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Evidence-Based Practice (EBP) is an approach that has emerged in medical practice. In 2000, Sackett et al. stated the most common definition of the EBP approach: "the integration of the best research evidence with clinical expertise and patient values". Over time, many elements have been added and discussed by various authors to this initial definition (cost and duration of the intervention, therapist skills, regional resources provided for health, cultural influences, …). With evolution of the EBP approach, and these successive additions, we wish to propose a new definition of the EBP in order to bring it a more contemporary and complete face. For that reason, the different objectives of this article are : - to explain why making such a proposal : a new extended definition - to propose a new extended definition - to explain our semantic choices - to propose (and explain) an updated graphic model for the extended definition

Resume La prescription d’activite physique est inscrite en France dans le Code de Sante Publique depuis 2016. Cette pratique vise a encourager et maintenir une activite physique reguliere et adaptee pour les patients en affection longue duree. Le medecin prescripteur realise un bilan prealable afin d’identifier les risques du patient, notamment les risques cardio-vasculaires, ainsi que les besoins en matiere d’activite physique. Le medecin indique sur la prescription les modalites d’activite physique recommandees (aerobie, force musculaire, souplesse…) ainsi que les elements de frequence, d’intensite, de temporalite et le type d’activite recommande. Les elements de peurs et croyances ainsi que la motivation du patient sont aussi renseignes. En fonction de son atteinte fonctionnelle, le patient peut etre adresse a differents professionnels de sante. Le developpement des competences necessaires a la prescription d’activite physique et la coordination interprofessionnelles seront deux enjeux a venir de la promotion d’activite physique pour les patients.

Resume L’enjeu pour les patients atteints de troubles rhumatologiques chroniques n’est pas de realiser une activite physique ponctuelle, mais de maintenir une habitude dans le temps. S’interesser en detail aux elements qui motivent ou freinent la realisation d’activite physique peut permettre d’optimiser les interventions visant a augmenter l’activite de ces patients en proposant des interventions sur-mesure. Des questionnaires ont ete developpes et valides pour standardiser l’evaluation des determinants de l’activite physique chez les patients atteints d’arthrose ou de rhumatismes inflammatoires chroniques. Une fois les determinants les plus impactants identifies, le recours aux techniques de changement comportemental comme l’entretien motivationnel montre des resultats prometteurs chez ces patients.

Although the management of rheumatoid arthritis (RA) has improved in major way over the last decades, this disease still leads to an important burden for patients and society, and there is a need to develop more personalized approaches. Machine learning (ML) methods are more and more used in health-related studies and can be applied to different sorts of data (clinical, radiological, or 'omics' data). Such approaches may improve the management of patients with RA.In this paper, we propose a review regarding ML approaches applied to RA. A scoping literature search was performed in PubMed, in September 2021 using the following MeSH terms: 'arthritis, rheumatoid' and 'machine learning'. Based on this search, the usefulness of ML methods for RA diagnosis, monitoring, and prediction of response to treatment and RA outcomes, is discussed.ML methods have the potential to revolutionize RA-related research and improve disease management and patient care. Nevertheless, these models are not yet ready to contribute fully to rheumatologists' daily practice. Indeed, these methods raise technical, methodological, and ethical issues, which should be addressed properly to allow their implementation. Collaboration between data scientists, clinical researchers, and physicians is therefore required to move this field forward.

Wearable activity trackers are playing an increasingly important role in healthcare. In the field of rheumatic and musculoskeletal diseases (RMDs), various applications are currently possible. This review will present the use of activity trackers to promote physical activity levels in rheumatology, as well as the use of trackers to measure health parameters and detect flares using artificial intelligence. Challenges and limitations of the use of artificial intelligence will be discussed, as well as technical issues when using activity trackers in clinical practice.Tragbare Aktivitätstracker spielen eine immer wichtigere Rolle im Gesundheitswesen. Im Bereich der rheumatischen und muskuloskeletalen Erkrankungen („rheumatic and musculoskeletal diseases“, RMD) sind derzeit verschiedene Anwendungen möglich. In der vorliegenden Übersichtsarbeit werden sowohl der Einsatz von Aktivitätstrackern zur Förderung des körperlichen Aktivitätsniveaus in der Rheumatologie vorgestellt als auch der Einsatz von Trackern zur Messung von Gesundheitsparametern und zur Erkennung von Krankheitsschüben mittels künstlicher Intelligenz. Herausforderungen und Grenzen des Einsatzes von künstlicher Intelligenz werden ebenso diskutiert wie technische Fragen beim Einsatz von Aktivitätstrackern in der klinischen Praxis.

International audience; Background: Functional restoration programs (FRPs) are integrative programs to improve function in chronic low back pain (cLBP). They are costly and time-consuming. The aim was to assess the effectiveness of a condensed FRP (CFRP) for patients with cLBP in professional activity. Methods: Longitudinal 3 months study of patients with cLBP in one tertiary care hospital, participating in a CFRP over 4 separate days. The primary outcome was the Oswestry Disability Index (ODI). Secondary outcomes included pain, quality of life (EQ5D), patient acceptable symptom state, presenteeism, absenteeism and psychological distress. Outcomes were compared using paired sample Student's t-test or Chi2 between baseline and last follow-up. Logistic regression was used to identify factors associated with better response (improvement of ODI higher than 12.8). Results: In all, 193 patients were analysed, mean age 44.6 (standard deviation (SD) 10.4) years, mean cLBP duration 9.0 (SD 8.8) years. A small improvement was observed for ODI (mean difference-5.9, 95% confidence interval:-7.6,-4.1), as well as most other outcomes. Multivariate analysis showed an association between ODI improvement and higher duration of low back pain (odds ratio for 5 years: 1.41 (1.06,1.88)) and lower baseline back strength (Sorensen, odds ratio for 1 minute: 0.54 (0.29,0.99)). Conclusion: this CFRP showed small effect to improve function, pain and other quality of life, in cLBP. Four-day programs may be an interesting option in cLBP patients still in professional activity for whom a long 1-month FRP is difficultly manageable. Further studies with randomized controlled designs are needed to confirm the benefits.

BackgroundBarriers and facilitators to physical activity in inflammatory arthritis can be assessed through the Inflammatory arthritis Facilitators and barriers questionnaire (IFAB) questionnaire. The objective was to measure the correlation between IFAB and self-reported physical activity levels.MethodsThis was an international, multicentric, cross-sectional study in 2019-20 (NCT04426747). Consecutive spondyloarthritis (axSpA), rheumatoid arthritis (RA) or psoriatic arthritis (PsA) patients completed the 10-item IFAB, ranging − 70 to 70 with lower scores indicating more barriers. Physical activity was measured by the IPAQ-S questionnaire, steps per day collected by smartphone, and psychological readiness to change by stages of behavior change. Spearman correlations and multivariable linear regression were calculated.ResultsOf 245 patients included, 150 were analysed: 69 (46%) axSpA, 63 (42%) RA, 18 (12%) PsA. Mean age was 48.6 years (standard deviation, SD 17.1), mean disease duration 11.7 (10.1) years and 60% were women. Barriers to physical activity were moderate: mean IFAB, 6 (SD 19.2); 39 (26%) patients scored less than − 5, corresponding to significant barriers. The mean physical activity was 2837 (SD 2668, median 1784) MET-minutes per week. Physical activity was correlated with the IFAB (rho 0.28, p

Background Barriers and facilitators to physical activity in inflammatory arthritis can be assessed through the Inflammatory arthritis FAcilitators and Barriers (IFAB) questionnaire. The objective was to measure the correlation between IFAB and self-reported physical activity levels. Methods This was an international, multicentric, cross-sectional study in 2019–20. Consecutive spondyloarthritis (axSpA), rheumatoid arthritis (RA) or psoriatic arthritis (PsA) patients completed the 10-item IFAB, which ranges from − 70 to 70 with lower scores indicating more barriers. Physical activity was measured by the IPAQ-S questionnaire, steps per day collected by smartphone, and psychological readiness to change by stages of behaviour change. Spearman correlations and multivariable linear regression were calculated. Results Of 245 patients included, 150 were analysed: 69 (46%) axSpA, 63 (42%) RA, 18 (12%) PsA. Mean age was 48.6 years (standard deviation, SD 17.1), mean disease duration 11.7 (10.1) years and 60% were women. Barriers to physical activity were moderate: mean IFAB, 6 (SD 19.2); 39 (26%) patients scored less than − 5, corresponding to significant barriers. The mean physical activity was 2837 (SD 2668, median 1784) MET-minutes per week. The IPAQ-S questionnaire was correlated with the IFAB (rho 0.28, p p Conclusion Perceived barriers and facilitators to physical activity were correlated with physical activity, indicating that targeting patients with high barriers and low facilitators to physical activity could be an effective option to improve physical activity levels. Trial registration ClinicalTrial NCT04426747. Registered 11 June 2020 - Retrospectively registered.

International audience

Objectives: The objective was to develop and validate a self-administered questionnaire to identify in people with Inflammatory arthritis (IA) Facilitators And Barriers to Physical activity (PA): the IFAB questionnaire. Methods: The development of the questionnaire included a systematic review of barriers and facilitators to PA to identify key themes, face validity assessment by 11 experts and cognitive debriefing with 14 patients. The psychometric properties of the questionnaire were assessed by convergent validity (Spearman correlation) against the modified Health Assessment Questionnaire (mHAQ), the Fear-Avoidance Beliefs Questionnaire subscale for PA and the Tampa Scale for Kinesiophobia, internal consistency (Cronbach α) in 63 IA patients with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA). Reliability and feasibility were assessed in 32 IA patients. Results: The questionnaire comprises 10 items: 4 assessing either barriers or facilitators, 3 assessing barriers and 3 assessing facilitators. The items are related to: psychological status (N=6), social support (N=2), disease (N=1), environmental factors (N=1). In the validation study of 63 patients: 26 RA, 24 axSpA, 13 PsA; mean age 52.8 (standard deviation 16.5) years, mean disease duration 12.5 (12.3) years, 53% women. The questionnaire was correlated (r=0.24) with mHAQ. Internal consistency (Cronbach α 0.69) and reliability (interclass coefficient 0.79 [95% confidence interval 0.59; 0.88]) were satisfactory, as was feasibility (missing data 12%, mean completion time Conclusion: The questionnaire allows the assessment of barriers and facilitators to PA in patients with IA. This questionnaire may guide targeted interventions to increase levels of PA in these patients.

International audience; To develop and validate a self-administered questionnaire to identify in people with Inflammatory arthritis (IA) Facilitators And Barriers to Physical activity (PA): the IFAB questionnaire. The development of the questionnaire included a systematic review of barriers and facilitators to PA to identify key themes, face validity assessment by 11 experts, and cognitive debriefing with 14 patients. The psychometric properties of the questionnaire were assessed by convergent validity (Spearman correlation) against the modified Health Assessment Questionnaire (mHAQ), the Fear-Avoidance Beliefs Questionnaire subscale for PA and the Tampa Scale for Kinesiophobia, internal consistency (Cronbach α) in 63 IA patients with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA). Reliability and feasibility were assessed in 32 IA patients. The questionnaire comprises 10 items: 4 assessing either barriers or facilitators, 3 assessing barriers, and 3 assessing facilitators. The items are related to psychological status (N = 6), social support (N = 2), disease (N = 1), environmental factors (N = 1). The validation study included 63 patients: 26 RA, 24 axSpA, 13 PsA; with mean age 52.8 (standard deviation 16.5) years, mean disease duration 12.5 (12.3) years, and 53% of women. The questionnaire was correlated (rho = 0.24) with mHAQ. Internal consistency (Cronbach α 0.69) and reliability (interclass coefficient 0.79 [95% confidence interval 0.59; 0.88]) were satisfactory, as was feasibility (missing data 12%, mean completion time < 5 min). The questionnaire allows the assessment of barriers and facilitators to PA in patients with IA. This questionnaire may guide targeted interventions to increase levels of PA in these patients.

BACKGROUND: Exercise programmes are often recommended for managing ankylosing spondylitis (AS), to reduce pain and improve or maintain functional capacity. OBJECTIVES: To assess the benefits and harms of exercise programmes for people with AS. SEARCH METHODS: We searched CENTRAL, the Cochrane Library, MEDLINE Ovid, EMBASE Ovid, CINAHL EBSCO, PEDro, Scopus, and two trials registers to December 2018. We searched reference lists of identified systematic reviews and included studies, handsearched recent relevant conference proceedings, and contacted experts in the field. SELECTION CRITERIA: We included reports of randomised controlled trials (RCT) of adults with AS that compared exercise therapy programmes with an inactive control (no intervention, waiting list) or usual care. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology. MAIN RESULTS: We included 14 RCTs with 1579 participants with AS. Most participants were male (70%), the median age was 45 years (range 39 to 47), and the mean symptom duration was nine years. The most frequently used exercises were those designed to help improve strength, flexibility, stretching, and breathing. Most exercise programmes were delivered along with drug therapy or a biological agent. We judged most of the studies at unclear or high risk of bias for several domains. All 14 studies provided data obtained immediately upon completion of the exercise programme. The median exercise programme duration was 12 weeks (interquartile range (IQR) 8 to 16). Three studies (146 participants) provided data for medium‐term follow‐up (< 24 weeks after completion of the exercise programmes), and one (63 participants) for long‐term follow‐up (> 24 weeks after completion of the exercise programmes). Nine studies compared exercise programmes to no intervention; five studies compared them to usual care (including physiotherapy, medication, or self‐management). Exercise programmes versus no intervention All data were obtained immediately upon completion of the exercise programme. For physical function, measured by a self‐reporting questionnaire (the Bath Ankylosing Spondylitis Functional Index (BASFI) scale, 0 to 10; lower is better), moderate‐quality evidence showed a no important clinically meaningful improvement with exercise programmes (mean difference (MD) ‐1.3, 95% confidence interval (CI) ‐1.7 to ‐0.9; 7 studies, 312 participants; absolute reduction 13%, 95% CI 17% to 9%). For pain, measured on a visual analogue scale (VAS, 0 to 10, lower is better), low‐quality evidence showed an important clinically meaningful reduction of pain with exercise (MD ‐2.1, 95% CI ‐3.6 to ‐0.6; 6 studies, 288 participants; absolute reduction 21%, 95% CI 36% to 6%). For patient global assessment of disease activity, measured by a self‐reporting questionnaire (the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scale, 0 to 10, lower is better), moderate‐quality evidence showed no important clinically meaningful reduction with exercise (MD ‐0.9, 95% CI ‐1.3 to ‐0.5; 6 studies, 262 participants; absolute reduction 9%, 95% CI 13% to 5%). For spinal mobility, measured by a self‐reporting questionnaire (the Bath Ankylosing Spondylitis Metrology Index (BASMI) scale, 0 to 10, lower is better), very low‐quality evidence showed an improvement with exercise (MD ‐0.7 95%, ‐1.3 to ‐0.1; 5 studies, 232 participants) with no important clinical meaningful benefit (absolute reduction 7%, 95% CI 13% to 1%). For fatigue, measured on a VAS (0 to 10, lower is better), very low‐quality evidence showed a no important clinically meaningful reduction with exercise (MD ‐1.4, 95% CI ‐2.7 to ‐0.1; 2 studies, 72 participants; absolute reduction 14%, 95% CI 27% to 1%). Exercise programmes versus usual care All data were obtained immediately upon completion of the exercise programme. For physical function, measured by the BASFI scale, moderate‐quality evidence showed an improvement with exercise (MD ‐0.4, 95% CI ‐0.6 to ‐0.2; 5 studies, 1068 participants). There was no important clinical meaningful benefit (absolute reduction 4%, 95% CI 6% to 2%). For pain, measured on a VAS (0 to 10, lower is better), moderate‐quality evidence showed a reduction of pain with exercise (MD ‐0.5, 95% CI ‐0.9 to ‐0.1; 2 studies, 911 participants; absolute reduction 5%, 95% CI 9% to 1%). No important clinical meaningful benefit was found. For patient global assessment of disease activity, measured by the BASDAI scale, low‐quality evidence showed a reduction with exercise (MD ‐0.7, 95% CI ‐1.3 to ‐0.1; 5 studies, 1068 participants), but it was not clinically important (absolute reduction 7%, 95% CI 13% to 1%) with important clinical meaningful benefit For spinal mobility, measured by the BASMI scale, very low‐quality evidence found a no important clinically meaningful improvement with exercise (MD ‐1.2, 95% CI ‐2.8 to 0.5; 2 studies, 85 participants; absolute reduction 12%, 95% CI 5% less to 28% more). There was no important clinical meaningful benefit. None of the studies measured fatigue. Adverse effects We found very low‐quality evidence of the effect of exercise versus either no intervention, or usual care. We are uncertain of the potential for harm of exercises, due to low event rates, and a limited number of studies reporting events. AUTHORS' CONCLUSIONS: We found moderate‐ to low‐quality evidence that exercise programmes probably slightly improve function, may reduce pain, and probably slightly reduce global patient assessment of disease activity, when compared with no intervention, and measured upon completion of the programme. We found moderate‐ to low‐quality evidence that exercise programmes probably have little or no effect on improving function or reducing pain, when compared with usual care, and may have little or no effect on reducing patient assessment of disease activity, when measured upon completion of the programmes. We are uncertain whether exercise programmes improve spinal mobility, reduce fatigue, or induce adverse effects.

Background: Physical activity (PA), including engagement in structured exercise, is a key element in the management of chronic inflammatory rheumatic diseases, in particular rheumatoid arthritis (RA) (ref). However, maintaining a physically active lifestyle is a challenge for people with RA. PA determinants in this population need to be understood better to be optimised through public health or healthcare interventions and social policy changes. Objectives: To collect qualitative evidence on barriers and facilitators of PA for patients with RA through a systematic literature review (SLR). Methods: A SLR of Medline, Web of Science and grey literature was performed from inception to January 2019; key search terms were exercise [MeSH], barriers [Title/Abstract]), facilitators [Title/Abstract] and Arthritis, Rheumatoid [MeSH]. All qualitative reports of barriers and facilitators in RA, published in english were collected. A thematic synthesis was applied. Results: Of 89 references, 10 (11.2%) studies were qualitative reports in RA and were analyzed: 3 (49 patients) were focus group and 7 (99 patients) were interviews. In all, 148 patients participated: mean age 57.4 years (standard deviation, SD 3.9, range of means 50.0-63.5), mean disease duration 14.3 years (SD 5.2, range 6.9-21.0). Barriers and facilitators were reported for general physical activity in 6 studies and for supervised exercises (e.g. exercise program leads by physiotherapist) in 4 studies. Overall, 7 categories of barriers (mean 3.4 (SD 1.9) per study) and 8 categories of facilitators (mean 3.7 (SD 2.1) per study) were reported. These could be grouped in 4 majors themes (physical health, psychological aspects, setting and social environment) (Table). The 3 most reported categories of barriers were symptoms of RA (8/10 studies), beliefs, fears and loss of motivation (7/10) and lack of support, exercise knowledge, confidence and conflict in advice from healthcare (4/10). The 3 most reported categories of facilitators were group socialization, influence of others, social support (8/10), positive beliefs, knowledge about benefits of PA (5/10) and positive emotions and experiences of PA (5/10). Conclusion: Our findings emphasize the complex interplay of physical and psychological health, setting and social environmental factors, corresponding to the facilitation and hindrance of PA engagement. References: [1] Osthoff A-KR, et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Annals of the Rheumatic Diseases 2018;77:1251–1260. Disclosure of Interests: Thomas Davergne: None declared, Rikke Helene Moe: None declared, Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, Medac, MSD, NORDIC Pharma, Novartis, Pfizer, Roche, Sanofi-Aventis, Sanofi Genzyme, SOBI, UCB, Laure Gossec Grant/research support from: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis-Sandoz, Pfizer, Sanofi, and UCB, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, MSD, Nordic Pharma, Novartis-Sandoz, Pfizer, Roche, Sanofi, and UCB, Consultant for: L Gossec has received honoraria from Celgene as investigator for this study

Background:Physical activity is important for patients with inflammatory arthritis (IA), such as spondyloarthritis (axSpA), rheumatoid arthritis (RA) or psoriatic arthritis (PsA). They are more prone to physical inactivity but derive specific benefits from regular physical activity (1,2). It is not easy to modify physical activity level (3). Barriers and facilitators to physical activity can be assessed through questionnaires (4), however, it is important to demonstrate a link between these explanatory elements and physical activity levels.Objectives:To measure the correlation between barriers and facilitators to physical activity, assessed through a simple questionnaire, and self-reported physical activity levels.Methods:This was an international, multicentric, cross-sectional study performed between October 2019 and June 2020 (ClinicalTrial NCT04426747). Consecutive patients were included if they had definite axSpA, RA or PsA, were aged above 18 and able to walk. Barriers and facilitators to physical activity were measured using the 10-item Inflammatory arthritis Facilitators and barriers questionnaire (IFAB) (5). The IFAB ranges -70 to 70 with lower scores indicating more barriers; scores below -5 correspond to significant barriers. Physical activity was measured by the IPAQ-S questionnaire (6). Exploratory analyses used steps per day collected by smartphone, and psychological readiness to change by stages of behavior change. Statistical analysis used Spearman correlation (rho, pResults:Of 245 patients included, 150 had analysable data (69 (46%) axSpA, 63 (42%) RA, 18 (12%) PsA). Mean age was 48.6 years (SD 17.1), mean disease duration 11.7 (10.1) years and 60% were women. The mean score of barriers and facilitators to physical activity was 6.0 (SD 19.2, median 4) (Figure 1). A total of 39 (26%) patients scored less than -5, which could justify a targeted intervention. The mean physical activity was 2837 (SD 2668, median 1784) Metabolic Equivalent of Task min per week. Physical activity was correlated with score of barriers and facilitators to physical activity in linear regression (rho 0.28, pTable 1for abstract: correlation between IFAB questionnaire, each items and level of physical activity with or without extreme valuesItemCorrelation with IPAQ-S min/met/week, rhoCorrelation with stage of behavior change, rhoCorrelation with mean steps per day, rhoTotal IFAB score0.28 ***0.35 ***0.08Item 10.29 ***0.16 *0.16 *Item 20.060.020.05Item 30.080.16 *0.01Item 40.130.09-0.07Item 5-0.090.100.07Item 60.22 **0.25 ***-0.05Item 70.22 **0.20 **0.12Item 80.16 *0.26 ***0.11Item 90.150.33 ***0.11Item 100.090.17 *0.02Social support questions0.140.27 ***-0.03Psychological and knowledge status questions0.22 **0.16 *0.09*=PConclusion:Perceived barriers and facilitators to physical activity are correlated with physical activity. Targeting patients with high barriers and low facilitators to physical activity could be an effective option to improve physical activity levels.References:[1]O’DWYER T., et al. Rheumatology 2014. Vol. 53, n° 10, pp. 1812-1817.[2]OSTHOFF, A et al. 2018. Vol. 77, n° 9, pp. 1251-1260. DOI 10.1136/annrheumdis-2018-213585.[3]MARLEY, J, et al: BMC Musculoskeletal Disorders. 2017. Vol. 18, pp. 482. DOI 10.1186/s12891-017-1836-2.[4]COSTE, N., et al. 2019. DOI 10.1016/j.rehab.2019.07.009.[5]DAVERGNE, T, et al. Rheumatology International 2020. DOI 10.1007/s00296-020-04692-4.[6]LEE, PH, et al. 2011. Vol. 8, pp. 115. DOI 10.1186/1479-5868-8-115.Figure 1.Distribution of the IFAB score Footnote: Y axis: effectifs, X axis: IFAB score (possibles values from -70 to 70)Acknowledgements:I have no acknowledgements to declare.We thank the following coinvestigators: Sylvie Rozenberg, Beatrice Banneville, Rachida Inaoui, Emmanuelle Dernis, Athan Baillet and Catherine Beauvais, and we thank Hervé Servy for expert CRO adviceDisclosure of Interests:None declared

Resume La recherche paramedicale interesse un grand nombre de professionnels de sante. Les resultats de la recherche paramedicale occupent une part importante de la litterature internationale. Ils sont le fondement a de nombreuses interventions de soins paramedicaux et repondent a des enjeux de sante societaux. La recherche paramedicale est complexe, difficile a realiser, couteuse. Elle doit faire face a de nombreux obstacles methodologiques, legislatifs, organisationnels et structurels. Un effort est necessaire pour ameliorer, en France, sa place dans la recherche clinique et changer son organisation afin de lui permettre de repondre plus efficacement aux problematiques de sante. Niveau de preuve Non adapte.

Introduction Les patients atteints de rhumatismes inflammatoires chroniques (RIC) (spondylarthrite axiale, polyarthrite rhumatoide et arthrite psoriasique) ne pratiquent souvent pas suffisamment d’activite physique (AP), en raison de barrieres individuelles. Objectifs Developper et valider un questionnaire auto-administre pour identifier chez les patients atteints de RIC les facteurs facilitant et entravant l’AP : le questionnaire IFAB. Patients et methodes L’elaboration du questionnaire comprenait une revue systematique des barrieres et facilitateurs a l’AP afin d’identifier les themes cles, une evaluation de la validite de face par 11 experts et un debriefing cognitif par 14 patients RIC. Les proprietes psychometriques du questionnaire ont ete evaluees par la validite convergente (correlation de Spearman) par rapport au questionnaire d’evaluation de la sante modifie (mHAQ), a la sous-echelle du questionnaire sur les croyances de peur et d’evitement a l’AP (FABQ) et a l’echelle de Tampa pour la kinesiophobie. La coherence interne (Cronbach a) a ete evaluee chez 63 patients souffrant de polyarthrite rhumatoide (PR), de spondyloarthrite axiale (axSpA) ou de rhumatisme psoriasique (PsA). La fiabilite et la faisabilite ont ete evaluees chez 32 patients atteints d’RIC. Resultats Le questionnaire comprend 10 items : 4 evaluant soit les barrieres soit les facilitateurs, 3 evaluant les barrieres et 3 evaluant les facilitateurs. Les items sont lies a l’etat psychologique (n = 6), au soutien social (n = 2), a la maladie (n = 1) ou aux facteurs environnementaux (n = 1) ( Tableau 1 ). L’etude de validation a porte sur 63 patients : 26 PR, 24 axSpA, 13 PsA ; avec un âge moyen de 52,8 (ecart type 16,5) ans, une duree moyenne de la maladie de 12,5 (12,3) ans et 53 % de femmes. Le questionnaire a ete correle avec le mHAQ (rho = 0,24). La coherence interne (Cronbach α 0,69) et la fiabilite (coefficient interclasse 0,79 [intervalle de confiance a 95 % 0,59 ; 0,88]) etaient satisfaisantes, tout comme la faisabilite (donnees manquantes 12 %, temps moyen d’achevement Conclusion Le questionnaire permet d’evaluer les barrieres et les facilitateurs de l’AP chez les patients atteints de RIC. Ce questionnaire peut permettre de mener des interventions ciblees pour augmenter les niveaux d’AP chez ces patients.

Introduction Les patients atteints de polyarthrite rhumatoide (PR) sont particulierement vulnerables a l’inactivite physique malgre les benefices rapportes d’une activite physique reguliere chez ces patients. Les applications smartphones ont le potentiel de promouvoir l’activite physique mais le choix d’une telle application reste aujourd’hui difficile pour le patient ou le professionnel de sante. Objectifs (1) Identifier les principales applications permettant de promouvoir l’activite physique chez les personnes atteintes de PR, (2) categoriser les applications developpees directement pour la population cible ou non et (3) identifier les 5 principales techniques de changement comportemental presentes dans les applications smartphones. Materiels et methodes Toutes les applications gratuites et disponibles en francais ont ete recherchees jusqu’en juin 2020 sur la base de recherche de l’Apple Store par 3 auteurs independants. Les applications selectionnees ont ete utilisees par les 3 auteurs pour en identifier les principales caracteristiques et reperer les 5 techniques de changement comportemental (TCC) identifiees precedemment comme etant efficaces pour augmenter l’activite physique (ref). Resultats Cette revue a identifie 15 applications pour promouvoir l’activite physique chez les personnes atteintes de PR (2 developpees pour la PR, 3 pour d’autres pathologies et 10 pour le grand public). Les applications les plus efficaces, c’est-a-dire referencant les 5 TCC recherchees, sont : Fizz Up ; Seven ; Adidas Running ; Nike Training, Strava et Pacer. Ces 6 applications sont developpees pour le grand public. Conclusion En se basant la presence des TCC montrees comme efficaces pour augmenter l’activite physique, les applications les plus pertinentes semblent etre celles developpees pour le grand public plutot que celles developpees directement pour la PR. Le developpement d’applications pour les patients devrait se baser sur les TCC montrees comme efficaces pour plus de pertinence.

Introduction L’adherence aux medicaments et a l’activite physique (AP) est insuffisante chez les patients atteints d’arthrite inflammatoire (AI), comme la spondylarthrite (axSpA), la polyarthrite rhumatoide (PR) ou le rhumatisme psoriasique (PsA). Recemment, deux recommandations de l’EULAR ont apporte de nouvelles informations sur la maniere d’ameliorer l’AP et de prescrire des medicaments aux patients souffrant d’AI [1] , [2] . Bien que l’observance ait ete declaree comme un probleme majeur, et qu’elle fasse actuellement l’objet d’un groupe de travail EULAR, aucune recommandation n’a ete faite sur la maniere de cibler les patients presentant des problemes d’observance. L’objectif de cette etude etait d’etudier le lien entre l’adherence medicamenteuse et l’adherence a l’activite physique chez les patients AI. Patients et methodes Il s’agissait d’une etude internationale, multicentrique et transversale menee entre novembre 2019 et juin 2020 ( NCT04426747 ). Des patients consecutifs ont ete inclus s’ils avaient une axSpA, PR ou PsA defini, etaient âges de plus de 18 ans et capables de marcher, avec des smartphones compatibles avec la mesure des pas. L’adhesion aux medicaments a ete evaluee a l’aide de l’echelle MARS-9 (allant de 9 a 45, les scores les plus eleves indiquant une plus grande adhesion). L’AP a ete mesuree par le nombre de pas par jour au cours des 4 dernieres semaines, par le biais de l’application du smartphone du patient. Le lien entre le score MARS-9 et l’AP a ete evalue par la correlation de Spearman, la regression lineaire et logistique (expliquant les 2 tertiles superieurs du score MARS). Les variables comprenaient l’âge, le sexe, la duree de la maladie, l’activite de la maladie, l’indice de masse corporelle, le statut professionnel, la prescription de DMARDs, les comorbidites et la capacite fonctionnelle grâce au questionnaire d’evaluation de la sante modifie (mHAQ). Il n’y a pas eu d’imputation des donnees manquantes. Resultats Sur 245 patients inclus, 152 disposaient de donnees analysables (66 (45 %) axSpA, 62 (42 %) PR, 18 (12 %) PsA). L’âge moyen etait de 48,0 ans (ecart-type 13,4), la duree moyenne de la maladie de 11,7 (10,2) ans et 47 % etaient des femmes. 70 % recevaient un produit biologique et l’activite de la maladie etait moderee. L’adhesion aux medicaments etait elevee : le score MARS moyen etait de 39,4 (6,3) avec une mediane de 41. L’AP etait moderee : le nombre moyen de pas par jour collectes par le biais d’Apps etait de 5457 (3730), la mediane de 4473 avec 28 % marchant plus de 7000 pas par jour. Nous n’avons pas mis en evidence de lien entre l’adhesion aux medicaments et le nombre de pas par jour (R = −0,06, p = 0,20); les patients ayant une adhesion plus faible aux medicaments (scores de tertile MARS les plus bas, c’est-a-dire ≤ 40) ne differaient pas en termes d’AP : 5611 (3634) contre 5051 (4155) pas par jour (p = 0,80). Dans la regression lineaire univariee, les patients ayant une plus faible adhesion aux medicaments avaient une duree de maladie plus longue et une tendance a une capacite fonctionnelle plus faible. La regression logistique a confirme ces resultats. Conclusion En conclusion, dans cette population de patients atteints d’AI de longue date, l’adhesion aux medicaments etait elevee alors que l’AP etait insuffisante. Les patients atteints d’AI qui etaient plus fideles au traitement n’etaient pas plus actifs physiquement que ceux qui etaient moins fideles. L’adhesion aux medicaments et aux changements de mode de vie peut etre liee a differents mecanismes d’adaptation, qui devraient etre etudies plus avant pour permettre la mise en œuvre des recentes recommandations de l’EULAR [1] , [2] .

Introduction L’entretien motivationnel (EM) apparait comme une strategie prometteuse pour augmenter le niveau d’activite physique insuffisant des patients atteints de rhumatisme inflammatoire chronique (RIC), de fibromyalgie ou d’arthrose. Objectif Etudier l’efficacite de l’EM sur l’adhesion a la pratique d’activite physique, la sedentarite et les capacites fonctionnelles chez ces patients par une revue systematique avec meta-analyse. Materiels et methodes Ce travail a ete realise selon le guide PRISMA. Trois bases de donnees (PubMed, Cochrane Library et PEDro) ont ete consultees jusqu’a juillet 2020. Tous les essais randomises controles mesurant l’effet de l’EM sur le niveau d’activite physique, la sedentarite ou la capacite fonctionnelle pour les patients atteint de rhumatisme inflammatoire chronique, fibromyalgie ou d’arthrose etaient inclus par 2 auteurs independants. L’analyse des biais a ete realisee a l’aide de la grille de la Cochrane. Une meta-analyse a ete realisee sur RevMan avec effet aleatoire et differences des moyennes standardisees (DMS). Resultats Cette revue systematique a inclus six essais randomises controles : soit 844 participants (77 % de femmes), de moyenne d’âge 55,1 ans (ecart-type [ET] ± 8,4 ans), avec une duree moyenne de la maladie de 9,9 ans (ET ± 1,9 ans). Concernant l’activite physique de faible intensite mesuree objectivement a la fin de l’intervention, la meta-analyse basee sur 2 etudes (190 patients) a montre un effet important en faveur du groupe EM (DMS 0,92 [IC95 % : 0,09, 1,74], I2 = 81 %). Concernant l’activite physique d’intensite moderee a intense mesuree subjectivement a la fin de l’intervention, la meta-analyse basee sur 2 etudes (394 patients) a montre un effet important (DMS 1,30 [(IC95 %) 0,09, 2,51], I2 = 27 %). Aucun effet significatif n’a ete montre pour les autres criteres d’evaluation. Conclusion L’EM montre des effets encourageants pour l’adhesion a l’AP mais non sur la sedentarite et les capacites physiques. Ces effets sont associes a un niveau de preuve faible aux vues du nombre de participants et des biais inclus dans les etudes. De nouvelles etudes de forte qualite methodologiques sont necessaires pour confirmer ces resultats.

Background:Patients with inflammatory arthritis (IA) like (ankylosing spondylitis (AS), rheumatoid arthritis (RA), and psoriatic arthritis (PsA) are more prone to physical inactivity but derive specific benefits from regular physical activity (PA) (1). Barriers and facilitators to PA are key elements that have not yet been well described.Objectives:To assess if barriers and facilitators for PA in patients with IA are mostly related to disease, psychological, social or environmental factors.Methods:A list of the most important barriers and facilitators was derived from a systematic review of barriers and facilitators to PA in rheumatoid arthritis (2). This list was assessed for face validity by 11 experts from Rheumatology or physiotherapy then tested by 10 patients through structured interview.The list of barriers and facilitators was completed in a binary way: “barriers or facilitators are relevant to me” yes or no, for 66 patients in a monocentric, cross-sectional study. Then, patients assessed the level of each barrier or facilitator on a 0-10 scale. Statistics were descriptive. There was no imputation of missing data.Results:The study included 66 patients (27 axial spondyloarthritis, 26 rheumatoid arthritis, 13 psoriatic arthritis), mean age 52.0 (standard deviation (SD) 16.6) years, mean disease duration 14.3 (SD 11.7) years, 53% women. Disease activity was moderate (mean DAS28 2.1 (SD 1.1), mean BASDAI 2.8 (SD 1.4)), and 75.4% received a biologic. The main factors described by patients were related to the knowledge of the benefits of PA and symptoms (table 1). Psychological factors were more reported and social factors less reported as influential for PA.Table 1.Barriers and facilitators for physical activity reported by patients with inflammatory arthritis.Barriers or facilitatorsCategoriesModifiableN (%) reporting this barrier or facilitatorLevel of patients reporting this item (0-10) (mean (SD))Knowledge of benefits of physical activity for healthPsychYes49 (78)6.6Knowledge of benefits of physical activity for moodPsychYes47 (75)6.8 (3.4)Level of symptoms (pain, fatigue, lack of mobility)PhyYes44 (69)5.7 (2.8)External reminders (eg: from health professionals, calendars…)SocYes36 (57)6.2 (3.1)Presence or absence of activity facilities (ex: green area for walking, gym …)EvmtNo34 (56)6.3 (3.7)Lack of motivationPsychYes34 (55)5.7 (3.2)Weather conditionsEvmtNo33 (52)5.7 (3.2)Confidence on how to exercise safelyPsychYes31 (49)6.0 (2.6)Contact and proximity with others during physical activitySocNo29 (47)6.1 (3.7)Presence or absence of support from others (friends, family)SocNo26(42)6.5 (3.9)Lack of timeEvmtNo35 (40)5.4 (3.4)Presence or absence of support and/or advice from healthcare professionalsSocYes25 (40)6.0 (3.7)A belief that physical activity will make symptoms worsePsychYes17 (27)4.8 (3.3)Lack of knowledge on which exercises to do and how muchPsychYes17 (27)4.7 (3.0)Psych = psychological, Evmt = environmental, Phy = physical, Soc = socialConclusion:The main factors that influence PA in patients with IA were mostly related to psychological aspects, and could be modifiable. The role of health professionals supporting patient PA is key. Interventions should be further explored to meet these important barriers and facilitators.References:[1] O’Dwyer T, Physical activity guidelines: is the message getting through to adults with rheumatic conditions? Rheumatol U K. 2014[2] Davergne T, Thu0716-Hpr Major Barriers and Facilitators to Physical Activity in Rheumatoid Arthritis Are Related to Physical and Psychological Health, Setting and Social Environmental Factors: A Systematic Literature Review. Ann Rheum Dis. 2019Disclosure of Interests:Thomas Davergne: None declared, Rikke Helene Moe: None declared, Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant of: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Lilly, Janssen, Medac MSD France, Nordic Pharma, Novartis, Pfizer, Roche, Sanofi Aventis, SOBI and UCB, Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB

Background Patients with rheumatic conditions, such as low back pain (LBP), lower limb osteoarthritis (OA) and chronic inflammatory rheumatic diseases (CIRDs) are vulnerable regarding physical inactivity, although they derive specific benefits from regular physical activity.1 2 Wearable activity trackers (WATs), including simple pedometers and more advanced WATs (e.g. Fitbit), could be a promising strategy to improve physical activity levels. Objectives To obtain an overview regarding the adherence and effectiveness of WATs to increase physical activity levels and to reduce sedentary behaviours in rheumatic patients. Methods This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement (PROSPERO CRD42018083532). All articles available in English, published between 2000 and 2018 (January), in MEDLINE, EMBASE, PsycINFO and Central Register for Controlled Trials were screened as well as extensive hand search. Study selection and data collection were performed by two independent reviewers. Studies were included if they assessed WATs in patients with OA, LBP or CIRDs. Data collected pertained to (a) adherence (i.e.% days with the WAT worn), (b) efficacy on physical activity (i.e. increase in step counts or moderate to vigorous physical activity), (c) efficacy on symptoms (function, pain, quality of life). Standardised mean differences were calculated and reported as null ( 0.8). Results Of 2378 abstracts, 15 studies were included in the review (of which, 7, 47%, published in 2017) with a total of 1344 patients: 42% men, range of mean age 16–64 years. Among the 15 studies, 7 (47%) were related to OA, 5 (33%) to LBP and only 3 (20%) to CIRDs. In all, 7 (47%) reported on advanced WATs and 8 (53%) on simple pedometers. (a) Adherence: 4/15 studies (27%) reported adherence, in a total of 416 patients. The weighted mean duration of the studies was 12.6 weeks and adherence was excellent (weighted mean time worn: 92.7% (SD 4.6)).(b) Efficacy on physical activity was reported in 11/15 (73%) studies (ie 876 patients). The mean increase in steps per day was 1579 (SD 770) in the intervention group over a weighted mean duration of 22.6 (SD 13.6) weeks. Effect sizes were null (2/10 studies), small (4/10 studies), moderate (3/10 studies) or large (1/10 studies) (figure 1). (c) For impact on symptoms, 14/15 (93%) studies reported on function, pain or quality of life (or several of these leading to 20 analyses). Overall, effect sizes were null (14/20, 70%) or small (6/20, 30%). Conclusions Short term adherence to WATs was high in published studies of LPB, OA or CIRDs but the efficacy to increase physical activity levels was small to moderate. There were no modifications of symptoms. The incorporation of WAT in patient care remains challenging. Further studies are needed, especially for CIRDs. References [1] O’Dwyer T. Rheumatology2014Oct 1;53(10):1812–7. [2] van der Heijde D, Ann Rheum Dis2017;210770. Disclosure of Interest None declared

Objective Wearable activity trackers (WATs) could be a promising strategy to improve physical activity in patients with rheumatic and musculoskeletal diseases (RMDs). The aim was to assess the adherence to and effectiveness of WATs to increase physical activity levels in patients with RMDs. Methods A systematic review was performed to identify all cohorts and controlled trials evaluating WATs in patients with RMDs, published between 2000 and 2018, by searching Medline, Embase, PsycINFO, and Cochrane. Data collected pertained to adherence, effectiveness on physical activity, or effectiveness on symptoms (pain, function, quality of life, or fatigue). Meta-analyses were performed with a random effects model. Results Of 2,806 references, 17 studies were included, with a total of 1,588 patients: 8 studies (47%) in osteoarthritis, 5 (29%) in low-back pain, and 3 (18%) in inflammatory arthritis. Adherence assessed in 4 studies was high (weighted mean ± SD time worn was 92.7% ± 4.6%). A significant increase in physical activity was noted (mean difference 1,520 steps [95% confidence interval (95% CI) 580, 2,460], I² = 77%; or 16 minutes [95% CI 2, 29] of moderate-to-vigorous physical activity, I² = 0%). A significant increase in pain was found for long interventions (>8 weeks) (standardized mean difference 0.25 [95% CI 0.07, 0.43], I² = 0%). Conclusion WATs in patients with RMDs had a high short-term adherence, with a significant increase in the number of steps and time spent in moderate-to-vigorous physical activity, although pain should be monitored. WATs may be an effective option to increase physical activity in this at-risk population.

Objective To describe the dose components and choice justifications in exercise interventions in a convenient sample of randomized controlled trials (RCTs). Data Sources We searched the following databases: PubMed and Cochrane Central Register of Controlled Trials in 2014. Study Selection We included published RCTs evaluating preventive or therapeutic interventions in people with clinical conditions or at risk to develop health problems. Data Extraction Two reviewers independently extracted data and evaluated the adequacy of the justifications. We contacted and invited the trials authors to complete an online survey to ask for additional information on dose justifications and dose-effect relation. Data Synthesis We included 187 published RCTs. Of these, 68 (36%) reported a justification for the dose choice, and 135 (72%) reported 3 doses components. Most reported components were duration (96%) and frequency (93%). Sixty-six survey responders (response rate, 35%) provided additional information. When combining the publications and survey responses, 104 (56%) trials had a justification for the dose choice. We judged justifications adequate in 45 (43%) articles. From the survey responders, 39% indicated that intensity was the dose component that can have the greatest effect on their study results. Conclusions Most of the published RCTs adequately reported the dose components of their exercise interventions but only a small number provided sufficient justifications for dosage choices. Further studies are recommended to justify the exercise intervention dose choices.