Conference aims and objectives

AStretch is the name given to a group of physiotherapists, from around the country, who meet twice a year to steer the management, and improve the understanding of, Ankylosing Spondylitis (AS). We provide biennial conferences to educate health professionals to help to advance the therapeutic management of patients with AS.

Feedback from previous conferences has highlighted that there is a paucity of education for the management of AS patients specifically appertaining to exercise therapy. empower health professionals in the delivery of appropriate exercise regimes for AS patients as this is an integral and essential part of therapeutic care of this condition.

This conference also seeks to deliver and generate debate about how exercise should be introduced and delivered to newly diagnosed patients. The principal objective of the course therefore being the delivery of enhanced patient care by the promotion of suitable exercise regimes tailored to individual needs. This conference is also aimed at encouraging networking and exchange of ideas between health professionals who specialise in the treatment of AS throughout the UK.

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AStretch 5^th Conference

Ankylosing Spondylitis and the concepts of exercise

The 5^th AStretch conference was held on Friday November 12^th at the MANDEC conference centre in Manchester with 70 physiotherapy delegates in attendance. Claire Harris chaired the meeting welcoming attendees, who had come from all over the country, and outlining the programme.

The opening presentation was from Stuart Porter a senior lecturer at Salford with the title of Exercise behaviours in AS. This was a highly entertaining talk taken from Stuarts PhD asking the questions “What do patients really do?” and what “motivates them to do or not do their exercises”. His results demonstrated that patients were very good problem solvers, they learnt very quickly who was good and who was not and when to adapt or ignore advice. They used a cycle of short term and long term adapted exercise behaviour, listening to their own bodies, and weighing up pros and cons of exercise with regards to their body’s needs at the time. Mixed messages were confusing and quoted as being a problem. Stuart highlighted that therewere four levels of response to the same question with only 2% of patients doing exactly what they were told to do in the form that they were advised to do it in. Patients would go through their own exercise behaviour route getting on and off or changing direction as required. This provoked an interesting discussion in question time giving therapists food for thought when discussing exercise expectations with patients in future.

The second presentation was from AStretch member Jane Martindale, a clinical specialist physiotherapist. She looked at “Exercise the debate” as part of a North West initiative. The aim was to standardise exercises, thinking about how they are delivered and in the best media for the patient. It was to sell the concept of exercise, raising awareness and choice, looking at the patient as an individual. Questions looked at a life long approach to exercise, the barriers faced and personality issues. Were we as therapists adapting exercises as these patients aged, modifying and tailoring them to their changing needs?

To assess this, patients and therapists attended a ‘world cafe ‘informally looking at challenges and possibilities. Patients felt that good explanations delivered at the right time was essential and that a buddy system for newly diagnosed would be beneficial. Patients also felt that choice was important rather than standardised exercises; Exercise needed to fit their lifestyles and to take into account their age and gender.

Definitions of exercise were often much wider than the traditional concept, meaning patients often felt that they were being active although not doing the usual exercise regime. As a group, the North West hoped to develop a recipe box of suitable exercises that could be mixed and matched to suit each individual patient. It is hoped that AStretch could take this project forward especially as the audience felt that this would be of high value to their departments.

The third presentation was from Tim Jones, (Consultant in Rheumatology and Rehabilitation Medicine at the MOD Medical Rehab Centre at Headley Court) and Claire Harris (AStretch Chair) entitled “Getting the newly diagnosed to exercise”. This talk introduced the new Back to Action exercise programme that was produced with NASS looking at the younger aged patients with regards suitable individualised exercises in the gym environment. It was in response to why this cohort of patients are finding it hard to take exercise on board. The aim was to produce an exercise programme suitable for unsupervised routines, looking at guidance and safety considerations.  The book is divided into sections and exercises were described with hints and suggestions as well as easy to understand colour pictures of correct techniques. It was felt that this had enormous benefit for not only the patient but for therapists and gym instructors alike. The book is available from NASS for a cost of £14.99 (www.nass.co.uk).

A panel was then set up with the morning’s speakers which led to some interesting discussion around the room, ranging from balance exercises to suitability of running/jogging, demonstrating how thought provoking the morning had been.

Jane Skerret the Director of NASS talked about the redevelopment of the new NASS website for both patient and therapist education. She mentioned World AS day on 8^th May 2011 and the need to increase awareness of the disease, promoting earlier diagnosis and correct intervention.  Do refer to the Looking Ahead document which can be downloaded from their website

A fantastic spread awaited the attendees at lunch and a short time to network (foreshortened by the fire alarm going off earlier in the morning!).

The afternoon session commenced with AStretch member Susimala Gaikwad, Clinical Specialist Physiotherapist presenting her MSc dissertation work “land v water based exercises”. It was hoped this systematic review work may identify whether water based exercises (WBE) were more effective than land based exercises (LBE) in improving spinal joint mobility, pain and physical function in AS patients. Out of 65 papers identified in this review’s study selection process, only 2 relevant randomised controlled trials (Altan et al 2006 and Helliwell et al 1996) were found to be eligible. The review concluded that WBE were more effective than LBE in improving 2 clinical outcome measures (Modified Schober lumbar flexion and chest expansion measures). The difference between the WBE and LBE was not large and not likely to be clinically significant.  However patients found WBE effective and reported no adverse effects.  So WBE can be offered as an alternative treatment. This systematic review is the stepping stone in this health sector, however, included trials were of poor validity.  Future research needs to include sufficient sample size, adequate data reporting, standardized assessment with outcome measures and lengthy follow up periods to compare the clinical effectiveness of WBE over LBE. Hydrotherapists (supported by self management groups such as NASS) need to conduct multi centred trials with Incremental Cost Effectiveness Ratio calculations to provide significant evidence to the decision makers advocating WBE as effective treatment to AS patients.

Susi highlighted that the hydrotherapy services are under threat across the country and emphasised that managers need to consider NICE guidelines in promoting patient choice/preferences to be incorporated in their disease management. This may aid maintaining/promoting WBE provisions in the UK.

An interactive session followed led by AStretch members Karen Irons and Claire Jefferies looking at case studies and possible treatment regimes. The results will be available on the website separately. This session was very enjoyable and certainly engaged the attendees promoting not only great discussion but net working opportunities as well.

Finally Raj Mahapatra, an AS patient himself gave a patients personal experience of exercise. This was a fantastic way to finish the day. Raj was highly motivated and very enthusiastic in his unique approach to exercise – not for the faint hearted amongst us. He spoke of the challenges he had set himself namely the “Bob Graham Round” a 72 mile run in 24 hrs involving 27,000 foot of up, down and round 42 of the highest Lakeland Peaks. He raised the question of giving the patient the choice of challenge – What do they want to achieve / what is their goal? -  therefore giving the patient the choice of outcome. He said he felt that the NHS often only focussed on the process, only to get the patient through the system rather than looking at the individual. This could potentially lead to depression due to the sacrifices the patient felt they had to make, giving things up rather than discussing choice. This last talk left the audience with some very important questions to ask themselves.  Who is taking the lead in the patient goal setting process, the health professional or the individual.

 

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4th AStretch Conference