The role of the Rheumatology nurse in improving compliance with exercise plans in patients with Ankylosing Spondylitis
Maria Lynch, Bernie McGowan, Bryan Whelan, Carmel Silke
North West Rheumatology Unit, Our Lady’s Hospital, Manorhamilton, Co. Leitrim
Ankylosing Spondylitis (AS) is a form of chronic inflammatory arthritis characterised by sacroilitis, spinal and peripheral enthesitis. It frequently features a propensity for sacroiliac joints and spinal fusion (Braun and Sieper, 2007). Maintenance and improvement of flexibility have been pinpointed as the focal point of exercise programmes in reviews of clinical trials investigating physiotherapy interventions for the AS patient (Dagfinrud et al., 2011).
In the absence of on-site physiotherapists at clinics, the Rheumatology nurse during her assessment, education and management of the patient with AS is ideally placed to include an assessment of the patients’ physical activity levels, measures of flexibility and adherence to tailored exercise programs.
A sample of 22 patients from the North West Rheumatology region with a diagnosis of AS, were reviewed and their personal reports of exercise habits were analysed. Each patient was questioned on their exercise patterns and grouped into 4 main groups. Along with the patients’ physical activity levels, their Bath Ankylosing Spondylitis Functional Index (BASFI) score for levels of exercise is also recorded.
The results of the survey of 22 patients attending the NWRU with a diagnosis of AS identified that only 13% of the patients were exercising on a weekly basis. The results showed that of the 22 patients (mean age 51yrs) with a diagnosis of AS presently attending the NWRU identified that in total 12(55%) of the AS patients were performing little or no exercise prior to their clinic.
In the NWRU and in many of the rheumatology units across the country due to limited resources patients with a diagnosis of AS do not have direct access to the physiotherapist unless they arrange same on a private basis therefore the CNS as “a gatekeeper” must advocate exercise as a vital component in the effective long-term management of AS. By increasing confidence and skills in exercise, patients can be empowered to take control of their overall health.