Feasibility of Fitness Assessments in Group Exercise Therapy for Individuals with Axial Spondyloarthritis - a Feasibility Study

Background The Ankylosing Spondylitis Association Switzerland has implemented the recommendations for physical activity of the European Alliance of Associations for Rheumatology in a group-therapy-concept for people with axial Spondyloarthritis (axSpA). This concept includes instructions for training in all 4 fitness dimensions (aerobic, strength, mobility, neuromotor performance) as well as counselling and regular fitness assessments for the planning and documentation of individual therapy progress, and for the quality evaluation of the therapy groups. Aim To evaluate the feasibility of the selected assessments across all 4 fitness dimensions, the acceptance, practicability, and integration was rated by physiotherapists (PT) and people with axSpA (TNaxSpA). Method A feasibility study was conducted in 4 pilot exercise therapy groups. PT performed the assessment battery consisting of a) Chester Step Test (CST) for aerobic fitness, b) Modified Core Strength Test for core strength, c) Bath Ankylosing Spondylitis Metrology Index (BASMI) for spinal mobility, and d) Single Leg Stance Test (SLST) for balance, with TNaxSpA. Subsequently, the PT and TNaxSpA assessed acceptability, practicability and integration by means of questionnaires. The feasibility of the assessments was defined based on 3 levels (I-III): with a positive evaluation of >80% (level I) a specific assessment was considered suitable, with a positive evaluation of 50-80% (level II) adjustments were necessary, with a positive evaluation of <50% (level III) a specific assessment was not considered suitable for group exercise therapy and a new choice had to be made. Results The BASMI was rated level I by TNaxSpA and PT, no adjustments were required. The CST, SLST and modified core strength test were rated level I by TNaxSpA and level II by PT, necessary adaptations were defined accordingly. Conclusion From patient perspective, the feasibility of the tests was evaluated positive in terms of acceptance, practicability and integration. From PT' perspective some adaptations were necessary. The assessment battery can now be used in group exercise therapy for people with axSpA. In this way, the individual fitness status can be evaluated, and interventions can be adapted, and thus the quality of group-exercise-therapy can be continuously monitored and improved if necessary.