1. RNHRD AS rehabilitation course Dr Raj Sengupta

2. How the course started Allan St John Dixon Within 5 years of starting at the RNHRD

3. Who we are.. Team of : 4 physios: Amanda Thomas Brisa France Emily Clarke Nicky Vigor Administrator: Belinda Jones Consultant: Raj Sengupta OT, Podiatrist, Pharmacist, Councillor and Specialist Nurse input on our 2 week course

4. 2 week residential course. Holistic approach addressing the physical and emotional aspects of their condition. Educate, Exercise and Engage Intensive, group approach builds friendships and support Link with local/ national groups What we do...

5. Knowledge is power! Pathology Diet Sleep Pain Foot Health Posture Fatigue Relationships Work Medication Appropriate Exercise Managing flare-ups Genetics Biomechanics Adherence to exercise Coping skills

6. Why the inpatient setting? Hierarchy of treatment for AS patients: (cochrane review, 2008) 1.Intensive inpatient therapy 2.Group exercise 3.Home exercise

7. What’s the best exercise for AS? Hydrotherapy Tai chi Pilates Nordic walking Stretching Aerobic exercise yoga Gentle strengthening Gym balls Balance

8. What our patients say.. “Without this I could not have managed, please keep going!” Male 45-64 “An example of the NHS at it’s best. I am leaving with a renewed sense of being able to manage my condition” Female aged 45-64 “I have gone from feeling totally lost and hopeless to feeling able to make myself feel normal” Male aged19-30 “I feel the course has helped change my life, and I know without it my illness would be considerably worse” Male aged19-30 “A shining example of the benefit of education and prevention. Empathy and information was tailored to my needs and level of understanding.” Female aged 31-44 “ I hobbled in on sticks and I’m going out dancing!” Female aged 45-64

9. Physio in the era of biologics… Does rehabilitation still have a role to play in the treatment of AS? Published data supports rehab for patients commencing, or stable on, biologic agents (Lubrano et al 2011, Masiero et al 2011). Motivation and time spent on exercise improves after introducing anti-TNF (Dubey et al 2008).

10. Evidence

11. Inpatient rehabilitation Course at RNHRD 2 week inpatient course with physio, hydro, OT, podiatry, pharmacy, medical input 236 patients Outcome measure beginning and end of course Which Patients with Ankylosing Spondylitis Derive Most Benefit from an Inpatient Management Program? Band et al. J Rheumatol 1997:24223814

12. Demographics MeanSt DevMinimumMaximum No of courses43.79120 Age46112175 Age at onset238865 Disease duration2311053 BASDAI4.71.90.79.4 BASFI52.10.410 BASMI4.52.10.29 BASG5.12.3010

13. Results BASDAIBASFIBASMI Pre course4.754.5 Post course3.83.73.5 Mean change0.841.270.97 % change20%25%22% P value<0.0001

14. The Bath Ankylosing Spondylitis Functional Index (BASFI) effectively measures treatment response in AS patients at all stages of disease duration Raj Sengupta 1, Emma Pomeroy 1,2, Rebecca Mogg 1,2, Jennifer Richardson 1, Lou Gay 1, Millicent A Stone 1,2 1 Royal National Hospital for Rheumatic Diseases, Bath, UK. 2 School for Health, University of Bath, UK. Conclusions Functional response to inpatient physiotherapy treatment does not change significantly with increased disease duration in AS. The BASFI is therefore a good outcome tool to measure response to treatment in AS patients at all stages of their disease. Reference: Ward M. Annals of the Rheumatic Diseases 2007;66 (Suppl III):iii32-iii34 Figure 1: Mean BASFI change, mean percentage BASFI change and effect size for groups of differing disease duration

15. Inpatient physiotherapy significantly reduces fatigue in Ankylosing Spondylitis patients Emma Pomeroy 1,2, Raj Sengupta 1, Rebecca Mogg 1,2, Jennifer Richardson 1, Lou Gay 1, Millicent A Stone 1,2 1 Royal National Hospital for Rheumatic Diseases, Bath, UK. 2 University of Bath, UK. Conclusions Participation in a two-week inpatient physiotherapy course decreased fatigue in the majority of patients, particularly for General and Physical Fatigue. General and Physical Fatigue show particular improvements with effect sizes similar to those for disease activity and function. Although the increased physical activity levels during inpatient physiotherapy might be expected to increase fatigue levels in the short term, these data suggest an immediate effect in alleviating fatigue which AS patients themselves identify as a major symptom. Figure 2: Effect sizes for outcome measures before and after the inpatient physiotherapy course

16. BASMI examples

22. Memories AS Rehabilitation course in pictures

24. How to refer to us Consultant or GP referral Written referrals should be made to: Dr Raj Sengupta Consultant Rheumatologist. RNHRD, Upper Borough Walls, Bath, BA1 1RL Tel: 01225 473444 Fax: 01225 473437 Further information about the course : Belinda Jones, Course Administrator. belindajones@nhs.net Tel: 01225 473455 Visit our website www.rnhrd.nhs.uk/page/64