten kombinierte Tätigkeiten in Klinik, Forschung und/oder Lehre. Bei 26 Personen (76 %) war für ihr Aufgabengebiet ein Master-Abschluss erforderlich. Die beste Passung zwischen im Studium erworbenen versus in der Berufstätigkeit geforderten Kenntnissen und Fähigkeiten betraf: (1) Forschungsergebnisse in die Praxis umzusetzen, (2) sich aktiv in Forschungsprojekte einzubringen, (3) Forschungsfragen aus der klinischen Praxis und anhand der wissenschaftliche Fachliteratur zu entwickeln, (4) ein aktives Wissensmanagement zu betreiben und Neuerungen im Team zu etablieren sowie (5) in einem interprofessionellen Projektteam mitzuarbeiten (40 – 79 % Zustimmung). Seit dem Master-Abschluss publizierten 23 Absolventen (68 %), und 9 Personen (26 %) schlossen ein Doktorat (PhD) ab oder waren dabei.

Schlussfolgerung: Der PTW-Abschluss bildet eine wichtige Grundlage für individuelle Berufskarrieren. Er verschafft Zugang zu Tätigkeiten in Forschung, Lehre und/oder Leitungspositionen und ermöglichte insbesondere eine wissenschaftliche Karriere einschließlich des möglichen Erwerbs eines Doktorats (PhD).

Absolventen-Nachbefragung (ABNA) des MSc-Studiengangs Physiotherapie – Was bringt der MSc-Abschluss im Berufsalltag?

Hintergrund: Aufgrund der veränderten Anforderungen an die Gesundheitsfachpersonen übernehmen auch Physiotherapeuten Aufgaben, die über ihre klinische Expertise hinausgehen. Ein MSc-Abschluss qualifiziert sie sowohl für erweiterte Aufgaben in der Klinik als auch für Tätigkeiten in der Forschung und Lehre.

Ziel: Das Ziel der Absolventen-Nachbefragung (ABNA) war, die Umsetzbarkeit der im Studium vermittelten Kompetenzen in den Berufsalltag zu untersuchen.

Methode: Im Herbst 2015 wurden die ersten beiden Abschlussjahrgänge 2013 und 2014 (n = 51) des MSc in Physiotherapie mit einem Online-Fragebogen befragt.

Ergebnisse: An der Befragung nahmen 34 Absolventen teil. Die Rücklaufquote betrug 68 %. Die Mehrheit der Teilnehmenden (84 %) arbeitet in direktem Patientenkontakt, häufig in Kombination mit erweiterten Tätigkeiten (92 %) wie etwa Fachentwicklung, Forschungs- oder Unterrichtstätigkeit. Als Veränderungen im Berufsalltag, die auf den MSc-Abschluss zurückzuführen sind, wurden interessantere und abwechslungsreichere Tätigkeiten (74 %), erweiterte Aufgabenfelder (71 %) oder Projektverantwortung (41 %) genannt. Rund ein Viertel der Absolventen treibt die akademische Karriere voran.

Schlussfolgerung: Die Erfahrungen der Absolventen der ersten beiden Studienjahrgänge zeigen, dass der MSc-Abschluss einen beruflichen Aufstieg ermöglicht und dies zu einer Vielzahl an beruflichen Veränderungen, wie z. B. neue Tätigkeiten, erweiterte Aufgabenfelder oder Projekt- und Personalverantwortung führt. Für MSc-Physiotherapeuten gibt es adäquate Stellen auf dem Arbeitsmarkt, in denen sie ihre Kompetenzen einsetzen können. Weiter ermöglicht der MSc-Abschluss den Zugang zu einem PhD.

Measurement properties of the EuroQoL EQ-5D-5L to assess quality of life in patients undergoing carpal tunnel release

The objective of this study was to investigate the measurement properties of the EuroQol EQ-5D-5L questionnaire (EQ-5D-5L). A total of 60 patients with carpal tunnel syndrome completed the EQ-5D-5L twice before surgical decompression and once more 6 weeks after surgery. In addition, they filled out the Short Form 12 and Michigan Hand Outcomes Questionnaire at the baseline and postoperative follow-up examinations. Test-retest reliability was excellent with an intraclass correlation coefficient of 0.81. Internal consistency was high with Cronbach's alpha of 0.83. Good validity of the EQ-5D-5L was indicated by correlations of r = 0.7 and r = 0.5 with the Short Form 12 and Michigan Hand Outcomes Questionnaire, respectively. Moderate responsiveness was shown by an effect size of 0.5. The minimal important change was 0.09 points. Overall, the EQ-5D-5L demonstrates sound measurement properties and can be recommended as a suitable tool to assess quality of life in patients with carpal tunnel syndrome.

LEVEL OF EVIDENCE

I.

The psychometric properties of the German version of the new Worker Role Interview (WRI-G 10.0) in people with musculoskeletal disorders

OBJECTIVE

Occupational therapists play an important role in work rehabilitation in getting people with chronic disabilities back to work. The Worker Role Interview (WRI) is intended to detect psychosocial and environmental factors influencing the ability to return to work for injured or disabled workers. This study examined the psychometric properties of the recently modified German version (WRI-G, 10.0) in a population with work-related musculoskeletal disorders (MSD) in Switzerland.

METHODS

Data were gathered from 20 participants with work-related MSD. The interviews were conducted face-to-face and videotaped. Five occupational therapists, trained in the use of the WRI-G, independently rated all 20 interview recordings following the official manual. Thus, 100 ratings were analysed by use of Rasch analysis to test construct validity and transform ordinal raw data into linear data (person locations) for interrater-reliability calculations.

RESULTS

All items fit the Rasch model, except the item 'perception of boss'. The final WRI-G, consisting of 15~items, showed good overall model fit (X2 = 54.66, p = 0.04); excellent person-separation reliability (PSI 0.91) and high inter-rater reliability (mean ICC 0.90).

CONCLUSIONS

Based on this sample, the WRI-G (10.0) is a valid and reliable instrument to assess psychosocial ability for return to work in a population with work-related MSD.

Perceived benefits and barriers to joint protection among people with rheumatoid arthritis and occupational therapists. A mixed methods study

BACKGROUND

Deciding whether or not to perform a health behaviour is an active decision-making process which has an impact on current and future behaviour and can be influenced by the beliefs both of patients and their healthcare professionals. The aim of this study was to explore rheumatoid arthritis (RA) patients' and occupational therapists' (OTs) perceptions of the benefits of and barriers to performing joint protection (JP).

METHODS

A mixed methods design was used. Questionnaires applied a theoretical framework of key themes to assess the relevance of JP benefits and barriers both to people with RA and OTs. Focused interviews with people with RA then enabled data triangulation. Investigator triangulation was used to check the validity of data interpretation.

FINDINGS

Ten people with RA and nine OTs participated. From the questionnaires, both groups agreed that highly relevant key themes for JP benefits were physical well-being, potential benefit and personal control. By contrast, the three key themes for JP barriers - negative attitude of others, negative impact on others and taking time from other things - were relevant for the majority of the OTs but not patients. The interviews enabled an understanding of the meaning behind RA patients' ratings, particularly their differences from OTs. People with RA explained JP benefits, and disease acceptance had altered some initial barriers into perceived benefits over time.

CONCLUSIONS

Emphasizing benefits and identifying individually relevant barriers could be an important communication strategy for OTs in understanding patients' rationale for whether or not to adopt JP methods.

Development and validation of a German version of the joint protection behavior assessment in patients with rheumatoid arthritis

OBJECTIVE

Joint protection (JP) is an important part of the treatment concept for patients with rheumatoid arthritis (RA). The Joint Protection Behavior Assessment short form (JPBA-S) assesses the use of hand JP methods by patients with RA while preparing a hot drink. The purpose of this study was to develop a German version of the JPBA-S (D-JPBA-S) and to test its validity and reliability.

METHODS

A manual was developed through consensus with 8 occupational therapist (OT) experts as the reference for assessing patients' JP behavior. Twenty-four patients with RA and 10 healthy individuals were videotaped while performing 10 tasks reflecting the activity of preparing instant coffee. Recordings were repeated after 3 months for test-retest analysis. One rater assessed all available patient recordings (n = 23, recorded twice) for test-retest reliability. The video recordings of 10 randomly selected patients and all healthy individuals were independently assessed for interrater reliability by 6 OTs who were explicitly asked to follow the manual. Rasch analysis was performed to test construct validity and transform ordinal raw data into interval data for reliability calculations.

RESULTS

Nine of the 10 tasks fit the Rasch model. The D-JPBA-S, consisting of 9 valid tasks, had an intraclass correlation coefficient of 0.77 for interrater reliability and 0.71 for test-retest reliability.

CONCLUSION

The D-JPBA-S provides a valid and reliable instrument for assessing JP behavior of patients with RA and can be used in German-speaking countries.

Loss of abdominal fat and improvement of the cardiovascular risk profile by regular moderate exercise training in patients with NIDDM

Non-insulin-dependent diabetes mellitus (NIDDM) is associated with an increased cardiovascular risk. Glycaemic control alone is often insufficient to control diabetic dyslipidaemia and other cardiovascular risk factors associated with NIDDM. The present trial was designed to evaluate the effects of physical activity as an adjunct to standard diabetes therapy on the lipid profile, blood pressure, glycaemic control, weight and body fat. Sixteen well-controlled (HbA1c 7.5%) patients with NIDDM participated in a regular aerobic exercise training programme at 50-70% maximal effort over 3 months. Thirteen age- and sex-matched patients with NIDDM served as a control group. The 3-month intervention with an increase in physical activity from 92 (mean +/- SD) +/- 79 to 246 +/- 112 min per week (p < 0.001) by means of a structured activity programme resulted in significant improvement of plasma lipids with a 20% decrease in triglycerides (p < 0.05), unchanged total cholesterol and increases in high-density lipoprotein and high-density lipoprotein-3 subfraction of 23% (p < 0.001) and 26% (p < 0.001), respectively. Systolic and diastolic blood pressure decreased significantly from 138 +/- 16 to 130 +/- 17 mm Hg (p < 0.05) and 88 +/- 10 to 80 +/- 10 mmHg (p < 0.001), respectively. Resting heart rate decreased from 81 +/- 13 to 74 +/- 14 beats per minute (p < 0.001), waist-hip circumference ratio decreased from 0.96 +/- 0.11 to 0.92 +/- 0.10 (p < 0.001) and body fat decreased from 35.3 +/- 7.2 to 33.0 +/- 8.0% (p < 0.001). These effects occurred independently of changes in body weight and glycaemic control, which did not change during the study. This study shows that improvement in physical fitness by introducing regular physical exercise as part of the treatment programme in patients with NIDDM results in a significant amelioration of their cardiovascular risk profile.

Effect of dopamine on hepatosplanchnic blood flow

Hepatosplanchnic blood flow (EHBF) was estimated with the single-injection method using indocyanine green in 10 patients without cardiac failure before and after 20 min of an intravenous infusion of dopamine. Five patients received 4 microgram/kg/min and another 5 patients 8 microgram/kg/min. The cardiac index (CI) was determined according to the Fick principle, and the arterio-hepatovenous oxygen difference (AV DO2 AO/HV) was measured. The mean increase in EHBF in the 10 patients was from 640 +/- 46 ml/min/m2 to 831 +/- 56 ml/min/m2 (p less than 0.001). The percentage of EHBF to CI increased from 24.1 +/- 2.0% to 26.4 +/- 1.6% (p less than 0.05). The mean AV DO2 AO/HV dropped from 49.6 +/- 3.8 ml/liter to 40.4+/- 2.9 ml/liter (p less than 0.005). We conclude that dopamine given at rates of 4 and 8 microgram/kg/min to patients whose hearts are well compensated increases hepatosplanchnic flow. Thus, the large increase in renal blood flow which occurs with dopamine is not at the expense of hepatosplanchnic blood flow.

[Liver circulation during dopamine therapy]

Intravenous dopamine (4 and 8 microgram/kg/min) causes an increase of hepatic flow and cardiac index, while the ratio hepatic flow:cardiac index remains unchanged. The increase of renal flow after dopamine therefore does not occur at the expense of hepatic flow.