Quality statement 3: Physiotherapy

Quality statement

Adults with axial spondyloarthritis are referred to a specialist physiotherapist for a structured exercise programme.

Rationale

Specialist physiotherapy is a key non-pharmacological management strategy for people with axial spondyloarthritis. Structured exercise programmes that are designed and tailored by specialist physiotherapists for a person's current and changing needs can have many benefits for people with spondyloarthritis. These include helping to reduce the impact of the disease, improving or maintaining mobility, function and quality of life, enabling self-management, and reducing pain and fatigue.

Quality measures

Structure

Evidence of local referral pathways to specialist physiotherapists for adults with axial spondyloarthritis.

Data source: Local data collection, for example, from referral pathways or referral strategies.

Process

a) Proportion of adults with axial spondyloarthritis referred to a specialist physiotherapist for a structured exercise programme.

Numerator – the number in the denominator referred to a specialist physiotherapist for a structured exercise programme.

Denominator – the number of adults with axial spondyloarthritis.

Data source: Local data collection, for example, local audit of patient records.

b) Proportion of adults with axial spondyloarthritis referred to a specialist physiotherapist for a structured exercise programme who attended the programme.

Numerator – the number in the denominator who attended the programme.

Denominator – the number of adults with axial spondyloarthritis referred to a specialist physiotherapist for a structured exercise programme.

Data source: Local data collection, for example, local audit of patient records.

Outcomes

a) Functional ability score of adults with axial spondyloarthritis.

Data source: Local data collection, for example, survey of adults with axial spondyloarthritis using a questionnaire to assess functional ability (such as the Bath Ankylosing Spondylitis Functional Index).

b) Self-reported pain score of adults with axial spondyloarthritis.

Data source: Local data collection, for example, survey of adults with axial spondyloarthritis using a questionnaire to assess pain (such as the Bath Ankylosing Spondylitis Disease Activity Index).

c) Self-reported fatigue score of adults with axial spondyloarthritis.

Data source: Local data collection, for example survey of adults with axial spondyloarthritis using a questionnaire to assess fatigue (such as the Bath Ankylosing Spondylitis Disease Activity Index).

d) Spinal mobility score of adults with axial spondyloarthritis.

Data source: Local data collection, for example, from measurements taken during a clinical examination to populate a validated tool (such as the Bath Ankylosing Spondylitis Metrology Index).

What the quality statement means for different audiences

Service providers (such as GP practices and rheumatology services) ensure that pathways are in place for adults with axial spondyloarthritis to be referred to a specialist physiotherapist to start a structured exercise programme.

Healthcare professionals (such as rheumatologists and GPs) refer adults with axial spondyloarthritis to a specialist physiotherapist to start a structured exercise programme.

Commissioners (clinical commissioning groups) commission physiotherapy services that have specialist physiotherapists in rheumatology and have service specifications that ensure that adults with axial spondyloarthritis are referred to them to start a structured exercise programme.

Adults who have axial spondyloarthritis are referred to a specialist physiotherapist who helps with joint, muscle and movement problems. The physiotherapist will tailor a plan of exercises to the person's individual and changing needs. The aim of the exercises is to ease symptoms such as stiffness and pain, and help with mobility and fitness.

Source guidance

Spondyloarthritis in over 16s: diagnosis and management (2017) NICE guideline NG65, recommendation 1.5.1

Definitions of terms used in this quality statement

Structured exercise programme

A plan of exercises tailored to a person's individual and changing needs that includes:

  • stretching, strengthening and postural exercises

  • deep breathing

  • spinal extension

  • range of motion exercises for the lumbar, thoracic and cervical sections of the spine

  • aerobic exercise.

[NICE's guideline on spondyloarthritis, recommendation 1.5.1]

Specialist physiotherapist

A physiotherapist with rheumatology experience and experience of treating axial spondyloarthritis.

[Expert opinion]