Barriers and Facilitators of Vigorous Cardiorespiratory Training in Axial Spondyloarthritis: Surveys Among Patients, Physiotherapists, and Rheumatologists
Barriers and Facilitators of Vigorous Cardiorespiratory Training in Axial Spondyloarthritis: Surveys Among Patients, Physiotherapists, and Rheumatologists
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DOI：
10.1002/acr.23705
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发表时间：
2019-06-01
影响因子：
4.7
通讯作者：
van Bodegom-Vos, Leti
中科院分区：
文献类型：
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作者：
Niedermann, Karin;Nast, Irina;van Bodegom-Vos, Leti
目的：强化心肺训练（CRT）治疗中轴性脊柱炎（SpA）有效、安全。可行的;然而，它还没有在轴向SpA运动项目中被采用。因此，本研究的目的是探讨患者、物理治疗师和风湿病学家之间进行有力CRT的障碍和促进因素。方法根据Grol和Wensing提出的建议，采用利益相关者特定调查来检查对积极CRT的障碍和促进因素的看法。受访者选择了3个最重要的障碍和促进因素类别，并以4分制对个别项目进行了评分。计算频率和比例，并比较运动和不运动患者之间的评分。结果所有患者（n = 575例[有效率34%]）中，前3个障碍类别为动机低（n = 317例[59%]）、日常生活时机不佳（n = 292例[55%]）和阻碍疾病症状（n = 272例[51%]）。前3个引导者类别是高动机（n = 248[47%]）、良好的组织条件（n = 217[41%]）和促进疾病症状（n = 209[40%]）。选择低动机作为障碍的非运动患者多于选择运动患者（P = 0.01）。在物理治疗师（n = 40[应答率48%]）中，前3个障碍类别是异质性群体（n = 26[70%]）、困难的组织条件（n = 19[51%]）和低感知动机（n = 19[51%]）。在物理治疗师中，前3个促进因素类别是知识（n =20[54%]），同质组组成和高感知动机（n = 17[46%]）。对于风湿病学家（n =73[回复率17%]，其中54[74%]回答障碍项，68[93%]回答促进因素），最大的障碍包括信息不足（n = 25[47%]）和预期或感知到的患者不感兴趣（n =27[50%]）。风湿病学家报告的最有力的促进因素包括在有限的咨询时间内锻炼重要的话题（n = 65[96%]）和明确的柔韧性锻炼有效性证据（n = 62[91%]）。确定的促进因素和障碍将指导利益相关者具体实施战略的制定。
ObjectiveVigorous 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.MethodsStakeholder-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.ResultsAmong 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%]).ConclusionThe identified facilitators and barriers will guide the development of stakeholder-specific implementation strategies.