1. Highlights EULAR 2012
Health Professionals Sessions
John Verhoef MSc PT PhD
Professor of Physical Therapy
University of Applied Sciences Leiden
The Netherlands

2. Wednesday 06th of June 2012:
Crossing boundaries of primary to
secondary care
Future demands for cooperation between
specialised care and primary care

3. Opportunities and challenges in a future
primary health care for people with rheumatic
diseases
– Primary care is not the same all over Europe!
– Primary care could give opportunities regarding:
• Early diagnosis, efficient referral, more future patients to treat
and follow, life long management, life style interventions, deal
with comorbidities, some diseases are mainly treated in PC and
organizing care.
– Primary care challenges:
• Use and develop checklists, specific training of HP and
patients, IT support for communication, and teamwork
No abstract available; S. Bergman, Sweden

4. Collaboration across health service levels
– Need for health sector reform: develop integrated care
and collaboration between primary and secondary
specialist care
– In Norway treatment for OA is taken as a pilot for
health sector reform, because there are no treatment
pathways available
– Three projects were started to stimulate cooperation
between PC and SC
– Key factors for succes: funding, changing behavior, and
keep it simple, but structured!
SP0040: Nina Osteras, Norway

5. Hopes and real life experiences of
communication between specialist health care
and primary health
–Real Life experiences:
• In communication the responsibility is transferred to the
patient (unwanted by the patient)
• Survey-results: patients are frequently used as messenger
between specialist care and primary care
–Hopes from the patient perspective:
• Responsibility for transfer of information goes back to the HP
• Develop tools to enhance communication
• Patients themselves should ask for changes
SP0041: Connie R. Ziegler, Denmark

6. Future challenges for health professionals;
communication across health care levels
– Literature overview from a health systems perspective
– Comparative institutional ethnographical (patient-
centered) study routine care processes to RA patients in
Austria, Sweden and the UK
– Despite the differences in the systems in principle it is
possible to ensure continuity of care
– Getting insight into processes and structures of
communication across care levels opens opportunities
for changing daily practice
SP0042: B.Prodinger, Canada

7. Thursday 7th of June 2012:
HPR abstract session
Progress in rehabilitation –
the future is bright

8. A MULTIDISCIPLINARY AND
MULTIDIMENSIONAL PROGRAM FOR
HAND OSTEOARTHRITIS IS NOT
EFFECTIVE:
–Single blinded randomized multicenter trial with patients with hand
OA:
• Four weekly multidisciplinary intervention (goal setting, exercises,
education, splinting): n=76
• 30 minutes education and 3 months on waiting list: n=75
• Outcome: pain, activity limitations, grip strength, self-efficacy, pain
coping and QoL
–Conclusion:
• No benefit on short term
• Future reseach focussed on effectiveness of single treatment elements
targeted on patient characteristics and needs
OP0075-HPR: M.J. Stukstette et al, Netherlands

9. EFFECTS OF A SOFT THUMB
BASE SPLINT
– Randomized controlled trial with patients with carpometacarpal
OA:
• Splint-group: hand exercises (twice a day) and splint; n=30
• Control-group: hand exercises (twice a day); n=29
• Outcome: grip- and pinch strength, pain, thumb-webspace, joint
mobility, self-reported hand function (two months follow-up)
– Conclusion:
• No benefit on long term
• Only an immediate pain-relieving when worn
OP0076-HPR: M. Hermann et al, Norway

10. EFFECT OF INTERACTIVE WORKSHOP
ON ADHERENCE WITH DUTCH PT
PRACTICE GUIDELINE HIP AND KNEE OA
– PT’s from 5 regions were randomly assigned to:
• Interactive workshop (content guideline, 3 clinical cases with patient
partners and 3 regional experts, lasted 3 hours): n=141
• Control group (waiting list group): n=134
• Outcome: QIP-HKOA, knowledge questionnaire, guideline barriers
questionnaire (before, after, 2 months later)
– Conclusion:
• Statistical difference on all measures in favour for IW
• Effective strategy to improve adherence with the recommendations of
the Dutch PT guideline on HKOA
OP0077-HPR: W.F. Peter et al, Netherlands

11. THREE WEEK REHAB PROGRAM HAD
POSITIVE LONG TERM EFFECTS IN
PATIENTS WITH ANKYLOSING SPONDYLITIS
– Observer blinded randomized contolled trial with patients with
ankylosing spondylitis:
• Three weeks inpatient rehab program: n=46
• Usual treatment: n=49
• Outcome: BASDAI (disease activity), BASFI (function), well-being,
spinal and hip mobility, SF-36 QoL (4 and 12 months)
– Conclusion:
• Significant benefit in favour for the rehab group regarding BASDAI,
well-being and some SF-36 variables.
• This 3-week inpatient program should be considered an important
complement to medical disease management in patients with AS
OP0078-HPR: I. Kjeken et al, Norway

12. EFFECTS OF A ONE WEEK
MULTIDISCIPLINARY INPATIENT SELF-
MANAGEMENT PROGRAMME FOR
PATIENTS WITH FIBROMYALGIA
– Randomized controlled two-armed assessor-blinded trial with
patients with fibromyalgia:
• One week multidisciplinary inpatient SMP (psychological distress,
health consumer skills, self-efficacy, information on FM): n=58
• Waiting list control group: n=60
• Outcome: General Health Questionnaire-20, Effective
Musculoskeletal Consumer scale-17, Fibromyalgia Impact
Questionnaire, Self-efficacy (ASES) (3-week follow-up)
– Conclusion:
• Small short-term effect on skills and behavior important for managing
and participating in health care (EC-17)
• No others differences found
OP0079-HPR: B.Hamnes et al, Norway

13. Aerobic training in patients with ankylosing
spondylitis
– Randomized controlled assessor-blinded trial with patients with
ankylosing spondylitis:
• Intervention group: fifty minutes of walking in the individual
anaerobic threshold associated with stretching exercises three times a
week for twelve weeks: n=32
• Control group: only stretching exercises: n=32
• Outcome: BASFI, HAQ-S, BASMI, BASDAI, CRP, aerobic capacity
treadmill-test and 6-minute walking test at T0, T6 and T12 weeks
– Conclusion:
• The IG showed significant improvement in 6MWT compared to the
control group. There was an increased walking distance and
cardiopulmonary capacity.
OP0080-HPR: F. Jennings et al, Brazil

14. Concepts important to patients with RA in rehab
and their coverage by rehab tools
– Qualitative focus group study with patients with RA in
combination with a systematic literature review:
• This study aimed to explore whether RA patients’ perspectives on
rehabilitation are covered by current rehabilitation instruments (RAP,
COPM, WHODAS-II, ICF Core sets)
• Outcome: Using the ICF as a common framework, the focus groups
(19 patients in 4 groups) showed that personal characteristics,
handling disease and limitation, self-confidence and maintaining
independency was not at all covered within the rehab tools
– Conclusion:
• Current rehabilitation tools poorly cover the concepts that patients
find essential during rehabilitation
• The ICF-CSRA best covered patients'’ perspective
OP0081-HPR: J. Meesters et al, Netherlands

15. Short term effect of 2-weeks rehab on disease
activity and health status in patients with AS
– Descriptive retrospectively study for AS patients who participated
in 2-week rehab program January 2007 to June 2011: n=87
• One week multidisciplinary inpatient SMP (psychological distress,
health consumer skills, self-efficacy, information on FM): n=58
• Waiting list control group: n=60
• Outcome: BASDAI, BASFI), BASMI, Gait Velocity, Timed-Stands
Test, Occiput-Wall Distance, Finger-Floor Distance, Chest
Expansion, ESR and CRP
– Conclusion:
• short term rehab improves disease activity and physical function.
• did not reduce ESR and CRP
OP0082-HPR: G. Haugeberg et al, Norway

16. Thursday 7th and Friday 8th of June 2012:
Guided Poster Tour HPR

17. Friday 8th of June 2012:
HP Workshop Session
Challenges in HP’ practice:
how to develop and execute a treatment
plan for a patient with rheumatic conditions
and comorbidities

18. Interactive presentation of two examples from
daily practice regarding a patient with OA and
comorbidities
– Setting individual treatment goals in complex cases
(T. Dager, Norway; SP0138)
– Exercise in case of multiple health problems
(M. de Rooij, Netherlands; SP0139 together with a patient Mrs. Linderman)
Tutor: J.A.M. Linderman, Netherlands

19. Setting individual treatment goals in complex cases
– Goal planning: essential part of rehab practice and is a
collaborative process between the patient and the
rehabilitation team
– Qualitative study of rehab outcomes emphasizes the
need to understand and take into account the patients'
own understanding of challenges when formulating
individual rehabilitation goals
– At the work-shop, the goal-setting process was
illustrated through patient cases, and factors facilitating
or hampering the goal setting process was discussed.
SP0040: Nina Osteras, Norway

20. Exercise in case of multiple health problems
– OA: highest rates of comorbidity associated with more pain,
greater limitations in daily activities, and worst functional
prognosis
– Comorbidities in knee OA: coronary diseases, heart failure,
hypertension, type 2 diabetic, obesity, copd, chronic pain, non-
specific low back pain, depression, and visual and hearing
impairments.
– Exercise therapy is one of the key recommendations lacking
comorbidity-associated adaptations
– In this inter active session the adaptations that have been made in
the diagnostic and intervention phase in a patient with OA of the
knee and comorbidities (diabetic type 2, hypertension and obesity)
was discussed
SP0040: Nina Osteras, Norway

21. Saterday 9th of June 2012:
Joint Clinical-HPR-PARE Session
Move, groove and improve
exercise and RMD’s
How to ensure safety, quality and
motivation in provision of exercise

22. Physical activity promotion in peolple with RMD’s:
RheumaNet
– No physical activity estimates for patients with RMDs
are available in Flanders.
– Initiated by patient organisations and Leuven
University: ReumNet.
– Goal: research project for developing tailored PA
intervention programs
– A web-based survey will start and will provide a good
estimate of PA needs in Flanders
SP0183: P. Verschueren, Belgium

23. How to ensure quality in exercise groups organised
by patient organisations
• In the state of North Rhine-Westfalia: 35.000 patients take
part in hydrotherapy exercise groups, about 10.000 in other
physiotherapy groups.
• Volunteers in about 100 local branches organize these
therapy groups.
• How do we enable that the patient gets the right therapy?
How is it made possible that the therapists working for us
are doing a good job?
• “asking these questions is the start of the solution’
SP0184: D. Wiek, Germany

24. An early morning stretch:
practical use of THERA band
No abstract: I. Kostas,Cyprus

25. Exercising safely – a PT perspective
– Aerobic and strengthening exercises are recommended
in treatment guidelines in patients with rheumatic
diseases, including rheumatoid arthritis and knee and/or
hip osteoarthritis
– adverse events 9low incidence) have been reported:
increase in pain, increase in joint inflammation,
increased cartilage degeneration, musculoskeletal
injuries and falls due to exercise
– There is a need to investigate adverse events resulting
from exercising as part of the improvement of care for
patients with rheumatic diseases
SP0185: M. van der Esch, Netherlands

26. Take Home Message
• Plan your next trip to the EULAR congress
• Give input to the EULAR HP Standing
Committee regarding the program
• Take a look at the EULAR website
regularly
• Have a save journey and see you next year!