Author: Katie Motion

Newcastle & Gateshead Newly Diagnosed Axial Spondyloarthritis (AxSpA) physiotherapy pathway (Version 3– March 2022)

Referral triaged by ESP in rheumatology (1)

Review 1 mobility and flexibility work—NASS Back to Action (4)
Add in bespoke web-based programme , physio tools as appropriate (4)

Review 2- assess exercise programme, add in breathing , Cardiovascular exercise, HiiT exercises as appropriate, patient education (4)

Assessment including BASMI (2)
Individualised exercise plan and patient centred care (3)
Education on condition - NASS (2)Discuss self refer

Review 3– review exercises, add in strengthening exercises, discuss bone health (4)

Annual hospital review
Re measure BASMI
Review exercise plan
If deterioration– further physio reviews/ treatment as necessary (5) / discuss with ESP

Refer for hydrotherapy if BASMI 2.2 or above and /or patient struggling to exercise on dry land. (3)
Patient books review with referring physio post hydro for review– including BASMI
**more physio reviews as appropriate post hydrotherapy– patient centred
** telephone contact midway through hydro course to review if appropriate

Review 4- re measure BASMI
-discuss long term management and open appointment in physio / how to access physio
- flare management (4)

Any concerns any time
-Discuss with ESP
- refer to discuss at weekly AxSpA MDT (6)

1. Triaging on complexity of case and location—
2. Bath Indices, Appendix 2—NICE Guidelines for AxSpA 2017, Quality standards for AxSpA 2018, APPG for AxSpA 2020
3. NICE guidelines for AxSpA, local guidelines– best practise, BASMI measured pre and post hydrotherapy by referring physio.
4. AStretch best practice, APPG best practise, Consider Giraffe/web based physio, signpost to NASS information and exercise videos– Back to Action www.nass.co.uk, Your AS Journey
5. NICE 2017 for AxSpA, best practise AStretch
6. Weekly MDT meeting
Further physios reviews as appropriate (3,4)
Further physio reviews as necessary (4)
Add in web based as appropriate

Indicates secondary care