T. Swinnen

2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis

Regular physical activity (PA) is increasingly promoted for people with rheumatic and musculoskeletal diseases as well as the general population. We evaluated if the public health recommendations for PA are applicable for people with inflammatory arthritis (iA; Rheumatoid Arthritis and Spondyloarthritis) and osteoarthritis (hip/knee OA) in order to develop evidence-based recommendations for advice and guidance on PA in clinical practice. The EULAR standardised operating procedures for the development of recommendations were followed. A task force (TF) (including rheumatologists, other medical specialists and physicians, health professionals, patient-representatives, methodologists) from 16 countries met twice. In the first TF meeting, 13 research questions to support a systematic literature review (SLR) were identified and defined. In the second meeting, the SLR evidence was presented and discussed before the recommendations, research agenda and education agenda were formulated. The TF developed and agreed on four overarching principles and 10 recommendations for PA in people with iA and OA. The mean level of agreement between the TF members ranged between 9.8 and 8.8. Given the evidence for its effectiveness, feasibility and safety, PA is advocated as integral part of standard care throughout the course of these diseases. Finally, the TF agreed on related research and education agendas. Evidence and expert opinion inform these recommendations to provide guidance in the development, conduct and evaluation of PA-interventions and promotion in people with iA and OA. It is advised that these recommendations should be implemented considering individual needs and national health systems.

A survey across four European countries to determine rheumatology health professionals’ awareness of physical activity measures in people with inflammatory joint diseases

Objectives The objectives of this study were to determine rheumatology health professionals (HPs) awareness of and confidence in using physical activity (PA) measures in people with inflammatory joint diseases (IJDs), their own self-reported PA levels and to identify HP-related educational needs. Methods Rheumatology HPs in Denmark, Sweden, Ireland and Belgium participated in an on-line survey. Descriptive statistics and latent class analysis (LCA) were undertaken SPSS (v21and SASv9.4) to describe data aggregates and range and to identify subclasses of groups with respect to use of PA measures. Results 322 (n=322, 75.5% women) HPs responded from Denmark (n=50, 15.5%), Sweden (n=66, 20.5%), Ireland (n=28, 8.7%) and Belgium (n=178, 55.3%) and the majority of respondents (n=286, 91.7%) reported it was important to measure PA in people with IJDs. Only 28.2% of HPs used simple body worn sensors to measure PA levels in their patients. The majority were interested in on-line education on measuring PA (82.9%). LCA, used to generate classes of PA measures employed by HPs, revealed three distinct classes reflecting differences in self-reported PA levels, awareness of PA measures, further education requirements and professional background. Conclusions The majority of respondents reported that they considered measuring PA as important in people with IJDs; however, the majority lacked confidence in how to measure it. There was strong interest in further education around measuring PA. Three distinct respondent classes were identified to inform targeted education on how to measure PA.

FRI0647-HPR Physical Activity and Aerobic Capacity Assessment - A Survey among Patients with Rheumatic Disease in Sweden, Ireland, and Denmark

Background Despite its positive effects on health outcomes, insufficient levels of physical activity (PA) have been found in the arthritis population. In addition, lower aerobic capacity adds to the patients risk for cardiovascular disease. Increasing PA is thus important for this group and the use of objective and self-reported measures of PA should be encouraged as self-monitoring and evaluation of PA support promotion of healthy PA behaviours. Objectives To investigate the familiarity with objective and self-reported PA and aerobic capacity assessments and to identify barriers for their implementation in patients with rheumatic disease in Sweden, Ireland and Denmark. Methods Patients with rheumatic disease were invited through each countrys patient organisations to participate in a cross-sectional, observational study using online survey methodology. Results A total of 791 patients (87% female) responded (579 Danish, 90 Irish and 122 Swedish) with Rheumatoid Arthritis (42%), Ankylosing Spondylitis (14%), Psoriatic Arthritis (25%) as main diagnoses. 99% of the patients reported pain during the past week in hand (62%), leg (60%), arm (58%), foot (51%), back (49%) and/or neck (36%). A total of 25% reported large limitations in moderate daily activities and 24% in climbing stairs. Use of biological disease modifying anti rheumatic drugs (Bio-DMARDS) was reported by 28% and non-biological DMARDS by 47%. Two thirds found it important to measure PA and approximately half stated they do not receive information regarding the same. Moderate levels of familiarity with simple body-worn sensor (mean 5.47/10; SD 4.04) to measure PA was found. Familiarity was lower with paper questionnaires (4.09/10; SD 3.69), complex body-worn sensors (3.70/10; SD 3.87), digital diaries (3.07/10; SD 3.53), paper diaries (3.45/10; SD 3.64) and digital questionnaires (3.46/10; SD 3.67) to measure PA. There was no statistically significant association between diagnosis, physical limitation or localisation of pain in relation to the familiarity of the above measures of PA (p>0.05), however, patients on Bio-DMARDS were more familiar with simple (p=0.016) and complex sensors (p=0.003), digital questionnaires (p=0.009) and diaries (p=0.006). 34% reported that their aerobic capacity had been tested whilst 57% reported no testing. Barriers for patients with rheumatic disease for measuring PA were reported by 43% and access to device (25%), uncertainty of handling the results (14–17%) and cost of device (10%) were most common. Conclusions Although most patients with rheumatic diseases in our sample perceived measures of PA as important, familiarity and information of their use was largely lacking. Also, aerobic capacity assessment occurred infrequently. To motivate behavioural change towards a more physically active lifestyle and to support individuals independence of health care, health professionals should facilitate awareness and knowledge of PA measures, encourage their patients to regularly self-monitor PA and more often offer PA and aerobic capacity testing to their patients. Disclosure of Interest None declared

FRI0237 Widespread Pain is Common in Patients with Axial Spondyloarthritis: A Topographical Analysis of Body Charts and the Relationship With Clinical Variables

Background Pain is a core outcome domain in the assessment of axial spondyloarthritis (aSpA) and can be therapeutically challenging. To date, only (spinal) pain intensity is captured in this patient group via numerical rating scales. State-of-the-art physiological insights suggest a role for topographical analysis to classify underlying pain mechanisms in clinical practice1. Unfortunately, no data on “the spread of pain” are available in aSpA. Objectives To explore pain locations and widespread pain in patients with aSpA and to explore their relationship with clinical variables. Methods We collected demographics, the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index total score (BASDAItot), stiffness items combined (BASDAIstiff) and spinal pain item (BASDAIpain) and the Bath Ankylosing Spondylitis Metrology Index (BASMI) in 125 participants with aSpA (male/female: 80/45; mean ± SD, age: 43.9±11.67 yrs; height: 171.06±9.54cm; weight: 76.96±15.27;BASMI: 3.27±1.78;BASFI: 3.81±2.57;BASDAI: 3.88±2.26; Biologicals yes/no: 65/60; disease duration: 13.23±9.99). Body charts divided in 80 body regions (20 spinal) were filled in by patients and informed on pain locations during the last week. Body charts were scored using a grid by two independent raters (mean kappa 0.940, range 0.778-1.00). Spearman rank correlations were used to examine relationships with clinical variables (p<0.05). Results Low back pain was reported by 94 patients (75%), while only low back (22;18%), thoracic (2; 2%) and cervical (3; 2%) pain was remarkably rare. Similarly, leg pain was infrequent (right: 3; 2.4%, left: 1; 0.8%). Widespread pain in all spinal regions was common (49, 40%). Low back pain correlated with thoracic (R=0.377; P<0.01) and cervical pain (R=0.180; P<0.05). The sum of the all painful regions was associated with BASDAItot (R=0.547; P<0.01), BASDAIpain (R=0.477; P<0.01), BASDAIstiff (R=0.413; P<0.01) and BASFI (R=0.405; P<0.01), indicating that the spread of pain is a related but distinct clinical construct. BASMI was not related to body chart outcomes (p>0.05). Conclusions Widespread spinal is a common clinical feature in aSpA that is associated with disease-specific outcome measures. Body charts add essential information in the assessment of pain and are a valuable focus for future research in aSpA. References Malfait AM, Schnitzer TJ. Towards a mechanism-based approach to pain management in osteoarthritis. Nat Rev Rheumatol. 2013 Nov;9(11):654-64. Disclosure of Interest None declared

THU0605-HPR Patterns of Physical Activity Matter: Bout Analysis Reveals Differences Between Patients with Axial Spondyloarthritis and Healthy Controls

Background Low total physical activity (PA) levels and remarkably less (very)vigorous physical activities have been shown in patients with axial spondyloarthritis (aSpA) compared to healthy controls using objective sensor-based technology1. Ten minute bouts of moderate to (very)vigorous PA (instead of frequent interruptions) are associated with additional health benefits. These within-day patterns of PA are unknown in aSpA. Objectives To compare PA patterns (bouts) between patients with aSpA and healthy controls. Methods PA was compared between 40 patients with aSpA (male/female: 24/16; Mean ± SD, Age:44.38±11.30 yrs, BMI:26.27±5.11 kg/m2, disease duration: 11.40±9.50 yrs) and 40 healthy, age and sex matched controls (Age:44.33±10.63 yrs, BMI:25.05±3.59 kg/m2) during five consecutive days (three weekdays and two weekend days) using the SenseWear Pro3 Armband. Weekly PA accumulated in 10-minute bouts (A) and the number of bouts (N) for each PA intensity level were contrasted between groups with Wilcoxon signed- rank tests (p<.05). Differences with prior non-bout (NB) data were provided for comparison with median group differences in %. Results Weekly vigorous and very vigorous PA were significantly lower in aSpA irrespective of analysis technique (vigorous: NB: p<0.001,A&N: p=.003; very vigorous: NB p<001,A&N p=.008). Bouts analysis revealed novel and more profound (%) differences for moderate PA (NB: p=.070,-28%, A: p=.062,-49%, N:.046,-55%) and moderate to (very)vigorous PA (NB: p=.029,-32%, A: p=.003,-65%, N:p=.002,-67%) with lower values for patients. Thus in absolute terms, patients accumulate 21 minutes (trend) and two 10-minute bouts (significant) less moderate PA per day, a difference not detected with NB analysis. Similarly, patients performed 40 minutes and three 10-minute bouts less moderate to (very)vigorous PA. No differences between groups were found for inactivity and light PA (p>.05). Conclusions Bout analysis revealed additional differences in health-enhancing PA behavior between patients with aSpA and healthy controls. This work adds to the emerging body of evidence showing lower PA in this patient group. Future work in aSpA should focus on the consequences of low PA, its relevance for outcome assessment and on the development of tailored PA interventions. References Swinnen TW, Scheers T, Lefevre J, Dankaerts W, Westhovens R, de Vlam K. Physical activity assessment in patients with axial spondyloarthritis compared to healthy controls: a technology-based approach. PLoS One. 2014 Feb 28;9(2): e85309. Disclosure of Interest None declared

FRI0146 Proof of Concept: Objective Assessment of Physical Function with the Instrumented Bath Ankylosing Spondylitis Functional Index (IBASFI)

Background To date, the established method to assess physical function in patients with axial spondyloarthritis is the self-reported Bath Ankylosing Spondylitis Functional Index (BASFI). In an attempt to overcome the shortcomings of self-reported outcomes such as recall bias and aberrant self-judgments, performance-based assessment of physical function has become increasingly popular in the field of axial spondyloarthritis1. We developed reliable and valid algorithms to automatically detect movement time during performance-based tests using on body-worn sensor that need to be compared to the established BASFI. Objectives To compare automated movement time detection to each corresponding Bath Ankylosing Spondylitis Functional Index (BASFI) item (i.e. construct validity). To reduce the number of performance-based tests to assess physical function in patients with axial spondyloarthritis. Methods Twenty-eight consecutively evaluated patients with axial spondyloarthritis (Age: 43.69 (10.45); BMI: 26.19 (5.71); BASMI: 3.11 (1.60); BASFI: 3.41 (2.19); sex: 16M,12F) completed twelve (10 with movement time, 1 with height and 1 with range of motion as the outcome of interest) performance-based tests derived from the BASFI questionnaire. All patients wore a two-axial accelerometer fixed on the upper arm or the trunk. A blinded physical therapist guided the tests and the BASFI and all other clinical data were collected up front. Movement time was extracted from filtered accelerometer signals using custom-written automated algorithms in MatLab. Prior work established the reliability of this method (ICC range 0.753 to 0.986). Each performance-based test was related for construct validity purposes to the corresponding BASFI item and total BASFI score using Pearson-product moment correlation coefficients. A stepwise linear regression was used to model the BASFI from an optimal set of performance-based tests. Results Good to excellent construct validity for each instrumented performance-based test was found with overall significant and moderate to good association with the corresponding BASFI scale (rs) or item (ri) for sock test (rs 0.376, ri 0.466), pen test (rs 0.482, ri 0.480), 5 pens speed test (rs 0.597, ri 0.402), maximal reach test (rs -0.374, ri -0.230), shoulder speed test (rs 0.300, ri 0.397), sit-to-stand test (rs 0.631, ri 0.706), getting up test (rs 0.488, ri 0.462), stair climbing test (rs 0.617, ri 0.546) and looking over the shoulder test (rs 0.520, ri 0.730). Together, sit-to-stand speed test (standardised Beta: 0.464, p: 0.003), looking over the shoulder test (standardised Beta: -0.362, p: 0.015) and maximal reach test standardised Beta: -0.325, p: 0.019) explained 55% of the variance in BASFI, confirming construct validity of the composite and successful reduction of items. No issues on collinearity were detected with the variance inflation factor and tolerance statistics. Conclusions The novel performance-based iBASFI showed excellent construct validity and is suitable for clinical use. The number of performance-based tests needed to model physical function can be minimized without compromising validity. References van Weely SF, et al. Rheumatology (Oxford). 2009 Oct;48(10):1254-60. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.6047

FRI0587-HPR Development of the Instrumented Bath Ankylosing Spondylitis Functional Index (IBASFI) in Axial Spondyloarthritis: Reliability and Validity of Automated Accelerometry-Based Algorithms

Background Performance-based in addition to self-reported assessment of physical function has become increasingly popular in the field of axial spondyloarthritis1. Unfortunately, the observer capturing movement time with a chronometer requires extensive training in standardized assessment. A body-worn sensor may enable automated detection of movement time during performance-based tests. Objectives To establish the within-session test-retest reliability of novel automated movement time detection algorithms using a body-worn accelerometer. To compare automated versus manual segmentation of acceleration signals. To compare movement time captured with an accelerometer versus a chronometer (i.e. concurrent validity). Methods Twenty-eight consecutively evaluated patients with axial spondyloarthritis (Age: 43.69 (10.45); BASMI: 3.11 (1.60); BASFI: 3.41 (2.19); Sex: 16M, 12F) completed ten performance-based tests derived from the BASFI questionnaire. All patients wore a two-axial accelerometer fixed on the upper arm or the trunk. An observer captured movement time with a chronometer. All tests were repeated twice and all clinical data were collected up front. Movement time was extracted from filtered accelerometer signals using custom-written automated algorithms in MatLab and by calculating the mean of manual signal segmentations by two blinded evaluators. Trials or methods were compared with the intraclass correlation coefficient and the standard error of measurement (SEM) clinically expressed in % of total movement time. Results Good to excellent test-retest reliability of automated movement time was found with the lowest ICC values for sock test (ICC 0.765, 0.482-0.893), maximal reach test (ICC 0.528, 0.185-0.753), shoulder speed test (ICC 0.785, 0.441-0.911) and sit-to-stand test (ICC 0.753, 0.537-0.877), but very high ICC values for pen test (ICC 0.812, 0.637-0.908), 5 pens speed test (ICC 0.974, 0.887-0.991), sit-to-stand speed test (ICC 0.959, 0.803-0.986), lying down (ICC 0.979, 0.954-0.991), getting up (ICC 0.993, 0.985-0.997) and stair climbing (ICC 0.863, 0.714-0.935). Overall, single/self-selected pace movements were less reproducible than repeated/fast pace movements. SEM values ranged from 13 to 46%, excluding the pen (46%) and maximal reach test (64%) . Automated segmentation of acceleration excellently mimicked the mean value of manual segmentation (ICC range 0.900-0.998), except for the maximal reach test (ICC 0.727, 0.063-0.906) and sit-to-stand test (ICC 0.599, 0.189-0.881). In comparison to to the chronometer, automated movement time was validly assessed (ICC range 0.878-0.998), apart from the maximal reach (ICC 0.532, 0.133-0.768) and sit-to-stand test (ICC 0.770, 0.565-0.886). SEM values ranged from 8 to 44%, ignoring the maximal reach test (66%). Conclusions We developed automated movement time detection algorithms that are psychometrically sound and viable for clinical application. Automated analysis for repeated and fast-paced performance tests shows excellent test-retest reliability and criterion-based validity and can replace the chronometer. The maximal reach test is nor reproducible nor valid. References van Weely SF, et al. Rheumatology (Oxford). 2009 Oct;48(10):1254-60. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.6021