King's Fund report praises physio-led residential course for people with axial spondyloarthritis
A ‘life changing’ residential course for patients with axial spondyloarthritis at the Royal National Hospital for Rheumatic Diseases in Bath features prominently in a King’s Fund report.
Released last week, the report, titled Innovation in treatment for people with rarer or less well-recognised long-term conditions, was written by Ben Collins.
As well as the Bath-based axial spondyloarthritis service, the report covers:
Salford Royal NHS Trust’s psoriasis clinic
Edinburgh’s Western General Hospital’s IBD service
Oxford University Hospitals NHS Trust’s osteoporosis service
Leeds Teaching Hospitals NHS Trust’s specialist spondyloarthritis service
Bath's two-week course
We invest in setting people on the right track, giving them key messages and helping to establish the right habits intensively and early. A lot of people say it is life-changing [Raj Sengupta]
In the report, staff outline their attempts to deliver care more holistically, by, for example, addressing patients’ biomedical, psychological and social needs.
A section focusing on Bath’s intensive two-week residential course – which is currently on hold due to Covid-19 – explains that it helps groups of eight patients at a time learn how to live their condition and prevent deterioration.
Raj Sengupta, clinical lead for axial spondyloarthritis, said: ‘We invest in setting people on the right track, giving them key messages and helping to establish the right habits intensively and early. A lot of people say it is life-changing.’
According to the King’s Fund report, key topics include disease pathology and progression, exercises to maintain mobility, and health and wellbeing strategies. These include stopping smoking, losing weight and using mindfulness techniques.
The Bath team includes four physiotherapists: rehabilitation programme lead Georgia Smyth and three specialist rheumatology physiotherapists: Emily Graham, Cathryn Baggley and Mike Wong.
The trust website says that specialist physios deliver most of the residential course content. 'We aim to improve spinal range of movement, confidence to exercise and begin to build fitness,' a section on the role of physiotherapy notes.
'Alongside daily exercise in the gym and hydro pool, we provide interactive education sessions addressing topics such as managing sleep, pain, fatigue and flare-ups.' See: https://bit.ly/3jkVmuW
Importance of stretching and exercises
For Dr Sengupta, the physiotherapy-led sessions on stretches and exercises are just as important as medicines, which help patients control their pain as they become more active and improve their lifestyles.
The report refers to evidence showing that obesity, smoking and alcohol consumption are contributory factors in axial spondyloarthritis and psoriasis. It praises the Bath approach, saying staff have out-paced others by boosting patients’ understanding of their condition.
Staff at Leeds Teaching Hospitals NHS Trust signpost patients to a dedicated portal for advice on how to manage spondyloarthritis, the report notes.
Building peer support
Turning to the importance of connecting patients with their peers to build mutual support, the report says this aspect was welcomed by a patient called Andrew Kirtley who attended the Bath residential course.
‘Participants on the course spend time socialising with each other during the day and in the evening, and often establish lasting friendships and support networks,’ the report notes.
While there is evidence that peer support can help people with long-term pain and fatigue, mental health problems and other long-term conditions, many specialist NHS services are apparently lagging behind.
‘It isn’t clear why specialist services have not invested in peer support, whether because they don’t consider it their role, are unsure of the benefits, don’t see it as a priority, or have simply overlooked it.
Associations such as the National Axial Spondyloarthritis Society play an important role in bringing patients together, although not specifically in peer-support groups, the report suggests. For more information, see: https://nass.co.uk
Pioneering service with a long history
- the pioneering Royal National Hospital for Rheumatic Diseases has been a specialist centre for axial spondyloarthritis since the 1960s
- over the past decade, it has led awareness campaigns among physiotherapists, primary care staff, chiropractors and other professional groups
- it has also developed a notification system for GPs on EMIS and SystmOne and a separate website to support more accurate initial diagnosis and referral to specialist services
- current guidelines encourage staff to start patients with anti-inflammatory drugs, track progress using patient-reported outcomes, and move patients on to biologics, if needed, later, the report states.
Intensive support is crucial
Staff at the Bath service use their clinical judgement to determine whether to start patients on biologics much earlier.
‘Rather than drip feeding support over a patient’s lifetime, the focus is on intensive support from consultants, nurses and therapists at an early stage to get the condition under control,’ the report adds.
To download copies of Innovation in treatment for people with rarer or less well-recognised long-term conditions, which was commissioned by UCB, visit: https://bit.ly/3rfY5s6
Author: Ian A McMillan