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Arthritis News

Last month, ARMA, supported by UK charity Arthritis Action, released a new report looking at the impact of mental health on people with arthritis and other musculoskeletal (MSK) conditions. The report followed a roundtable event, organised by ARMA in March, which, for the first time, brought together leaders from Mind, NHS England, Arthritis Action, and other health charities to look at ways to improve access to effective psychological support for MSK patients. ARMA published the report during Mental Health Awareness Week.

roundtable-document

Sue Brown, CEO of ARMA, says:

It’s not surprising that mental health is so common amongst people with conditions which cause long term pain. What is surprising is how little support with their psychological well-being is offered to people who live with daily pain. This roundtable report should be an important first step in changing this. There are interventions that have been shown to work, but they aren’t available in most areas. ARMA believes that everyone who could benefit from them should be offered them.”

MSK conditions comprise over 100 different diseases and syndromes that interfere with a person’s ability to carry out their normal daily activities. MSK conditions are thebiggest cause of disability in the country, with around 17.8 million people in the UK affected by them.[i]

Around one in five people with osteoarthritis, the most common form of arthritis, report depression and anxiety.[ii] In terms of receiving mental health support, one in five patients with rheumatoid arthritis report being asked about emotional issues by a rheumatology professional, even though almost half of the population would like the opportunity.[iii]

Key themes highlighted in the report are:

  • Treating emotional and mental health conditions should be a fundamental part of managing arthritis from point of diagnosis. A recent survey found that two in five people with arthritis had never been asked by a healthcare professional about their emotional wellbeing [iv].
  • Mental health support is needed at every diagnosis/transition point in a person’s journey.
  • People with MSK conditions often feel that they are the only ones experiencing them. Contact with patient support organisations, either through helplines or support groups, can help people understand their experiences are common.
  • Keeping people in work is as important as getting them into work.
  • Training/supporting employers in managing staff with long-term conditions is key.

Recommendations:

  • Integrated physical and mental health support should be available from basic educational materials to integration in pain clinics and rheumatology.
  • Every healthcare professional with an MSK patient should ask about their emotional/psychological wellbeing at every appointment.
  • Healthcare professionals should ensure that patients are aware of patient support groups and organisations available, both nationally and locally.
  • MSK professionals should receive training and CPD to help them better understand and assess mental health. Training should include risk assessment and knowledge of referral pathways.

Leigh Walmsley, arthritis patient and London 2012 Paralympic Archer, says:

“I developed osteoarthritis after a serious cycling accident aged 11, but noticed the first signs of inflammatory arthritis in my 20s. The impact arthritis had on my life was very significant. I couldn’t run in PE with my classmates, walk too far, stand for too long and as my inflammatory arthritis began to rear its head; there were times I almost couldn’t walk home after work. The fatigue of chronic pain is debilitating and causes depression.

“Arthritis Action appeared in my life when I was at a low point. It was a huge comfort to know there were other people like me, that have the same ideals as me and most importantly, they allow me to help other people with arthritis. I was so inspired, I decided to start a support group for the Charity in the North West. Groups are a great way of bringing people together, helping them feel less isolated or alone, which is really beneficial for our mental health.”

Read the Mental Health Roundtable Report.

[i] Versus Arthritis: State of Musculoskeletal Health Report 2018
[ii] Versus Arthritis: State of Musculoskeletal Health Report 2018
[iii] National Rheumatoid Arthritis Society (NRAS): Emotional Health & Well-being Matters Survey 2018
[iv] National Rheumatoid Arthritis Society (NRAS): Emotional Health & Well-being Matters Survey 2018

The Musculoskeletal Association of Chartered Physiotherapists (MACP) is shortly to call a vote of its current members to widen its membership categories in order to broaden access and strengthen the voice of musculoskeletal physiotherapy. The vote for change in membership signifies a potentially large change for the organisation and so it has consulted its membership over the past six months to determine if this is the direction the organisation wants to explore.

It recognises that training to become an MACP is one form of specialist post registration in the UK and so by broadening access through different categories it will lead to wider workforce of physiotherapists providing excellent care for people musculoskeletal conditions.

The MACP is a member organisation of the International Federation of Orthopaedic Manipulative Physical Therapists which is a sub-group of World Confederation for Physical Therapy. IFOMT conducted a review of its international member organisations which included membership categories and benefits as they vary across the world. Membership categories vary considerably ranging from Fellows through to Affiliates. The MACP is seeking to align with other organisations at an international level to enhance its inclusivity, whilst maintaining the distinction that full members have achieved the level of advanced practice as recognised by IFOMPT.

Making quality the standard: ‘Aspiring to Excellence’ award programme targets clinicians determined to improve axial SpA (AS) care

On 1 May 2019, the National Ankylosing Spondylitis Society (NASS) will open applications for Aspiring to Excellence—an innovative new award programme designed to encourage and recognise service improvement in axial SpA (AS) patient care.

Axial spondyloarthritis (axial SpA) including ankylosing spondylitis (AS) is a painful, progressive, life-long form of inflammatory arthritis affecting 1 in 200 adults in the UK, with symptoms usually starting in late teens to early twenties. Awareness of axial SpA (AS) amongst GPs and the general public is low and, as such, the current average delay to diagnosis for axial SpA (AS) in the UK is eight and a half years, which can result in life-changing outcomes including debilitating and irreversible spinal fusion.

Aspiring to Excellence is a partnership between NASS, AbbVie, BRITSpA, Novartis and UCB, aimed at ensuring that ‘every patient, every time’ receives high quality, patient-centred axial SpA (AS) care in accordance with the NICE Guideline for Spondyloarthritis (2017) and Quality Standard (2018).

aspiring-to-excellence-banner

“We are immensely proud to partner with these organisations, each applying a unique set of insights and perspectives towards a shared vision of enduring, system-wide improvements,” said NASS CEO Dr Dale Webb.

Aspiring to Excellence will support those rheumatology services across the UK which are aiming high to achieve excellent axial SpA care provision. It will support them to identify that which they are doing well, and will use a collaborative approach to develop and disseminate knowledge so that others are able to improve in tandem.”

Services will be selected for participation through a competitive award process, and move on to work together in a national network with an ‘all teach, all learn’ methodology. They will explore and test approaches to axial SpA service provision, seeking to reduce the delay to diagnosis. The knowledge generated will be shared in real-time both across the UK and internationally to help stimulate across-the-board improvements in care and patient experience.

“Strategic innovations that lead to new systems and structures which deliver sustainable high performance will be key to the long-term impact of Aspiring to Excellence,” said programme manager Anna McGilvray.

Awards will be announced in London on 16 November, after which the network will meet four times a year over three years. Applicants interested in participating in Aspiring to Excellence are invited to attend the launch evening on 1 May 2019 from 5:45 – 6:45 pm, in Hall 7 at the British Society for Rheumatology Conference. Please also visit NASS during the conference at stand 3-5, and visit the NASS website to learn more.

by Sue Brown, ARMA CEO

MSK services seem to me to operate very like an ecosystem.  If any part of the system isn’t in balance, the pressures will be felt elsewhere. No ESCAPE-pain means surgeons spending time with people who don’t need surgery; poor understanding of inflammatory conditions in primary care means more pressure on GPs as people don’t reach the rheumatologist; no Fracture Liaison Service means more fractures and more pressure on hospitals. Always the result of the system being out of balance is a person, in pain, not getting what they need.

As this newsletter goes out, ARMA will be at the BSR conference in Birmingham. It’s a great opportunity to engage with a wide range of our stakeholders. Many of our patient member organisations exhibit there too and we have many supporters working with rheumatoid arthritis and other inflammatory conditions. Our stand always gets lots of interest. If you are at the conference, do drop by.

Last month we welcomed our latest member, BASRaT, who represent sports rehabilitators. How do they fit with an organisation that covers inflammatory conditions you might ask? My answer is that, even though individual MSK conditions may be very different, they all rely on an effective MSK health service. That service must work together as a seamless pathway, an ecosystem that supports people’s need holistically. Almost everyone sees a physiotherapist at some point in their journey. Everyone comes into the system through primary care. If your inflammatory condition damages your joints, then you may need a surgeon. We depend on radiologists to correctly interpret scans, specialist nurses to help people manage their conditions, pharmacists to assist with multiple medications. Many are supported to recover from or manage their conditions through exercise programmes, which is where BASRaT, and other ARMA members, come in.

nice iconThis ecosystem is wider still. Responding to a submission from ARMA, NICE included a recommendation to ensure seating is provided at regular intervals along footways that are key walking routes in their guidance on physical activity and the environment. It doesn’t matter if you need to rest because of osteoarthritis, rheumatoid arthritis, fibromyalgia or any other MSK condition. Those seats could be the difference between a short, slow walk, that will keep you moving and improve your health, and staying at home while someone else goes to the post office for you. The forthcoming prevention green paper is not just about older people and OA, it is a vital part of the MSK health ecosystem.

Our MSK core offer for local NHS plans expresses the breadth of that system. Our webinars show the range of topics that we cover, from physical activity and MSK to pregnancy and inflammatory conditions.

As I write this, Extinction Rebellion have been blocking roads in London for a week, demanding action on climate change to prevent imbalance in the ecosystem. Like climate change, the importance of MSK health has been ignored for too long. But this is changing and there is a growing understanding of how central MSK is to the nation’s health and economy. An effective MSK health offer must be at the centre of solving the problem of NHS sustainability; I hope we won’t need to bring London to a standstill with an MSK rebellion to put it there.

NHSX is conducting a short survey to find out about staff, patient and service users’ tech priorities. It takes less than three minutes to complete and all responses are anonymous.

NHSX is a new body which aims to bring the benefits of modern technology to every patient and clinician. It will combine the best talent from government, the NHS and industry. NHSX will aim to create the most advanced health and care service in the world to diagnose diseases earlier, free up staff time and empower patients to take greater control of their own healthcare. The organisation will use experts in technology, digital, data and cyber security to deliver on the Health Secretary’s tech vision and the Long Term Plan for the NHS.

The survey results will be used to inform their future work, so do complete it and make sure your views are included.

BASRaT, the British Association of Sport Rehabilitators has joined ARMA and we are delighted to welcome them on board.

As the UK regulator, BASRaT guides Sport Rehabilitators on all aspects of their role and responsibilities, ensuring professional competency and continued professional development. BASRaT’s mission is to champion, raise awareness and support areas of growth within the profession.

BASRaT works hard to promote the benefits of Sport Rehabilitation and awareness of the profession. Sport Rehabilitators aid people with musculoskeletal pain, injury or illness. They help people to maintain their health and fitness, recover from and prevent injury and reduce pain using exercise, movement and therapy.

We look forward to working with the BASRaT team.

The Institute for Voluntary Action Research (IVAR) has developed free support resources for health, care and voluntary sector leaders who want to drive action through partnership working around the NHS Long Term Plan. The resources include online learning, webinars, workshops, coaching and individual support and are aimed at ICS/STP leads, commissioners, clinicians, and professionals from the voluntary sector.

The NHS Long Term Plan commits local healthcare systems to working in a new way, including a focus on prevention and reducing health inequalities. Building relationships – with other health agencies, local government, providers and communities – will be essential for the leaders charged with bringing this ambitious vision to life.

The NHS Long Term Plan recognised the role Voluntary, Community and Social Enterprise (VCSE) organisations could play, in partnership with the NHS, to help deliver its vision. At a strategic level, NHS England is committed to working with VCSEs and establishing models for more equitable partnerships and better integration, and to increase the influence of the voice of patients. More locally, STP’s/ICS’s, as with any relatively new player in a system, are taking time to build consistently high and constructive levels of engagement with VCSE organisations and communities more widely. 

The Building Health Partnerships programme and this wider support offer – Transforming Healthcare Together – have been designed in response to all these challenges, to work intensively with statutory services to test and pilot new approaches to partnership working, and to support the leaders working to bring the NHS Long Term Plan to life.

The free support offer is for health, care and VCSE leaders who want to drive action through partnership working. There is a range of support for different levels, whether you are just getting started or have been working in this way for some time.

The Oxford University Hospitals Foundation Trust Pilot

By Dr Christopher Speers, Sport and Exercise Medicine Consultant Oxford University Hospitals Foundation Trust

Physical inactivity is the fourth leading cause of death worldwide1 and it contributes significantly to the worldwide burden of non-communicable disease2, 3. Hospitals, historically, have been dominated by a culture of rest4. Promoting rest contradicts the evidence which clearly demonstrates that disease outcomes are better for moving more and that post hospital syndrome, or hospital deconditioning, leads to increased risk and adverse outcomes5, 6. Furthermore, there is a significant evidence-base demonstrating the potential for physical activity to improve management and treatment outcomes for a wide range of long-term health conditions, including arthritis7.

Healthcare provides a unique point of access to a section of the population who are likely to gain the most from only small improvements in increasing their physical activity. Therefore hospital admission is a key opportunity to influence patients to change behaviour for the better. This preventative approach to healthcare is a key objective of the NHS 10 year plan8.

‘Moving Healthcare Professionals’ forms part of Public Health England’s (PHE) ‘Everybody Active Every Day’ strategy9, and aims to engage professional networks to support understanding and awareness of, and greater engagement in, physical activity among the wider public.

In 2017, PHE and Sport England invited expressions of interest from applicable NHS Trusts (i.e. the Trust employs a Sports and Exercise Medicine (SEM) consultant to deliver a SEM pilot in secondary care. We were successful and were commissioned to deliver an SEM pilot that focused on the integration of physical activity into care pathways within secondary care.

The primary aim of the SEM pilot was to explore the potential for multi-disciplinary SEM teams in secondary care to contribute to patient outcomes through targeted and tailored support to integrate physical activity into the care plans of in-patients prior to discharge. We developed physical activity interventions across five different clinical pathways involving multi-morbidity and frailty (figure 1). Each intervention was designed using the COM-B model and Behaviour Change Wheel10. A clinical champion was employed within each pathway to develop and deliver the interventions, provide leadership and training to other staff within that clinical setting.

clinical pathways diagram

A range of different interventions were used to improve the levels of physical activity in patients, but underpinning our approach was an ambition to target healthcare professionals and change their behaviour to improving the frequency and quality of conversations between staff and patients about physical activity. Tools to do this included integrating the Exercise Vital Sign11, 12 into electronic patient records, staff training in motivational interviewing, exercise classes, as well as bed-, chair-based, and standing-exercise programs matched to functional ability of patients. A community navigator was available to help patients and staff members find community-based exercise teams and classes during the discharge process to ensure integrated care.

External independent evaluation was undertaken by the National Centre for Sport and Exercise Medicine in Sheffield; early reports have shown that this approach is highly valued and acceptable to patients and staff within the NHS. We have learnt a huge amount about integrating physical activity into secondary care systems throughout the pilot, and are going to publish our findings, learning and experience in the form of an ‘Active Hospital Toolkit’ later in 2019. This will be accessible through the Moving Medicine website.

References:

  1. Kohl HW, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, Kahlmeier S; Lancet Physical Activity Series Working Group. The pandemic of physical inactivity: global action for public health. Lancet. 2012 Jul 21;380(9838):294-305.
  2. Lee IM, Shiroma EJ, Lobelop F, Puska P, Blair SN, Katzmarzyk PT; Lancet Physical Activity Series Working Group. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012 Jul 21;380(9838):219-29.
  3. Blair SN. (2009) Physical inactivity: the biggest public health problem of the 21st century. British Journal of Sports Medicine; 43:1-2
  4. Brown CJ, Redden DT, Flood KL, Allman RM. The underrecognized epidemic of low mobility during hospitalization of older adults. J Am Geriatr Soc . 2009;57:1660–1665.
  5. HM Krumholz Post-hospital syndrome—an acquired, transient condition of generalized risk. N Engl J Med 2013; 368:100-102.
  6. Wen CP, Wai JPM, Tsai MK, Yang YC, Cheng TYD, Lee M, et al. (2011) Minimum effort of physical activity for reduced mortality and extended life expectancy. The Lancet; 378:(9798): 1244-1253.
  7. Gleeson, M., Bishop, N. C., Stensel, D. J., Lindley, M. R., Mastana, S. S. & Nimmo, M. A. 2011. The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nature Reviews Immunology, 11,
  8. NHS England NHS Long Term Plan. https://www.longtermplan.nhs.uk/ (accessed on 27.03.2019.
  9. Public Health England 2014. Everybody Active Everyday: National Physical Activity Framework. In: ENGLAND, P. H. (ed.). London: Public Health England.
  10. Michie, S., Atkins, L. & West, R. 2014. The behaviour change wheel: A guide to designing interventions, Great Britain, Silverback Publishing
  11. Sallis R, Franklin B, Joy L, et al. Strategies for promoting physical activity in clinical practice. Prog Cardiovasc Dis 2015;57:375–86.
  12. Coleman KJ, Ngor E, Reynolds K, et al. Initial Validation of an Exercise ‘Vital Sign’ in Electronic Medical Records. Med Sci Sport Exerc 2012;44:2071–6

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