ABSTRACT
Background/Aims The physiotherapist's role in the assessment and management of axial spondyloarthritis (axSpA) is evolving. The axSpA Specialist Interest Group North-West (ASSIGNw) surveyed practices of its members in 2016. This reports on a 5-year follow-up survey, exploring how our North-West physiotherapy axSpA services are running following the impact of the COVID-19 pandemic. The aim is to benchmark practice of physiotherapists working with axSpA, identifying discrepancies between services and recommending ways forward. Methods In June 2021, members of ASSIGNw identified areas of practice to benchmark;questions were formulated to elucidate these, creating a SmartSurveyTM sent to ASSIGNw members August-September 2021. Results Sixteen Trusts replied, two more than the 2016 survey. Ratios of physiotherapy:medical staffing range from 1:1 to 1:8. All centres intended to offer virtual appointments as a long-term option. The majority of centres (60%) offered yearly follow up;40% offered 6-monthly follow up. The median appointment duration had reduced from 45 minutes in 2016 to 30 minutes in 2021. The number of centres offering 60 minute slots reduced from 36% in 2016 to 20% in 2021. The vast majority of consults were undertaken independently by the physiotherapist (86%), a small number offering combined appointments with medical colleagues (7.1%). Half of centres surveyed had no access to onsite hydrotherapy, most of these actively signpost to local pools for self-led water-based exercise (62.5%). A dedicated flare/emergency access service was not offered by 60% of centres. Most centres undertake patient education on a one-to-one basis (94%);formal axSpA education programmes are only offered in one centre surveyed. P252 Table 1: Use of Outcome Measures in the Physiotherapy services of the ASSIGNw groupPaperElectronicMixture of paper and electronicBSR ePROMs platformMethod of collection of PROMs50%31%13%6%Outcome measures routinely collected% UseBASDAI94%BASMI94%BASFI81%Spinal Pain VAS75%Chest expansion69%Height69%Weight50%BMI31%Recent falls44%Walking aid use44%EASi-QoL13%Osteoporosis risk factors13%HAD scale score13%MSK-HQ6%FACIT-F6%HAQ-DI6%Patient-rated medication efficacy6%ASDAS0% PROM=Patient Reported Outcome Measure;ASSIGNw=Axial Spondyloarthritis Specialist Interest Group North-west;BSR=British Society of Rheumatology;ePROMs=electronic PROMs;BASDAI=Bath Ankylosing Spondylitis Disease Activity Index;BASMI=Bath Ankylosing Spondylitis Metrology Index;BASFI=Bath Ankylosing Spondylitis Functional Index;VAS=Visual Analogue Scale;BMI=Body Mass index;EASi-QoL=Evaluation of Ankylosing Spondylitis Quality of Life;HAD=Hospital Anxiety and Depression Scale;MSK-HQ=Versus Arthritis Musculoskeletal Health Questionnaire;FACIT-F=Functional Assessment of Chronic Illness Therapy-Fatigue;HAQ-DI=Health Assessment Questionnaire-Disability Index;ASDAS=Ankylosing Spondylitis Disease Activity Score. Conclusion This survey, as in 2016, has highlighted a large inter-trust variation in physiotherapy:medic staffing ratio. A broad collection of outcome measures was collected and there is an unchanged general consensus that the BASMI and BASDAI are essential. The average and maximum appointment durations have both reduced. Urgent/flare and hydrotherapy access remains limited. Formal patient education is yet to be adopted, one-to-one education remains the prevalent model. Further work on standardising axSpA physiotherapy-led services is warranted. As we drive forwards best-care, the enhanced use of the full rheumatology multi-disciplinary team and standardisation of staffing levels is recommended. Disclosure W.J. Gregory: Honoraria;WG has received honoraria from Abbvie, Novartis, Pfizer and UCB. J. Brazendale: None. C. Greenall: None. G. McCall: None.