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Zusammenfassung Hintergrund Die Schweizerische Vereinigung Morbus Bechterew (SVMB) hat kürzlich das BeFit-Konzept in der Gruppentherapie für Personen mit axialer Spondyloarthritis (axSpA, umgangssprachlich M. Bechterew) implementiert. Ein wichtiger Bestandteil des BeFit-Konzepts ist eine gezielte Bewegungsberatung zur Förderung von selbstständigem Training. Die Kommunikationskompetenz von Physiotherapeut*innen (PT) gilt dabei als Voraussetzung für eine gelungene und wirksame Patientenedukation (PE), ist bisher aber wenig untersucht. Ziel Analyse, welche Kommunikationstechniken PT während der Bewegungsberatung mit Personen mit axSpA anwenden. Methode Es wurde eine Querschnittstudie mit PT und Personen mit axSpA der SVMB-Gruppentherapien durchgeführt. Die Bewegungsberatungen wurden mit Audio aufgenommen, die Kommunikationstechniken anhand des Manuals „The Calgary Cambridge Referenced Observation Guide One“ identifiziert. Das Manual enthält 5 Gesprächsabschnitte (1. Einleiten der Sitzung, 2. Informationssammlung, 3. Strukturierung der Konsultation, 4. Beziehungsaufbau, 5. Beenden der Sitzung) mit 38 Techniken, wovon 6 nicht analysiert werden konnten. Eingeschlossen wurden die Techniken, die mindestens einmal identifiziert wurden. Je strukturierter die Beratung war und je mehr Techniken identifiziert wurden, desto besser konnte die Kommunikation der PT während der Beratungsgespräche bewertet werden. Ergebnisse Es nahmen 12 PT und 41 Personen mit axSpA teil. Somit wurden 41 Bewegungsberatungen ausgewertet. Insgesamt wurden bei 10 von 12 (85 %) der PT in allen Beratungen die 32 eingeschlossenen Kommunikationstechniken mit einer Häufigkeit der einzelnen Techniken zwischen einmal und 41-mal identifiziert. Der Gesprächsabschnitt „Strukturierung der Konsultation“ zeigte die höchste Häufigkeit zwischen 29- und 41-mal. Schlussfolgerung Die strukturierte Kommunikation ist ein wesentlicher Bestandteil der PE. Die Ergebnisse zeigen, dass die Mehrheit der PT die Bewegungsberatungen mit Patient*innen mit axSpA strukturiert durchführten und die Kommunikationstechniken umfassend identifiziert werden konnten. Die unterschiedlich häufige Anwendung der einzelnen Techniken kann dazu genutzt werden, die Kommunikation der PT in den Bewegungsberatungen für Personen mit axSpA gezielt zu schulen und zu optimieren.

Zusammenfassung Hintergrund Körperliche Aktivität kann die Symptomatik von Personen mit axialer Spondyloarthritis (axSpA) verbessern. Die Selbstwirksamkeit ist dabei ein wichtiger prädiktiver Faktor. Mit dem Fragebogen „Exercise Self-Efficacy Scale“ (ESES) kann die Selbstwirksamkeit für körperliche Aktivität erfasst werden. Bislang gab es noch keine deutsche, validierte Version des Fragebogens. Ziel Untersuchung der transkulturell adaptierten deutschen Version der ESES (ESES-D) bezüglich Test-Retest-Reliabilität, interner Konsistenz sowie Konstruktvalidität bei Personen mit axSpA. Methode Die ESES-D wurde anhand des TRAPD-Team-Translation-Models in die deutsche Sprache übersetzt und in einer Beobachtungsstudie evaluiert. Die interne Konsistenz wurde mittels Cronbachs Alpha und die Test-Retest-Reliabilität mittels Intraklassen-Koeffizienten (ICC, Two-way Mixed Effects Model) überprüft. Die Konstruktvalidität wurde aufgrund a priori definierter Hypothesen mittels Korrelationen zwischen der ESES-D, demografischer Merkmale und Messinstrumente zu krankheitsbedingten Symptomen, Funktionseinschränkungen, körperlicher Aktivität sowie Ergebniserwartung für das Training untersucht. Bei Erfüllung von 6 von 8 Hypothesen galt die Konstruktvalidität als bestätigt. Ergebnisse Die ESES wurde in die deutsche Sprache übersetzt. Es wurden 52 Personen mit axSpA zwischen 31 und 80 Jahren in die Studie eingeschlossen. Die deutsche Version der ESES demonstrierte gute Werte bezüglich der Reliabilität mit einem ICC von 0,78 (95 % CI; 0,63–0,88) und einem Cronbachs Alpha von 0,85. 5 von 8 a priori definierte Hypothesen zur Überprüfung der Konstruktvalidität wurden bestätigt. Schlussfolgerung Die ESES-D erfasst die Selbstwirksamkeit für körperliche Aktivität mit guter Test-Retest-Reliabilität und interner Konsistenz. Die Konstruktvalidität konnte nicht abschließend bestätigt werden. Weitere Forschung zur Konstruktvalidität und Responsivität wird empfohlen.

Zusammenfassung Hintergrund Regelmäßige Bewegung und spezifisches Training sind wichtige Bausteine in der Therapie rheumatischer Erkrankungen, weil ein gesundheitlicher Nutzen für die Patient*innen nachgewiesen ist. Basierend auf den internationalen Empfehlungen der WHO für Gesunde, geben die „2018 EULAR Empfehlungen zu körperlicher Aktivität von Menschen mit entzündlich-rheumatischen und degenerativen Erkrankungen“ erstmals evidenzbasierte Empfehlungen zu Gestaltung, Durchführung und Implementierung von Bewegungsübungen bei diesen Patient*innen. Ziel Übersetzung ins Deutsche und sprachliche Validierung in Deutschland, Österreich und der Schweiz. Methoden Eine professionelle Übersetzung der EULAR Bewegungsempfehlungen ins Deutsche wurde durch deutschsprachige Experten*innen aus allen 3 Ländern überarbeitet. Die Validierung erfolgte in einem Feldtest mit Rheumatolog*innen, Ergo- und Physiotherapeut*innen, Pflegefachpersonen und medizinischen Fachangestellten aus der Rheumatologie. In den 3 Ländern wurden jeweils 8 strukturierte Interviews zu Verständlichkeit, Wortwahl, Vollständigkeit und Umsetzbarkeit durchgeführt. Die Experten*innen diskutierten die Änderungsvorschläge, bis jeweils ein Konsens erreicht wurde. Zuletzt gaben sie den Grad ihrer Zustimmung zu der finalen Übersetzungsversion an. Ergebnisse Die professionelle Übersetzung wurde substanziell überarbeitet. Aufgrund der Ergebnisse der Feldtests wurden verschiedene Änderungen einzelner Worte sowie Umformulierungen zur besseren Verständlichkeit vorgenommen. Der Grad der Zustimmung lag mit durchschnittlichen Bewertungen zwischen 10 (SD 0,0) und 8,9 (SD 1,5) insgesamt sehr hoch. Diskussion Die vorliegende sprachlich validierte deutschsprachige Version der 2018 EULAR Bewegungsempfehlungen kann und soll dazu beitragen, Fachpersonal darin zu unterstützen, körperliche Aktivität bei Menschen mit entzündlich-rheumatischen und degenerativen Erkrankungen zu fördern.

International guidelines recommend the use of exercise, education and weight reduction, when appropriate, as first-line treatment for the conservative management of knee osteoarthritis (OA). These guidelines have not been applied systematically in Switzerland, resulting in an evidence-performance gap. After an analysis of available programmes, the Good Life with osteoArthritis Denmark (GLA:D) programme was determined as the most applicable exercise and education programme for its implementation in Switzerland. The implementation of GLA:D Switzerland OA was initiated to encourage the wider implementation of the clinical guideline recommendations and to improve conservative management of knee OA. The aim of this study protocol is to describe the evaluation of the implementation strategy and its impact on implementation, service and clinical outcomes; as well as to identify contributing barriers and facilitators.The Implementation Research Logic Model will be used to evaluate the strategy and analyse its impact on the implementation outcomes by means of a mixed methods approach. This protocol outlines the proposed measures, data sources and strategies for the evaluation. Predefined implementation outcomes will help to identify the implementation impact and analyse barriers and facilitators systematically. The study population will be the healthcare professionals who are involved in the conservative management of knee OA in Switzerland, that is, physiotherapists and medical doctors, and their patients.The use of the registry data containing data of patients participating in the GLA:D Switzerland OA programme does not fall within the scope of the Swiss Human Research Act (BASEC-Nr. Req-2019-00274). However, all participants involved in the evaluation will be asked to give informed written consent and all measures are taken to protect data and privacy of participants. Research findings will be submitted to journals relevant for the topic.Not applicable.

Zusammenfassung Hintergrund Die Schweizerische Vereinigung Morbus Bechterew hat die Empfehlungen für körperliche Aktivität der europäischen Rheumaliga in einem Gruppentherapie-Konzept für Personen mit axialer Spondyloarthritis (axSpA) umgesetzt. Dieses Konzept beinhaltet neben der Anleitung zum Training in allen 4 Fitnessdimensionen (Ausdauer, Kraft, Beweglichkeit, Neuromotorik) auch Bewegungsberatung und regelmäßige Fitness-Assessments für die Planung und Dokumentation des individuellen Therapiefortschritts sowie für die Qualitätsevaluation der Therapiegruppen. Ziel Evaluation der Durchführbarkeit der Fitness-Assessments, indem Physiotherapeut*innen (PT) und Gruppenteilnehmende mit axSpA (TNaxSpA) Akzeptanz, Praktikabilität und Integration beurteilen. Methode Machbarkeitsstudie in 4 Pilottherapiegruppen. PT führten die Assessmentbatterie, bestehend aus a) Chester Step Test (CST) für die aerobe Fitness, b) modifizierter Rumpfkrafttest für die Rumpfkraft, c) Bath Ankylosing Spondylitis Metrology Index (BASMI) für die Beweglichkeit der Wirbelsäule und d) Single Leg Stance Test (SLST) für das Gleichgewicht, mit den TNaxSpA durch. Anschließend bewerteten die PT und TNaxSpA mittels Fragebögen die Akzeptanz, Durchführbarkeit und Integration. Die Durchführbarkeit der Bewertungen wurde anhand von 3 Stufen (I–III) definiert: Bei einer positiven Bewertung von > 80 % (Stufe I) wurde eine bestimmte Bewertung als geeignet angesehen, bei einer positiven Bewertung von 50–80 % (Stufe II) waren Anpassungen erforderlich, bei einer positiven Bewertung von Ergebnisse Der BASMI wurde von TNaxSpA und PT mit Stufe I bewertet, es waren keine Anpassungen erforderlich. Der CST, SLST und modifizierte Rumpfkrafttest wurden von TNaxSpA mit Stufe I und von PT mit Stufe II bewertet, notwendige Anpassungen wurden entsprechend definiert. Schlussfolgerung Aus Sicht der Patient*innen wurde die Durchführbarkeit der Tests in Bezug auf Akzeptanz, Durchführbarkeit und Integration positiv bewertet. Aus Sicht der PT waren einige Personen mit axSpA einsetzbar. Auf diese Weise kann der individuelle Fitnesszustand evaluiert und die Interventionen angepasst werden, sodass die Qualität der Gruppenübungstherapie kontinuierlich evaluiert und gegebenenfalls verbessert werden kann.

People living with axial Spondyloarthrtis (axSpA) have an increased risk of cardiovascular diseases, which can be reduced by regular physical activity (PA) and its subset of cardiorespiratory training (CRT). To fulfil their crucial role in PA promotion, physiotherapists and other health professionals need to understand the beliefs that people living with axSpA possess concerning general PA and CRT. The aim of this study is to explore these behavioural, normative and control beliefs.A qualitative descriptive design approach was chosen. Five semi-structured focus group interviews with 24 individuals living with axSpA were performed. Data was analysed using structured thematic qualitative content analysis.People with axSpA possessed multifaceted behavioural, normative and control beliefs concerning general PA and CRT. Behavioural beliefs revealed a positive attitude towards general PA, with participants mentioning numerous physical, psychological, and social benefits and only few risks. However, the conceptual difference between general PA and CRT, and the relevance of CRT, was unclear to some participants. Normative beliefs were expressed as the beliefs of significant others that influenced their motivation to comply with such beliefs, e.g. spouses, other people living with axSpA, rheumatologists. Regarding control beliefs, general PA and CRT were both mentioned as effective self-management strategies to control the disease. From experience, a high level of self-discipline, as well as technology, were shown to be useful.General PA is understood to be an important self-management strategy for people with axSpA and most participants build general PA into their daily routines. They believe that general PA beneficially impacts personal health and wellbeing. However, some participants are unaware of the difference between general PA and CRT and the important impact that this difference could have on their health. The consequences of CRT promotion for people living with axSpA should be the subject of further research.

Objectives: The aim of this study was to assess the applicability of six OARSI (Osteoarthritis Research Society International) approved exercise and education programmes for the conservative management of knee osteoarthritis to the Swiss health care system.Methods: The RE-AIM framework was used in this cross-sectional survey study to analyse the characteristics of the six exercise and education programmes. A survey was developed based on the RE-AIM dimensions, “Reach, Effectiveness, Adoption, Implementation, and Maintenance,” for rating the applicability of the programmes (on a scale of 1 = “least applicable” to 10 = “most applicable”). Programme scores of ≥7 indicated applicability to the Swiss health care system. Nine selected physiotherapy experts for knee OA management in Switzerland were invited for the rating.Results: The six programmes were rated by six of the nine invited research experts with mean scores of between 5.9 and 9.45. Four programmes scored 7 or more. These four programmes all included supervised exercise sessions and education with the goal that the participants understand the diagnosis and the management of OA. The two lower rated programmes focused on exercise counselling or weight reduction.Conclusion: The programme with the highest scores consists of exercise and education and scored higher than 7 in all RE-AIM dimensions. Therefore, this programme is most applicable to the Swiss health care system as only a few adaptations would be needed for its successful implementation.

Regular physical activity is beneficial for people with rheumatic diseases and one of the cornerstones in its management. Based on the international recommendations of the World Health Organization for the general population, the "2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis" provide evidence-based recommendations on the prescription, performance, and implementation of physical activity exercises in this population for the first time.Translation of the 2018 EULAR recommendations into German and linguistic validation in Germany, Austria and Switzerland.A professional translation of the EULAR recommendations into the German language was performed and revised by German-speaking experts from all three countries. The translation was validated by healthcare professionals consisting of rheumatologists, occupational therapists, physiotherapists, nurses, and medical assistants in a field test. In each of the three countries, eight structured interviews were conducted on comprehensibility, wording, completeness, and feasibility. The experts then discussed changes until consensus was reached and indicated the level of agreement with the final translation.The translation of the EULAR recommendations was substantially revised. Based on the results of the cognitive test, formulations were adapted in order to increase comprehensibility. The level of agreement between 10 (SD 0.0) and 8.9 (SD 1.5) was very high.The final German version of the EULAR recommendations is comprehensible and accepted across all three German-speaking countries. It can help to improve the structure and clarity of the handling of physical activity and promote physical activity for healthcare providers and patients.HINTERGRUND: Regelmäßige Bewegung und spezifisches Training sind wichtige Bausteine in der Therapie rheumatischer Erkrankungen, weil ein gesundheitlicher Nutzen für die Patient*innen nachgewiesen ist. Basierend auf den internationalen Empfehlungen der WHO für Gesunde, geben die „2018 EULAR Empfehlungen zu körperlicher Aktivität von Menschen mit entzündlich-rheumatischen und degenerativen Erkrankungen“ erstmals evidenzbasierte Empfehlungen zu Gestaltung, Durchführung und Implementierung von Bewegungsübungen bei diesen Patient*innen. ZIEL: Übersetzung ins Deutsche und sprachliche Validierung in Deutschland, Österreich und der Schweiz.Eine professionelle Übersetzung der EULAR Bewegungsempfehlungen ins Deutsche wurde durch deutschsprachige Experten*innen aus allen 3 Ländern überarbeitet. Die Validierung erfolgte in einem Feldtest mit Rheumatolog*innen, Ergo- und Physiotherapeut*innen, Pflegefachpersonen und medizinischen Fachangestellten aus der Rheumatologie. In den 3 Ländern wurden jeweils 8 strukturierte Interviews zu Verständlichkeit, Wortwahl, Vollständigkeit und Umsetzbarkeit durchgeführt. Die Experten*innen diskutierten die Änderungsvorschläge, bis jeweils ein Konsens erreicht wurde. Zuletzt gaben sie den Grad ihrer Zustimmung zu der finalen Übersetzungsversion an.Die professionelle Übersetzung wurde substanziell überarbeitet. Aufgrund der Ergebnisse der Feldtests wurden verschiedene Änderungen einzelner Worte sowie Umformulierungen zur besseren Verständlichkeit vorgenommen. Der Grad der Zustimmung lag mit durchschnittlichen Bewertungen zwischen 10 (SD 0,0) und 8,9 (SD 1,5) insgesamt sehr hoch.Die vorliegende sprachlich validierte deutschsprachige Version der 2018 EULAR Bewegungsempfehlungen kann und soll dazu beitragen, Fachpersonal darin zu unterstützen, körperliche Aktivität bei Menschen mit entzündlich-rheumatischen und degenerativen Erkrankungen zu fördern.

Background The Swiss containment strategy for the COVID-19 pandemic during the first wave in spring 2020 resulted in a moratorium on non-urgent physiotherapy via regular direct patient contact. Consequently, such physiotherapy sessions declined by 84%. This study investigates the impact of this moratorium on the use of digital remote physiotherapy in Switzerland during this period and the perceptions of its use by Swiss physiotherapists (PTs). Methods A cross-sectional online questionnaire was distributed between June and August of 2020 via the Swiss Physiotherapy Association (physioswiss) and various associations of physiotherapy specialists (e.g., sport, pediatric) working in both inpatient and outpatient settings. The questionnaire was designed to capture the demographics of participants and the perceptions of PTs using 33 questions in the following domains: Demography; Attitudes towards digital technology; Private and professional use of digital technology; Use of digital technology during therapy; and, Support requirements. Closed and open-ended questions were included and the frequency of answers was analyzed. Non-parametric inferential statistics were used to identify differences, where appropriate. The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) was adopted. Results Participants in the survey were 742 PTs (23.5% male, mean age of 43 years, mean working experience of 18 years) from the German-speaking (75.5%), French-speaking (15.1%), and Italian-speaking (9.4%) regions of Switzerland. The percentage of PTs using digital remote therapy increased from 4.9% prior to the lockdown to 44.6% during the lockdown period. The majority of PTs did not consider that digital remote therapy could complement usual physiotherapy practice and did not plan to continue with digital remote therapy after the pandemic. Conclusions During the lockdown, Swiss PTs adopted various low-cost and easily accessible digital technologies. However, several barriers hampered further implementation of this modality. Specific education and training programs need to be provided among PTs, appropriate digital technologies should be introduced, and a correct reimbursement scheme should be developed. Trial registration COVIDPhysio Registry of World Physiotherapy, registered 15th June 2020 (https://world.physio/covid-19-information-hub/covid-19-covidphysio-registry).

Gesetze, Verträge mit den Krankenkassen und insbesondere das physiotherapeutische Berufsethos schreiben vor, dass jeder Patientenkontakt (Anamnese, Diagnose, Untersuchung, Untersuchungsergebnis, Befund, Therapie, Wirkung, Aufklärung, Einwilligung und Therapiebericht) elektronisch oder in Papierform dokumentiert und 10 Jahre lang aufbewahrt werden muss. „World Physiotherapy“ und verschiedene nationale Berufsverbände (z. B. USA, England) haben hierzu Leitlinien veröffentlicht. Auch der Deutsche Verband für Physiotherapie (ZVK), physioaustria und physioswiss erwähnen die „Dokumentation“ in ihren Professionsbeschreibungen.

Objectives To adapt the core strength endurance test battery (aCSE), previously used for testing athletes, to a target group of patients with axial spondylarthritis (axSpA), to evaluate its intra-tester reliability and its associations with disease-specific factors. Methods A cross-sectional study was conducted at axSpA exercise therapy groups, including both axSpA patients and the physiotherapist group leaders (PTs). The aCSE was used to measure the isometric strength endurance of the ventral, lateral, and dorsal core muscle chains (measured in seconds), as well as to assess the disease-specific factors of functional status, self-reported pain, and perceived strength performance. The aCSE was repeated after 7–14 days to measure intra-tester reliability for the same rater (PT group leader). Reliability was calculated as an intra-class correlation coefficient (ICC) using a nested design. The associations between ventral, lateral, and dorsal strength endurance and the disease-specific factors were calculated using Pearson correlation coefficients. Results Study participants were 13 PT group leaders and 62 axSpA patients. The latter were all capable of performing the aCSE, with the exception of one individual. A moderate to substantial intra-rater reliability (ICCs (95%CI)) was found for the ventral (0.54 (0.35, 0.74)), lateral (0.52 (0.33, 0.70)), and dorsal (0.71 (0.58, 0.86)) core muscle chains. None of the aCSE measures correlated with the disease-specific factors. Conclusion The aCSE was found to be a reliable test battery for assessing core strength endurance in axSpA patients. Interestingly, aCSE performance was not associated with any disease-specific factors. Key Points • The adapted core strength endurance test battery measures the isometric strength of the ventral, lateral and dorsal core muscle chains. • The adapted core strength endurance test battery showed a moderate to substantial intra-rater reliability for all three muscle chains tested in axSpA patients. • No correlations were found between the adapted core strength endurance test battery and the disease-specific factors of self-reported pain, functional status and perceived strength performance.

Objectives Physiotherapy is recommended in the management of people with axial Spondyloarthritis (axSpA), with new insights into its preferred content and dosage evolving. This study aimed to describe the use and preferences regarding individual and group physiotherapy among people with axSpA. Methods A cross-sectional survey was conducted among people with axSpA living in the Netherlands (NL) and Switzerland (CH). Results 713 people with axSpA participated (56.7% male, median age 55 years, median ASAS-Hi-score 4.2). Response rates were 45% (n = 206) in NL and 29% in CH (n = 507). 83.3% of participants were or had been using physiotherapy. Individual therapy only was or had been used by 36.7%, a combination of individual plus land- and water-based group therapy was or had been used by 29.1% and group therapy only by 5.3%. Only less than half participants attending individual therapy reported active therapy (like aerobic, muscle strength, flexibility exercises). Although the majority (75.9%) was not aware of the increased cardiovascular risk, participants showed an interest in cardiovascular training, either individually or in a supervised setting. If supervised, a majority, in CH (75.0%) more than in NL (55.7%), prefers supervision by a specialized physiotherapist. Conclusion The majority of people with axSpA uses or used physiotherapy, more often in an individual than in a group setting. The content of individual therapy should be more active; in both therapy settings aerobic exercises should be promoted. Especially, enabling people with axSpA to perform exercises independently would meet their needs and might enhance their daily physical activity.

Background The Ankylosing Spondylitis Association of Switzerland (SVMB) offers 68 exercise groups (EG) for people with axial Spondyloarthritis (axSpA). Participants exercise weekly with focus on strength and flexibility supervised by a physiotherapist (PT). Given the EULAR physical activity (PA) recommendations [1] and recent research [2, 3], the SVMB aims to further develop the concept of their EG by introducing: a) exercises in all dimensions, cardiorespiratory fitness, muscle strength, flexibility and neuromotor performance, according to the general PA recommendations [4]; b) individual exercise-coaching (three sessions in first six months) by the group PT, specifically trained in communication and action planning skills to support individual exercising, and c) bi-annual fitness-assessments for all exercise dimensions. Objectives To evaluate the new EG concept among the participating people with axSpA and PTs across four pilot groups. Methods After six months, a survey on the perception and satisfaction towards the new EG concept was sent to 30 people with axSpA, who rated the questions on a 0-10 numeric rating scale (0=not satisfied, 10=very satisfied). Semi-structured telephone-interviews were conducted with the PTs to explore their experiences with the new GE concept. Results People with axSpA: The survey’s response rate was 83% (25/30); of these, 15 (62%) participants were satisfied with the concept (mean 6.7±2.23) and 20 (80%) with the exercise-coaching (mean 7.7±2.92). 22 (88%) individuals defined a training goal and 15 (60%) achieved it. The exercise diary was used by 16 (64%) participants, five reported app-based. Reasons for not using the diary were the daily effort and problems with correctly allocating activities to exercise dimensions. A minority (n=7, 28%) reported to use a technical device for cardiovascular exercising. 17 (68%) were satisfied with the fitness-assessment (mean 7.5±1.78). PTs perceived the exercise-coaching as very useful for supporting individualised exercising. However, they emphasised that the frequency of the sessions should be flexibly based on the participant’s individual training goal and motivation. The PTs perceived controversial reactions to the fitness-assessments: increased but also decreased motivation towards exercising. Conclusion Exercise-coaching and fitness-assessments were generally appreciated; however, the frequency was perceived as too high. The GE concept will be adapted accordingly to improve feasibility for national implementation: the exercise-coachings will be reduced to two in the first six months, the first one compulsory for all participants, then bi-annually, according to individual needs and training goals. The fitness-assessments will take place annually instead of bi-annually. There is a need for easy-to-use exercise diaries, covering all exercise dimensions. References [1] Rausch AK, et al. Ann Rheum Dis2018; 9(77):1251-1260. [2] Sveaas SH, et al. Br J Sports Med2017;51:1065-1072 [3] Rausch AK, et al. RMD open, accepted [4] Garber CE, et al. Med Sci Sports Exerc2011;43:1334–59. Disclosure of Interests None declared

Background Public health recommendations for physical activity (PA) advice that exercise programs include all four fitness dimensions, i.e. cardiorespiratory, muscle strength, flexibility and neuromotor exercise training at well-defined frequency, intensity and duration/repetitions, and regular evaluations (1). The 2018 EULAR recommendations for PA (2) state that this is also effective, feasible and safe for people with rheumatic diseases. Therefore, the Ankylosing Spondylitis Association of Switzerland (SVMB) has started to implement assessments of all four fitness dimensions in their exercise groups (n=68). Criteria for selection of an assessment were its psychometric properties and feasibility for group setting, i.e. low costs and material requirements: Chester step test (CST) for cardiorespiratory fitness (3); adapted Core Strength Endurance test battery (CSE) for muscle strength (4); Bath AS Metrology Index (BASMI) for flexibility (5); Single-Leg-Stance test (SLS) for balance (as proxy for neuromotor activities) (6). For all assessments, except CSE, norm values for healthy people are available. Objectives To assess the fitness status of people with axSpA across four volunteering pilot groups and evaluate if between-subject variables of interest are associated with fitness status. Methods Participants were assessed at baseline and after 6 months on all four fitness dimensions. For each dimension, a linear mixed model with random intercept was fitted to the data with the within-subject variables time and measurement condition and the between-subject variables age, disease duration, disease activity (Bath AS Disease Activity Index, BASDAI) and PA level (weekly Metabolic Equivalent of Task MET) as explanatory variables. Results Of 30 patients assessed, 10 (33%) were women, mean age was 58.8 (SD 9.68) years, mean disease duration was 32.6 (SD 9.68) years, mean disease activity was 3.1. (SD 2.36) and mean PA per week was 5013 (SD 3479.77) METs. Mean estimated VO2max for cardiorespiratory fitness was 35.2 (SD 6.59). Disease activity was negatively (slope=-1.49, p=0.01) and PA level positively (slope=3.28, p=0.01) associated with cardiorespiratory fitness. Mean core muscle strength endurance was 78.8 (SD 51.98) seconds. PA level was positively associated with core muscle strength (slope= 8.62, p=0.05). Mean flexibility score was 3.1 (SD 2.36), with age being positively associated with flexibility (slope=0.100, p=0.04). Mean balance was 43.1 (SD 21.09) and 7.7 (SD 5.84) seconds with open and closed eyes respectively. Age was negatively associated with balance (slope = -0.84 (p=0.00). Conclusion The SVMB has made an important step by implementing regular fitness evaluations in their axSpA exercise groups. The test scores of the assessed people with axSpA were lower than in healthy people but within the norms. PA level was positively associated with cardiorespiratory fitness and core muscle strength. Disease duration and disease activity were negatively associated with cardiorespiratory fitness only, but not with the other fitness dimensions, which may be different from what is usually assumed. References [1] Garber CE, et al. MedSciSportsExerc 2011;43:1334–59. [2] Rausch AK, et al. AnnRheumDis 2018; 9(77): 1251-1260. [3] Buckley JP. B J Sports Med, 2004;38(2);197-205 [4] Rausch AK, et al. Intra-rater reliability and construct validity of a core strength-endurance test battery in people with axial Spondyloarthritis (manuscript in preparation) [5] Jenkinson TR. 1994;21(9):1694-8. Epub 1994/09/01 [6] Springer BA. J Ger Phys Ther. 2007;30(1);8-15 Disclosure of Interests Karin Niedermann Speakers bureau: Novartis, Anne-Kathrin Rausch: None declared, Andre Meichtry: None declared, Beatrice Walker: None declared, Rene Braem: None declared, Adrian Ciurea Consultant for: AbbVie, Celgene, Janssen-Cilag, MSD, Eli Lilly, Novartis, Pfizer, UCB, Speakers bureau: Abbvie, Celgene, Janssen-Cilag, MSD, Eli Lilly, Novartis, Pfizer, UCB

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Objective: Regular physical activity (PA) is increasingly promoted for people with rheumatic and musculoskeletal diseases as well as the general population. We evaluated if the public health recommendations for PA are applicable for people with inflammatory arthritis (iA; Rheumatoid Arthritis and Spondyloarthritis) and osteoarthritis (hip/knee OA) in order to develop evidence-based recommendations for advice and guidance on PA in clinical practice. Methods: The EULAR standardised operating procedures for the development of recommendations were followed. A task force (TF) (including rheumatologists, other medical specialists and physicians, health professionals, patient-representatives, methodologists) from 16 countries met twice. In the first TF meeting, 13 research questions to support a systematic literature review (SLR) were identified and defined. In the second meeting, the SLR evidence was presented and discussed before the recommendations, research agenda and education agenda were formulated. Results: The TF developed and agreed on four overarching principles and ten recommendations for PA in people with iA and OA. The mean level of agreement between the TF members ranged between 9.8 to 8.8. Given the evidence for its effectiveness, feasibility and safety, PA is advocated as integral part of standard care throughout the course of these diseases. Finally, the TF agreed on related research and education agendas. Conclusion: Evidence and expert opinion inform these recommendations to provide guidance in the development, conduct and evaluation of PA-interventions and promotion in people with iA and OA. It is advised that these recommendations should be implemented considering individual needs and national health systems.

ObjectiveTo evaluate the effectiveness of exercise and physical activity (PA) promotion on cardiovascular fitness, muscle strength, flexibility, neuromotor performance (eg, balance) and daily PA in people with rheumatoid arthritis (RA), spondyloarthritis (SpA) and hip/knee osteoarthritis (HOA/KOA).Methodssystematic review (SR) and meta-analysis (MA) were performed searching the databases PubMed/Medline, CENTRAL, Embase, Web of Science, Emcare and PsycInfo until April 2017. We included randomised controlled trials (RCTs) in adults (≥18 years) with RA, SpA and HOA/KOA, investigating the effects of exercise or PA promotion according to the public health PA recommendations by the American College of Sports Medicine. The time point of interest was the first assessment after the intervention period. If suitable, data were pooled in a MA using a random-effects model presented as standardised mean difference (SMD).ResultsThe SR included 63 RCTs, of which 49 (3909 people with RA/SpA/HOA/KOA) were included in the MA. Moderate effects were found of aerobic exercises and resistance training on cardiovascular fitness (SMD 0.56 (95% CI 0.38 to 0.75)) and muscle strength (SMD 0.54 (95% CI 0.35 to 0.72)), respectively, but no effect of combined strength/aerobic/flexibility exercises on flexibility (SMD 0.12 (95% CI -0.16 to 0.41)). PA promotion interventions produced a small increase in PA behaviour (SMD 0.21 (95% CI 0.03 to 0.38)).ConclusionExercises and PA promotion according to public health recommendations for PA improved cardiovascular fitness, muscle strength and PA behaviour, with moderate effect sizes in people with SpA, RA and HOA/KOA.Trial registration numberCRD42017082131.

Multicomponent interventions (MCT) combine physical exercises and cognitive training and seem to be most effective in improving cognition in elderly people. However, literature is inconclusive if MCTs are superior to active comparison interventions, if delivery modes matter, and if people can transfer achieved effects to instrumental activities of daily living (IADL). This network meta-analysis aimed to a) identify MCTs that were effective on physical capacity and/or cognitive function and able to transfer these effects into IADL in elderly people with normal cognition (NC) and mild cognitive impairment (MCI); b) provide a rating on the best interventions per outcome; c) evaluate MCTs’ mode of delivery. Eligible studies were randomized controlled trials comparing MCTs to active comparison or no treatments. Six studies in participants with MCI (n = 1088) and eleven studies in participants with NC (n = 670) were included. Five effective MCTs that were superior to physical exercises or cognitive training alone in improving physical capacity and/or cognitive function were detected, however none of these MCTs improved IADL. In people with NC MCTs performed separately or simultaneously were effective. However, in people with MCI MCTs performed separately were more effective. A framework needs to be developed to better understand the mediating effects of physical capacity and cognitive function on IADL and to design MCTs that effectively improve IADL.

Study design Systematic review and meta-analysis. Objective To evaluate if patients with nonspecific chronic low back pain (NSCLBP) show a greater lumbar reposition error (RE) than healthy controls. Summary of background data Studies on lumbar RE in patients with NSCLBP present conflicting results. Methods A systematic review and meta-analysis of the available literature were performed to evaluate differences in RE between patients with NSCLBP and healthy controls. Data on absolute error, constant error (CE), and variable error were extracted and effect sizes (ESs) were calculated. For the CE flexion pattern and active extension pattern, subgroups of patients with NSCLBP were analyzed. Results of homogeneous studies were pooled. Measurement protocols and study outcomes were compared. The quality of reporting and the authors' appraisal of risk of bias were investigated. Results The original search revealed 178 records of which 13 fulfilled the inclusion criteria. The majority of studies showed that patients with NSCLBP produced a significantly larger absolute error (ES, 0.81; 95% confidence interval [95% CI], 0.13-1.49) and variable error (ES, 0.57; 95% CI, 0.05-1.09) compared with controls. CE is direction specific in flexion and active extension pattern subgroups of patients with NSCLBP (ES, 0.39; 95% CI, -1.09 to 0.3) and ES, 0.18; 95% CI, -0.3 to 0.65, respectively). The quality of reporting and the authors' appraisal of risk of bias varied considerably. The applied test procedures and instrumentation varied between the studies, which hampered the comparability of studies. Conclusion Although patients with NSCLBP seemed to produce a larger lumbar RE compared with healthy controls, study limitations render firm conclusions unsafe. Future studies should pay closer attention to power, precision, and reliability of the measurement approach, definition of outcome measures, and patient selection. We recommend a large, well-powered, prospective randomized control study that uses a standardized measurement approach and definitions for absolute error, CE, and variable error to address the hypothesis that proprioception may be impaired with CLBP.

Specific exercises for the improvement of movement control of the lumbopelvic region are well-established for patients with non-specific low back pain (NSLBP) and movement control impairment (MCI). However, a lack of adherence to home exercise regimens is often observed. The aim of the study was to explore the differences in home exercise (HE) adherence between patients who perform conventional exercises and those who exercise with Augmented Feedback (AF). Twenty patients with NSLBP and MCI were randomly allocated into two groups. The physiotherapy group (PT group) completed conventional exercises, and the AF group exercised with an AF system that was designed for use in therapy settings. The main outcome measure was self-reported adherence to the home exercise regimen. There was no significant difference in HE duration between the groups (W = 64, p = 0.315). The AF group exercised for a median of 9 min and 4 s (IQR = 3'59"), and the PT group exercised for 4 min and 19 s (IQR = 8'30"). Exercising with AF led to HE times that were similar to those of conventional exercise, and AF might be used as an alternative therapy method for home exercise.

Physical activity promotion in people with Chronic Obstructive Pulmonary Disease (COPD) is focus of research and public health. Patient-centred interventions like counselling are promising approaches to help patients reducing sedentary behaviour. Aim of the present study is to investigate if a physical activity counselling program during pulmonary rehabilitation increases physical activity level in daily life in people with COPD. A two-armed, single blind randomised controlled trial including 56 people with COPD will be conducted in an outpatient pulmonary rehabilitation. Patients will participate in a 12-week-rehabilitation program; individuals randomized to the interventional group will additionally participate in five counselling sessions with a physiotherapist, based on the principles of motivational interviewing. The participants’ physical activity level will be measured using an accelerometer (SenseWear Pro®) before, directly and 3 months after pulmonary rehabilitation. Semi-structured interviews will be conducted to learn more about barriers and facilitators regarding daily physical activity. If the strategy successfully improves the physical activity level in people with COPD, counselling might be implemented in pulmonary rehabilitation. Clinical Trials.gov NCT02455206 (05/21/2015), Swiss National Trails Portal SNCTP000001426 (05/21/2015).

Background Sensory discrimination training (SDT) for people with chronic low back pain (CLBP) is a novel approach based on theories of the cortical reorganization of the neural system. SDT aims to reverse cortical reorganization, which is observed in chronic pain patients. SDT is still a developing therapeutic approach and its effects have not been systematically reviewed. The aim of this systematic review was to evaluate if SDT decreases pain and improves function in people with CLBP. Methods A systematic review was performed on the available literature to evaluate the effects of SDT. Randomised controlled trials compared the effectiveness of SDT on pain and function in people with CLBP with the effectiveness of other physiotherapy interventions, no treatment, or sham therapy. The methodological quality of the included studies and the clinical relevance of reported treatment effects were investigated. Results The original search revealed 42 records of which 6 fulfilled the inclusion criteria. The majority of studies showed that SDT caused statistically significant improvements in pain and function, but only two studies reported clinically relevant improvements. The applied SDT varied considerably with regard to dosage and content. The methodological quality of the included studies also varied, which hampered the comparability of results. Conclusions Although SDT seems to improve pain and function in people with CLBP, study limitations render firm conclusions unsafe. Future studies should pay closer attention to power and sample selection as well as to the content and dosage of the SDT intervention. We recommend a large, well-powered, prospective randomized control study that uses a standardized SDT approach to address the hypothesis that SDT causes clinically relevant improvements in pain and function. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-0997-8) contains supplementary material, which is available to authorized users.

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Neck pain is a common problem in the general population with high risk of ongoing complaints or relapses. Range of motion (ROM) assessment is scientifically established in the clinical process of diagnosis, prognosis and outcome evaluation in neck pain. Anatomically, the cervical spine (CS) has been considered in two regions, the upper and lower CS. Disorders like cervicogenic headache have been clinically associated with dysfunctions of the upper CS (UCS), yet ROM tests and measurements are typically conducted on the whole CS. A cross-sectional study assessing 19 subjects with non-specific neck pain was undertaken to examine UCS extension-flexion ROM in relation to self-reported disability and pain (via the Neck Disability Index (NDI)). Two measurement devices (goniometer and electromagnetic tracking) were employed and compared. Correlations between ROM and the NDI were stronger for the UCS compared to the CS, with the strongest correlation between UCS flexion and the NDI-headache (r = -0.62). Correlations between UCS and CS ROM were fair to moderate, with the strongest correlation between UCS flexion and CS extension ROM (r = -0.49). UCS flexion restriction is related to headache frequency and intensity. Consistency and agreement between both measurement systems and for all tests was high. The results demonstrate that separate UCS ROM assessments for extension and flexion are useful in patients with neck pain.

AGREE (Appraisal of Guidelines for REsearch and Evaluation) ist der internationale Goldstandard zur Beurteilung methodologischer Qualitat bei Entwicklung und Anwendung medizinischer Leitlinien. Die 2. Version wurde jetzt ubersetzt.

Background: The 6-min walk test (6MWT) is representative of daily life activities and reflects the functional capacity of patients with chronic obstructive pulmonary disease (COPD). Information on the cardiopulmonary and gas exchange responses to the 6MWT is limited. Objectives: We aimed to analyze the breath-by-breath cardiopulmonary and gas exchange responses of patients with COPD during the 6MWT. We also investigated the extent to which parameters reflecting cardiopulmonary and gas exchange function are associated with exercise capacity. Methods: The oxygen uptake (VO2) kinetics of patients were obtained using mobile telemetric cardiopulmonary monitoring during a 6MWT. A new mean response time (MRT) index was developed to quantify VO2 on-kinetics by correcting MRT for work rate (wMRT). Multiple linear regression analysis was performed to assess the association between variables reflecting cardiopulmonary and gas exchange function and exercise capacity [6-min walking distance (6MWD) and VO2 at steady state (VO2SS)]. Results: In 72 COPD patients (29 females) with a mean (SD) age of 65 (10) years, FEV1 44 (14) % predicted exercise capacity as assessed by VO2SS (p = 0.003) was significantly reduced across the stages of COPD. The criteria for maximal effort during the 6MWT were fulfilled by 82% of the patients. After adjustment for covariates, wMRT was independently associated with 6MWD (p = 9.7 × 10-5) and VO2SS (p = 5.5 × 10-10). Conclusions: As wMRT mostly depends on the rate of increase of pulmonary blood flow, our results underline the fact that cardiocirculatory function may play a significant role in exercise tolerance in patients with COPD. Our findings imply that modification of cardiocirculatory function may be beneficial in the treatment of COPD patients and improve their outcome more than anticipated previously.

BACKGROUND: Patients with chronic obstructive pulmonary disease have skeletal muscle dysfunction and reduced daily physical activity (PA). Whether the reduction in quadriceps strength (QS) is directly linked to physical inactivity remains to be elucidated. METHODS: A systematic review and a meta-analysis were conducted to determine the potential relationship between QS and the level of PA. The overall estimate of the correlation coefficient (r *) was calculated, and a subgroup analysis was conducted to analyze the association between QS and indices of PA separately. RESULTS: A total of 8 studies were included in the meta-analysis. The overall association between QS and PA was low but highly significant (r * = 0.288, 95% CI = 0.180-0.389; P < .001). In the subgroup analysis, the association between QS and the number of steps per day was low (r = 0.260; 95% CI = 0.060-0.440) and the association between QS and the time spent walking was moderate (r = 0.418; 95% CI = 0.229-0.576). CONCLUSIONS: Peripheral muscle strength is associated with PA as assessed by the number of steps per day and the time spent walking in patients with chronic obstructive pulmonary disease. The overall association between QS and PA was low to moderate and highly significant.