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Präsentation im Symposium "Bewegungsversorgungsforschung meets Sports Medicine: ein Symposium der AG Bewegungsbezogene Versorgungsforschung im DNVF e.V."

Background: Ongoing education of health professionals in rheumatology (HPR) is critical for high-quality care. An essential factor is education readiness and a high quality of educational offerings. We explored which factors contributed to education readiness and investigated currently offered postgraduate education, including the European Alliance of Associations for Rheumatology (EULAR) offerings. Methods and participants: We developed an online questionnaire, translated it into 24 languages and distributed it in 30 European countries. We used natural language processing and the Latent Dirichlet Allocation to analyse the qualitative experiences of the participants as well as descriptive statistics and multiple logistic regression to determine factors influencing postgraduate educational readiness. Reporting followed the Checklist for Reporting Results of Internet E-Surveys guideline. Results: The questionnaire was accessed 3589 times, and 667 complete responses from 34 European countries were recorded. The highest educational needs were ‘professional development’, ‘prevention and lifestyle intervention’. Older age, more working experience in rheumatology and higher education levels were positively associated with higher postgraduate educational readiness. While more than half of the HPR were familiar with EULAR as an association and the respondents reported an increased interest in the content of the educational offerings, the courses and the annual congress were poorly attended due to a lack of awareness, comparatively high costs and language barriers. Conclusions: To promote the uptake of EULAR educational offerings, attention is needed to increase awareness among national organisations, offer accessible participation costs, and address language barriers.

BackgroundOngoing education of health professionals in rheumatology (HPR) is critical for high-quality care. An essential factor is education readiness and a high quality of educational offerings. We explored which factors contributed to education readiness and investigated currently offered postgraduate education, including the European Alliance of Associations for Rheumatology (EULAR) offerings.Methods and participantsWe developed an online questionnaire, translated it into 24 languages and distributed it in 30 European countries. We used natural language processing and the Latent Dirichlet Allocation to analyse the qualitative experiences of the participants as well as descriptive statistics and multiple logistic regression to determine factors influencing postgraduate educational readiness. Reporting followed the Checklist for Reporting Results of Internet E-Surveys guideline.ResultsThe questionnaire was accessed 3589 times, and 667 complete responses from 34 European countries were recorded. The highest educational needs were professional development, prevention and lifestyle intervention. Older age, more working experience in rheumatology and higher education levels were positively associated with higher postgraduate educational readiness. While more than half of the HPR were familiar with EULAR as an association and the respondents reported an increased interest in the content of the educational offerings, the courses and the annual congress were poorly attended due to a lack of awareness, comparatively high costs and language barriers.ConclusionsTo promote the uptake of EULAR educational offerings, attention is needed to increase awareness among national organisations, offer accessible participation costs, and address language barriers.

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.

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.

Introduction: 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. Methods and analysis: 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. Ethics and dissemination: 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 jo

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.

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. 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 indi

Background: Public health recommendations for physical activity (PA) advise that a program of regular exercises include cardiorespiratory, muscle strength, flexibility and neuromotor exercise training at well-defined frequency, intensity and duration/repetitions, and regular evlaution over time (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 for all four fitness dimensions in their exercise groups (n=68). Criteria for selection of an assessment were validity and feasibility for group setting, i.e. low costs and material requirements: Chester step test (CST) (3) for cardiorespiratory fitness; adapted Core Strength Endurance test battery (CSE) (4) for muscle strength; Bath AS Metrology Index (BASMI) (5) for flexibility; Single-Leg-Stance test (SLS) (6) for balance (as proxy for neuromotor activities). 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: A total of 30 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 (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.

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.

Objective: To 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). Methods: systematic 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). Results: The 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)). Conclusion: Exercises 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.

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. 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. The TF developed and agreed on four overarching principles and 10 recommendations for PA in people with iA and OA. The mean level of agreement between the TF members ranged between 9.8 and 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. 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.

Background: 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. Methods: 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. Discussion: If the strategy successfully improves the physical activity level in people with COPD, counselling might be implemented in pulmonary rehabilitation.