17th July 2020
Updated 1st September 2020
We are indeed living in ‘unprecedented’ times and many things may never return to the ‘old’ normal but instead be replaced by a ‘new’ normal. We all now talk with new vocabularies including ‘social distancing’, ‘2 meter rules’ ‘Stay Safe’, ‘Track and Trace’ and many more. The virtual world and what this would have to offer for the way that we encourage our axial SpA patients to exercise and remain healthy has been knocking on the door for several years. COVID-19 blew that door wide open with the winds of change blowing us through it at ‘unprecedented’ speed.
This blog captures and shares personal journeys of physiotherapy colleagues as they have embraced new ways of working and reaching their patients during the ‘lock down’.
Exercise as Medicine
BRITSpA members, Mr Christopher Martey Specialist Physiotherapist and Dr Raj Sengupta Consultant Rheumatologist, have published a review in the Current Opinion in Rheumatology Journal in the last month, giving an insightful overview of the role of Physical Therapy (or Physiotherapy) in the management of Axial Spondyloarthritis (axSpA). They specifically highlight the role of physical activity promotion and exercise therapy as mainstays of treatment.
Chris and Raj outline how Physiotherapy is recommended ‘as an integral part of standard care’ for the management of axSpA, with the focus of promoting physical activity and prescribing exercise within four domains, defined by the European League against Rheumatism (EULAR) as: aerobic, resistance (strength), flexibility and neuro-motor exercise. This most recent EULAR manuscript additionally provides 10 recommendations for physical activity in people with Spondyloarthritis, Rheumatoid Arthritis, and hip and knee osteoarthritis.
The BRITSpA members state that there is an increasing evidence base to support Physiotherapy interventions in axSpA and present evidence supporting the use of exercise; updates among different exercise modalities; and make clear its critical place in the management of this condition. Recent large, multicentre data have shown that high-intensity exercise can improve disease activity and also positively impact cardiovascular risk factors in these patients. This study from Sveaas et al. (2019) is a pragmatic randomised controlled trial which evaluated high-intensity exercise in 100 patients with axSpA. The study goes some way to debunk concerns that high intensity exercise might exacerbate disease activity in this population. Another salient paper mentioned in the review is Perrotta et al (2019) excellent and concise review into new insights surrounding rehabilitation and physical therapy, which includes comments on the importance of patient education.
Chris and Raj’s review highlights the integral role that exercise plays and also that Allied Health Professionals, namely Physiotherapists, have in leading on such interventions. Although international treatment guidelines advocate the inclusion of physical activity and exercise for the optimal management of axSpA, specific guidance about the amount of exercise required to produce a beneficial effect is lacking. Chris and Raj summarise that exercise mustbe used in the management of axSpA, but whilst hydrotherapy and flexibility exercises are traditionally the main focus, other applications, such as strength training, may be underutilized domains, and that further studies are needed to determine the dose–response relationship between exercise and axSpA patient subsets.
Melanie is an Advanced Physiotherapy Practitioner and Topol Digital Health Fellowshares. Here she shares her insights in how digital health is here to stay.
“Over the last two months I have started regular zoom exercise sessions, on a voluntary basis, with the Bath NASS group. These started as daily sessions then moved to three times weekly. The sessions were well received by the Bath branch and NASS HQ have asked if I can offer them to other NASS groups. Due to my concerns on the logistics of providing Zoom sessions to larger numbers, I am looking to provide online videos via YouTube. These will be pre-recorded or live-streamed sessions via the NASS YouTube site.
AStretch were approached by NASS to provide online content to their members to help them self-manage during the COVID period. As a committee member, I have provided a Facebook live session on appropriate types of exercise in axial SpA and how to stay motivated. I also produced some pre-recorded exercise videos that can be easily followed at home.”
Zoom NASS sessions, the new world during Lockdown!
Last year I did a blog about running a NASS group for 20 years. At that point I thought our group had tried a good variety of different exercises, mat work, Pilates, Nordic working, even rounders to name a few. However, recent weeks have seen such dramatic changes to our way of life, that I would never have predicted our sessions would have gone virtual.
When NASS advised group sessions to stop on 16th March, I emailed the group links to the NASS YouTube clips, ‘Back to Action’ and any other appropriate exercise. However, this didn’t really seem enough. Not being a natural ‘techi’ I was trying to work out if I could email video clips of myself doing exercises, when one of our group said his daughter had been doing dance lessons via Zoom (Yorkshire Rose Academy of Dance) and could we use it for our sessions. The rest of the group were really keen to try and we did our first session on 7thApril. It has been lovely to keep in touch with the members and see that everyone is managing ok. Most of the members are self-isolating and have found keeping in touch with each other really helpful. We have kept the day and time the same as our normal sessions to try to keep some normality at this strange time.
Some quotes from our members:
‘Really good to be part of the group again. Look forward to it each week. Something to focus on as well as a good reminder to keep up the exercises’
‘I’m very happy to do Zoom, it keeps us together as a group and focused. Just have to manage the technology’
‘The 2 things no pre-recorded can replicate. They provide personalised, appropriate exercise from physios who knew us all as individuals. And they enable a degree of mutual interaction which has never been more important in terms of maintaining morale’
‘Really good to keep in touch with the group during lock-down and still benefit from exercising together’
I would recommend if you run a NASS group to suggest virtual sessions to your members. It is easy to download the App and set up a meeting. Members can be easily talked through how to do it and don’t need to be technically minded. It allows members to keep in touch and exercise which is so valuable at this most unusual of times. Coming out of the lock down period, we hope to be back in the gym in the autumn. However, the group are keen to keep the option of zoom sessions going. If the weather is bad in winter or the Christmas period seems busy, the online option may be a quicker and easier way to keep active and in touch with everyone.
Primary Care and Community Physiotherapy Clinics during COVID-19
BRITSpA member, Chris Martey, is a specialist Physiotherapist who, after moving from secondary care Rheumatology, now works in primary care as a first contact physiotherapist (FCP) and advanced Allied Health Professional with skills and expertise in assessment and management of musculoskeletal (MSK) conditions. Here, Chris shares his experience on how the COVID-19 pandemic has led to a new way of working.