Recommendations for physical activity and exercise in persons living with Systemic Lupus Erythematosus (SLE): consensus by an international task force

Objective: This international task force aimed to provide healthcare professionals and persons living with systemic lupus erythematosus (SLE) with consensus-based recommendations for physical activity and exercise in SLE. Methods: Based on evidence from a systematic literature review and expert opinion, 3 overarching principles and 15 recommendations were agreed on by Delphi consensus. Results: The overarching principles highlight the importance of shared decision-making and the need to explain the benefits of physical activity to persons living with SLE and other healthcare providers. The 15 specific recommendations state that physical activity is generally recommended for all people with SLE, but in some instances, a medical evaluation may be needed to rule out contraindications. Pertaining to outdoor activity, photoprotection is necessary. Both aerobic and resistance training programmes are recommended, with a gradual increase in frequency and intensity, which should be adapted for each individual, and ideally supervised by qualified professionals. Conclusion: In summary, the consensus reached by the international task force provides a valuable framework for the integration of physical activity and exercise into the management of SLE, offering a tailored evidence-based and eminence-based approach to enhance the well-being of individuals living with this challenging autoimmune condition

Educational readiness among health professionals in rheumatology: Low awareness of EULAR offerings and unfamiliarity with the course content as major barriers—results of a EULAR-funded European survey

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

Determinants of physical activity in rheumatology

Les patients atteints de maladies rhumatologiques chroniques ont souvent une activité physique insuffisante alors que la participation à une activité physique régulière est un point-clé de leur traitement. De nombreux freins empêchent cette activité et les stratégies visant à augmenter durablement le niveau d’activité physique dans cette population ont une efficacité très modeste. Dans cette thèse, nous nous sommes attachés à 1) identifier et évaluer les déterminants de l’activité physique et 2) évaluer des stratégies permettant d’augmenter le niveau d’activité chez les patients atteints de pathologies rhumatologiques chroniques. Le premier axe de la thèse nous a permis de développer et valider un questionnaire de 10 barrières et facilitateurs à l’activité physique pour les patients atteints de rhumatismes inflammatoires chroniques. Ce questionnaire peut être utilisé en pratique clinique pour identifier les principaux déterminants de l’activité physique et pour construire des programmes favorisant le maintien d’une activité adaptée avec une meilleure chance d’adhésion sur le long cours. L’observation du comportement d’adhésion au médicament et à l’activité physique chez 152 patients atteints de rhumatismes inflammatoires chroniques nous a permis de constater une absence de corrélation entre les deux. Ceci démontre que les déterminants de l’activité physique conditionnant le mode de vie sont surement plus complexes que ceux de la prise de médicament. Le 2ème axe de cette thèse nous a permis de constater par le biais d’une revue systématique que l’utilisation de traceurs d’activité entrainait un bénéfice de 1500 pas par jour. L’utilisation de ces dispositifs est encouragée au vu de leur efficacité et du faible coût d’utilisation, bien que leur efficacité à long terme reste à démontrer. Une dernière étude nous a permis d’observer que chez les patients présentant des freins importants à l’activité physique, l’utilisation d’une stratégie supervisée multidisciplinaire et adaptée aux disponibilités des participants apportait un bénéfice sur la santé. Les futures stratégies gagneront à combiner les interventions supervisées et les dispositifs technologiques pour plus d’efficacité. L’enjeu actuel de l’activité physique en rhumatologie n’est plus de démontrer sa pertinence mais d’identifier les stratégies permettant son maintien sur le long cours. À l’avenir, d’autres stratégies gagneront à être étudiées pour favoriser le maintien de l’activité physique, telles de l’utilisation d’applications smartphone ou l’entretien motivationnel. La prescription d’activité physique gagnera également à être développée via la formation des médecins prescripteurs et des professionnels de santé à l’utilisation de techniques éprouvées.Patients with chronic rheumatic diseases often have insufficient physical activity level, whereas participation in regular physical activity is a key component of their treatment. Many barriers limit participation in regular physical activity, and strategies to increase physical activity levels in this population show very modest effectiveness. In this thesis, we focused on 1) identifying and evaluating the determinants of physical activity and 2) evaluating strategies to increase the level of activity in patients with chronic rheumatic diseases. The first axis of the thesis allowed us to develop and validate a questionnaire of 10 barriers and facilitators to physical activity for patients with chronic inflammatory arthritis. This questionnaire can be used in clinical practice to identify the main determinants of physical activity and to build programs promoting the maintenance of an adapted activity with a better chance of adherence over the long term. The observation of medication and physical activity adherence behavior in 152 patients with chronic inflammatory arthritis allowed us to observe a lack of correlation between the two. This shows that the lifestyle determinants of physical activity are probably more complex than those of medication. The 2nd axis of this thesis allowed us to observe through a systematic review that the use of activity trackers resulted in a benefit of 1500 steps per day. The use of these devices is encouraged given their effectiveness and low cost of use, although their long-term effectiveness remains to be demonstrated. In a final study, we observed that in patients with significant barriers to physical activity, the use of a supervised multidisciplinary strategy adapted to the participants' availability provided a health benefit. Future strategies will benefit from combining supervised interventions and technological devices for greater effectiveness. The current challenge of physical activity in rheumatology is no longer to demonstrate its relevance, but to identify strategies that allow it to be maintained over the long term. In the future, other strategies should be studied to promote long-term maintenance of physical activity, such as the use of smartphone applications or motivational interviewing. Prescription of physical activity will also benefit from being developed through the training of prescribing physicians and health professionals in the use of proven techniques

Facteurs déterminants de l'activité physique en rhumatologie

Patients with chronic rheumatic diseases often have insufficient physical activity level, whereas participation in regular physical activity is a key component of their treatment. Many barriers limit participation in regular physical activity, and strategies to increase physical activity levels in this population show very modest effectiveness. In this thesis, we focused on 1) identifying and evaluating the determinants of physical activity and 2) evaluating strategies to increase the level of activity in patients with chronic rheumatic diseases. The first axis of the thesis allowed us to develop and validate a questionnaire of 10 barriers and facilitators to physical activity for patients with chronic inflammatory arthritis. This questionnaire can be used in clinical practice to identify the main determinants of physical activity and to build programs promoting the maintenance of an adapted activity with a better chance of adherence over the long term. The observation of medication and physical activity adherence behavior in 152 patients with chronic inflammatory arthritis allowed us to observe a lack of correlation between the two. This shows that the lifestyle determinants of physical activity are probably more complex than those of medication. The 2nd axis of this thesis allowed us to observe through a systematic review that the use of activity trackers resulted in a benefit of 1500 steps per day. The use of these devices is encouraged given their effectiveness and low cost of use, although their long-term effectiveness remains to be demonstrated. In a final study, we observed that in patients with significant barriers to physical activity, the use of a supervised multidisciplinary strategy adapted to the participants' availability provided a health benefit. Future strategies will benefit from combining supervised interventions and technological devices for greater effectiveness. The current challenge of physical activity in rheumatology is no longer to demonstrate its relevance, but to identify strategies that allow it to be maintained over the long term. In the future, other strategies should be studied to promote long-term maintenance of physical activity, such as the use of smartphone applications or motivational interviewing. Prescription of physical activity will also benefit from being developed through the training of prescribing physicians and health professionals in the use of proven techniques.Les patients atteints de maladies rhumatologiques chroniques ont souvent une activité physique insuffisante alors que la participation à une activité physique régulière est un point-clé de leur traitement. De nombreux freins empêchent cette activité et les stratégies visant à augmenter durablement le niveau d’activité physique dans cette population ont une efficacité très modeste. Dans cette thèse, nous nous sommes attachés à 1) identifier et évaluer les déterminants de l’activité physique et 2) évaluer des stratégies permettant d’augmenter le niveau d’activité chez les patients atteints de pathologies rhumatologiques chroniques. Le premier axe de la thèse nous a permis de développer et valider un questionnaire de 10 barrières et facilitateurs à l’activité physique pour les patients atteints de rhumatismes inflammatoires chroniques. Ce questionnaire peut être utilisé en pratique clinique pour identifier les principaux déterminants de l’activité physique et pour construire des programmes favorisant le maintien d’une activité adaptée avec une meilleure chance d’adhésion sur le long cours. L’observation du comportement d’adhésion au médicament et à l’activité physique chez 152 patients atteints de rhumatismes inflammatoires chroniques nous a permis de constater une absence de corrélation entre les deux. Ceci démontre que les déterminants de l’activité physique conditionnant le mode de vie sont surement plus complexes que ceux de la prise de médicament. Le 2ème axe de cette thèse nous a permis de constater par le biais d’une revue systématique que l’utilisation de traceurs d’activité entrainait un bénéfice de 1500 pas par jour. L’utilisation de ces dispositifs est encouragée au vu de leur efficacité et du faible coût d’utilisation, bien que leur efficacité à long terme reste à démontrer. Une dernière étude nous a permis d’observer que chez les patients présentant des freins importants à l’activité physique, l’utilisation d’une stratégie supervisée multidisciplinaire et adaptée aux disponibilités des participants apportait un bénéfice sur la santé. Les futures stratégies gagneront à combiner les interventions supervisées et les dispositifs technologiques pour plus d’efficacité. L’enjeu actuel de l’activité physique en rhumatologie n’est plus de démontrer sa pertinence mais d’identifier les stratégies permettant son maintien sur le long cours. À l’avenir, d’autres stratégies gagneront à être étudiées pour favoriser le maintien de l’activité physique, telles de l’utilisation d’applications smartphone ou l’entretien motivationnel. La prescription d’activité physique gagnera également à être développée via la formation des médecins prescripteurs et des professionnels de santé à l’utilisation de techniques éprouvées

Wearable activity trackers and artificial intelligence in the management of rheumatic diseases

International audienceTragbare 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.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

Wearable Activity Trackers in the Management of Rheumatic Diseases: Where Are We in 2020?

In healthcare, physical activity can be monitored in two ways: self-monitoring by the patient himself or external monitoring by health professionals. Regarding self-monitoring, wearable activity trackers allow automated passive data collection that educate and motivate patients. Wearing an activity tracker can improve walking time by around 1500 steps per day. However, there are concerns about measurement accuracy (e.g., lack of a common validation protocol or measurement discrepancies between different devices). For external monitoring, many innovative electronic tools are currently used in rheumatology to help support physician time management, to reduce the burden on clinic time, and to prioritize patients who may need further attention. In inflammatory arthritis, such as rheumatoid arthritis, regular monitoring of patients to detect disease flares improves outcomes. In a pilot study applying machine learning to activity tracker steps, we showed that physical activity was strongly linked to disease flares and that patterns of physical activity could be used to predict flares with great accuracy, with a sensitivity and specificity above 95%. Thus, automatic monitoring of steps may lead to improved disease control through potential early identification of disease flares. However, activity trackers have some limitations when applied to rheumatic patients, such as tracker adherence, lack of clarity on long-term effectiveness, or the potential multiplicity of trackers

Use of wearable activity trackers to improve physical activity behavior in rheumatic and musculoskeletal diseases: A systematic review and meta-analysis

International audienceObjectiveWearable 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.MethodsA 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.ResultsOf 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%).ConclusionWATs 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

New models of care integrating more autonomous roles for physiotherapists: a narrative review

With the increased prevalence of non-communicable diseases and chronic disorders, including musculoskeletal disorders, access to care is limited in many health care systems and new multidisciplinary collaborative models of care have now been implemented in several countries in an effort to improve access to care. The paper aimed to describe the characteristics and present relevant evidence supporting different models of care that integrate physiotherapists as primary or secondary care practitioners for the management of patients with non-communicable diseases or chronic disorders. On the basis of a literature review up to August 2020 in 4 major bibliographical databases, we searched for studies of any design, including systematic reviews with or without meta-analysis and position statements, that were related to direct access physiotherapy and advanced practice physiotherapy models of care. The impact of direct access physiotherapy and advanced practice physiotherapy models of care is presented in terms of clinical outcomes, patient satisfaction, health care resource use and costs. These models appear to provide equal or better outcomes in terms of access to care, quality of care, and patients’ satisfaction. The strength of the evidence is variable, and outcomes vary depending on clinical settings, roles of physiotherapists, and characteristics of patients. This review highlights that these enhanced roles for physiotherapists, such as diagnosing, ordering diagnostic tests, or referring patients to physicians, in both primary and secondary care settings, are beneficial and may help optimize patients’ journey by providing earlier access to effective and efficient services compared with physician-led usual care models

Exercise programmes for ankylosing spondylitis

International audienceObjective To describe the criteria used to guide clinical decision-making regarding when a patient is ready to return to running (RTR) after ACL reconstruction. Design Scoping review. Data sources The MEDLINE (PubMed), EMBASE, Web of Science, PEDro, SPORTDiscus and Cochrane Library electronic databases. We also screened the reference lists of included studies and conducted forward citation tracking. Eligibility criteria for selecting studies Reported at least one criterion for permitting adult patients with primary ACL reconstruction to commence running postoperatively. Results 201 studies fulfilled the inclusion criteria and reported 205 time-based criteria for RTR. The median time from when RTR was permitted was 12 postoperative weeks (IQR=3.3, range 5–39 weeks). Fewer than one in five studies used additional clinical, strength or performance-based criteria for decision-making regarding RTR. Aside from time, the most frequently reported criteria for RTR were: full knee range of motion or >95% of the non-injured knee plus no pain or pain 70% plus extensor and flexor LSI>70%; and hop test LSI>70%. Conclusions Fewer than one in five studies reported clinical, strength or performance-based criteria for RTR even though best evidence recommends performance-based criteria combined with time-based criteria to commence running activities following ACL reconstruction