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Barriers and Facilitators of Vigorous Cardiorespiratory Training in Axial Spondyloarthritis: Surveys Among Patients, Physiotherapists, and Rheumatologists
Author(s) -
Niedermann Karin,
Nast Irina,
Ciurea Adrian,
Vliet Vlieland Thea,
BodegomVos Leti
Publication year - 2019
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23705
Subject(s) - facilitator , medicine , physical therapy , cardiorespiratory fitness , family medicine , psychology , social psychology
Objective Vigorous cardiorespiratory training ( CRT ) in patients with axial spondyloarthritis (SpA) is effective, safe. and feasible; however, it has not yet been adopted in axial SpA exercise programs. Therefore, the aim of this study was to explore the barriers and facilitators for vigorous CRT among patients, physiotherapists, and rheumatologists. Methods Stakeholder‐specific surveys were used to examine perceptions of barriers and facilitators to vigorous CRT , with categories organized according to the recommendations proposed by Grol and Wensing. Respondents chose the 3 most important barrier and facilitator categories and rated individual items on a 4‐point scale. Frequencies and proportions were calculated, and ratings between active and inactive patients were compared. Results Among all patients (n = 575 [response rate 34%]), the top 3 barrier categories were “low motivation” (n = 317 [59%]), “unsuccessful timing in daily routine” (n = 292 [55%]), and “hindering disease symptoms” (n = 272 [51%]). The top 3 facilitator categories were “high motivation” (n = 248 [47%]), “good organizational conditions” (n = 217 [41%]), and “facilitating disease symptoms” (n = 209 [40%]). More inactive patients than active patients chose “low motivation” as a barrier ( P = 0.01). Among physiotherapists (n = 40 [response rate 48%]), the top 3 barrier categories were “heterogeneous groups” (n = 26 [70%]), “difficult organizational conditions” (n = 19 [51%]), and “low perceived motivation” (n = 19 [51%]). Among physiotherapists, the top 3 facilitator categories were “knowledge” (n = 20 [54%]), “homogeneous group composition,” and “high perceived motivation” (both n = 17 [46%]). For rheumatologists (n = 73 [response rate 17%], with 54 [74%] answering barrier items and 68 [93%] answering facilitator items), the strongest barriers included “not enough information” (n = 25 [47%]) and “anticipated or perceived disinterest of patient” (n = 27 [50%]). The strongest facilitators reported by rheumatologists included “exercise important topic even in limited consultation time” (n = 65 [96%]) and “clear evidence for effectiveness of flexibility exercises” (n = 62 [91%]). Conclusion The identified facilitators and barriers will guide the development of stakeholder‐specific implementation strategies.