Author: Lynda

March 2025

Establishing a Flaring Pathway and Fast Access to Physiotherapy for Patients with Axial Spondyloarthritis - Motion, M ; Otun, D ; Collins, S ; Peart, B

CONTEXT
Axial Spondyloarthritis (AxSpA) is an inflammatory arthritis with the main symptom being back pain. During a flare of AxSpA, the symptoms of pain, loss of movement and stiffness can worsen – urgent access to specialist physiotherapy is important at this time. The Rheumatology Team were part of NASS Aspiring to Excellence programme (https://nass.co.uk/) from 2020 -2024, designed to encourage and recognise service improvement in AxSpA care. A pathway for specialist physiotherapy was implemented (Fig 1) However, the waiting time for flaring AxSpA patients had risen in 2024 to 16 weeks, caused by referral patterns increasing by 100% and with no increase in resources. GIRFT (www.gettingitrightfirsttime.co.uk) states AxSpA patients be seen in a timely manner - this was not being achieved .

Service Improvement Initiative:
Review the specialist physiotherapy AxSpA pathway ensuring NICE and GIRFT recommendations were being achieved, facilitating rapid access to specialist physio in a flare and reducing the delay for follow up treatment.
Ensure the patient pathway for AxSpA was being followed.
AxSpA patients also have access to hydrotherapy – especially helpful when they are in a flare and struggling to exercise on dry land.

Outcome:

BASMI improved by 42%

What I did:
Weekly gym session implemented – asked current patients what they wanted from a flaring service. Patients offered 6 weeks graded individualised exercise to attend at their choice and incorporating shared decision making.
All patients offered access to web based physiotherapy - an online physiotherapy exercise plan they access at home daily, encouraging self-management and exercise adherence (www.giraffehealth.com)
Utilised QI strategies and a “you said, we did“ approach, implemented outcome measures including sixty second sit-stand test, BASMI to assess score for AxSpA (www.nass.co.uk), confidence in movement pre-and- post.
Early results all referred patients completing the sessions - all improving in confidence to move and functional ability.

Confidence to exercise improved by 40%

Improvement Project

1 Minute Timed Sit-to-Stand improved by 32%

Impact of the Changes:
Improved quality of care for AxSpA patients, implemented a rapid-access service with a “you said, we did” approach and increased the number of physio staff trained in specialist physio. Waiting time for AxSpA patient accessing physiotherapy reduced from18 weeks to 1 week.
Hydrotherapy evaluated and bespoke programme introduced with rapid access for flaring patients,

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.
Look to set up NASS patient exercise group at Newcastle Hospitals, to encourage patient long term self management – www.nass.co.uk.

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

Project Lead: Mo Motion, Extended Scope Physiotherapist – Rheumatology