Library and Resources

At AStretch we are committed to ensuring that up to date information is made available to a wide audience. If you have anything you would like to contribute, please contact us on: 

Best Practice in Assessment:

The  NICE GUIDANCE  on Spondyloarthritis, covers the diagnosis and mangement of Spondyloarthritis. Raising awareness of the symptoms of inflammatory back pain can break through the challenges of diagnosis and reduce diagnostic delay. Physiotherapists are well placed in screening these patients as the physiotherapy department may be the first port of call. Early onward referral to Rheumatology when appropriate can improve diagnostic standards and improve outcomes for this group of patients.

Early Diagnosis of inflammatory back pain is essential for effective treatment and good management of Axial Spondyloarthritis.
AStretch members have worked tirelessly in promoting early recognition of inflammatory back pain.  We were involved in the delivery of facilitated workshops in the NASS Back Pain Seminars between 2012 and 2014 reaching almost 900 delegates throughout England and Wales. The seminars informed delegates how to distinguish inflammatory back pain from mechanical back pain and other types of back pain. 

Back in Focus have produced e-learning modules to assist recognition, diagnosis and management of AxSpA.
These modules are now available for AHP EDUCATION: click here

Here is a quick and easy online diagnostic tool that will help you to define the likelihood that your patient with back pain is likely to have Axial Spondyloarthritis:

Here you will find a useful presentation link, describing experiences in 2017, using these e-learning modules as part of in house training for musculoskeletal physiotherapist who are likely to come into contact with people describing chronic low back and joint pain and to flag up the possibility of Spondyloarthritis.

This presentation was devised as an interactive session for   The British Society of Rheumatology 2014.    Combining some of the diagnostic principles in distiguishing back pains and based on two short videos. You can interact with this presentation by trying to answer the questions yourself and follow this up with the evidence based answers and discussions that follow. Unfortunately we cannot publish these videos, however, a short summary is provided for you to work from.

A DVD produced to educate potential referrers in recognition of inflammatory back pain, appears here :  

This 2017 article  published in Horizons and gives some insight for extra scope and advanced physiotherapy practitioners in the musculoskeletal fields. It highlights the difficulties in teasing out some of the often subtle differences in back pain presentations found in clinical practice and subsequent diagnostic decision making.

Campaigning for early diagnosis, how to get involved:

Common extra-articular features found in axial spondyloarthropathy

Closely linked to the above information on best practice in assessment, we need to be very mindful, both during assessment and treatment / review sessions to consider the possibility of extra-articular features in our spondyloarthritis cohort. This presentation covers the main extra-articular features and will hopefully change how you assess and treat (and refer on!)Facts to consider:

• 5-10% of patients with Axial SpA have IBD
• 25-49%  of Axial SpA patients have subclinical gut inflammation when endoscoped
• There is an increased prevalence of getting IBD with Axial SpA if HLA B27 +
• When patients with IBD had MRIs 30-40% had SI joint changes

• 40% of people with AAU have axial SpA
• 26% of people with axial SpA have AAU
• AAU can occur before spinal disease or at any point during the course of the disease
• Increased prevalence of getting AAU with Axial SpA if HLA B27 +

•8% of patients with axial SpA have psoriasis
•7-8% of patients with AS have psoriasis, and they tend to be HLA-B27+

Outcome Measures:

The Bath Indices, outcome measure information booklet, for use with ankylosing spondylitis patients was reviewed and edited by four members of the AStretch Committee-  Heather Harrison, Karen Irons, Amanda Thomas and Jane Martindale. The extensive reference section represent the vast literature search undertaken, this was supported by the librarians at Wrightington Wigan and Leigh NHS Foundation trust.

The updated version of the Bath Indices can be obtained from :

Evaluating Ankylosing Spondylitis Quality of Life with the EASi-QoL: a new patient-reported outcome measure for AS
Dr. Kirstie L Haywood
For further information pertaining to the development, evaluation and application of the EASi-QoL please contact:
Dr Kirstie Haywood
School of Health and Social Studies, University of Warwick (
Tel: 024761 50616

  EASi-QoL Evaluating Ankylosing Spondylitis Quality of Life. A patient - reported outcome measure

Physio Matters Podcast

The Physio Matters Podcast session 26 on axial SpA (AS) was sponsored by NASS and features physiotherapist Jack March interviewing Professor Karl Gaffney (Consultant Rheumatologist, Norfolk and Norwich University Hospital).

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About us

AStretch is a not for profit organisation; our main aim is to provide a co-ordinated approach to the planning and delivery of education and best practice. Also to support physiotherapists working with people who have Axial Spondyloarthritis (AxSpA) and Ankylosing Spondylitis (AS).


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