Background
Axial Spondyloarthritis (AxSpA) is an inflammatory arthritis, the main symptom is back pain. During a flare of AxSpA, the symptoms of pain, loss of movement and stiffness can worsen -access to specialist physiotherapy is important at this time.
The Rheumatology Team were part of National Axial Spondyloarthritis Society- Aspiring to Excellence programme (https://nass.co.uk/) from 2020 -2024, designed to encourage and recognise service improvement in AxSpA care, and reduce the delay to diagnosis for those with this condition.
A pathway for specialist physiotherapy for newly diagnosed AxSpA patients was implemented then - (Fig 1)
However, the waiting time for flaring AxSpA patients had risen in 2024 to 18 weeks-referral patterns increased by 100% -with no increase in resources. GIRFT (www.gettingitrightfirsttime.co.uk) states AxSpA patients should be seen in a timely manner- this was not being achieved
2. Aims of the project
- to review the specialist physiotherapy AxSpA pathway ensuring NICE and GIRFT recommendations achieved;
- ensure access to specialist physio in a flare and reduce the delay for follow up treatment was achieved.
3. Measurement: Audit Method/QI Measurement
A weekly gym session was implemented– we asked our current patients what they wanted from a flaring service.
Patients offered 6 weeks graded individualised exercise, attend at their choice, incorporating shared decision making. All patients are offered access to web based physiotherapy- an online physiotherapy exercise plan they access at home daily, encouraging self-management, exercise adherence (www.giraffehealth.com)
we utilised QI strategies ,implemented outcome measures including sixty second sit-stand test, Bath Indices BASMI score for AxSpA (www.nass.co.uk), and patient confidence in movement pre-and- post the gym sessions intervention.
Early results all referred patients completing the sessions -all improving in confidence of movement/ functional ability.
4. Interventions
Each patient attending discussed with their physiotherapist long-term management of flares- and how they access specialist Rheumatology physio in a timely manner.
5. Implementation Strategies
Gym session started May 2024. With increase in flaring AxSpA patients, a member of staff joined the AxSpA team.
6. Results/ Impact on Service/Patient Care/Learning
Improved quality of care for AxSpA patients,
implemented a rapid-access service, with a ‘you said, we did approach,’
increased the number of physio staff trained in specialist physio.
Waiting time for AxSpA patient accessing physiotherapy reduced from 18 weeks to 1 week.
7 What happens next:
Continue with weekly gym session - patient satisfaction high and the wait for a flaring AxSpA patient is now less than one week – in line with national standards of care.
Model could be expanded into other Rheumatology inflammatory conditions, improving quality of care and reducing waiting times
8. Personal Reflections of your Learning Journey
Working collaboratively with Tyneside Integrated staff to provide AxSpA service and improved communication links. (www.tims.nhs.uk)
Understanding the importance of set development time to allow progression of a service.
Patient involvement in planning was crucial to success of the project and the new service via “you said, we did” approach.
Improved the clinical skills of junior staff as the project allowed them to work with this complex patient group and expand their specialist Rheumatology knowledge
You can read and download the project Poster HERE and the service pathway HERE