Apr 27, 2018 - attending a tertiary care rheumatology service had used at least one .... Conclusion: As one in two AS patients have fallen at least once since.
E-POSTER ABSTRACTS
Novartis Pharma. Shareholder/stock ownership: Novartis Pharma. P.G.: Other: Novartis Healthcare employee. E.N.: Other: Novartis employee. L.M.: None. C.N.G.: Consultancies: Novartis. Grants/ research support: Novartis.
E70. A QUALITATIVE EXPLORATION OF THE USE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE THERAPIES IN AXIAL SPONDYLOARTHRITIS: INFORMING A REDUCTION IN THE DELAY TO DIAGNOSIS Kelly Blaxall1, Hannah Family1, Abbie Jordan2 and Raj Sengupta3 1 Department of Pharmacy and Pharmacology, 2Department of Psychology, University of Bath and 3Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath, UNITED KINGDOM Background: Axial spondyloarthritis (AxSpA) is a chronic inflammatory disease predominantly affecting the spine, causing back pain and stiffness. A significant issue for the treatment of AxSpA in the UK is an often lengthy delay in diagnosis after initial onset of symptoms. This delay is partly due to the difficulties that health care professionals experience in identifying inflammatory back pain. Previous research has shown that up to 40% of 276 AxSpA patients attending a tertiary care rheumatology service had used at least one form of complementary and alternative medicine (CAM) therapy prior to diagnosis. Methods: Through semi-structured telephone interviews, this study aimed to address what is known about CAM use in AxSpA and how this might contribute to knowledge about reducing delay to diagnosis. Approval was received from the Research Ethics Committee at Bath Spa University. Eight CAM practitioners (4 male) currently practising in the UK, were recruited to take part in the study through a public engagement event and/or completion of a previous online CAM practitioner survey. Interview data were transcribed verbatim and analysed using thematic analysis to identify initial codes and subsequent themes to represent participant experiences. Results: Participants reported practising a range of CAM therapies (e.g. acupuncture and reflexology) over a period of 8–46 years. Three themes were identified: a therapeutic practice; where participants’ narratives highlighted that that CAM is a very broad church and provides an effective symptom management that is holistic and client-led. CAM practice life; practitioners work in a range of settings and this theme describes their journey into becoming a CAM practitioner, their knowledge of AxSpA (which varied greatly) and how this developed, the trigger symptoms for referral and their approach to diagnosis. Working together; CAM practitioners vary in their level of working with mainstream services and this theme captured their experiences of communication and referral pathways between mainstream and CAM treatment, and their hopes for further integration in the future. CAM was perceived by all practitioners to be a truly complementary therapy to mainstream healthcare (not frontline). Conclusion: This study explored the perceived opportunities and barriers to symptom identification and early referral to rheumatology services through CAM settings, which could help to reduce delay to diagnosis. CAM practitioner knowledge of AxSpA varied which affected their referral and treatment decisions. Improved communication between CAM and mainstream practitioners could address this. The usefulness of CAM in supporting AxSpA individuals in symptom management and taking a holistic and client centred approach should not be ignored, and could be implemented into an integrative approach to diagnosis and treatment. Future research could explore AxSpA individuals’ experiences of CAM therapies. Disclosure statement: K.B.: Grants/research support: Bath Institute for Rheumatic Diseases, Bath Spa University. H.F.: Grants/research support: Bath Institute for Rheumatic Diseases, Bath Spa University, AstraZeneca. A.J.: Grants/research support: Bath Institute for Rheumatic Diseases, Bath Spa University. R.S.: Grants/research support: Pfizer, AbbVie, Novartis, UCB, MSD.
E71. IS FALLING REALLY A PROBLEM FOR PEOPLE LIVING WITH ANKYLOSING SPONDYLITIS? A SURVEY OF NATIONAL ANKYLOSING SPONDYLITIS SOCIETY MEMBERS Jane H. Martindale1,2, Sally Dickinson3 and Theodoros Bampouras4 1 Faculty of Health and Medicine, Lancaster University, Lancaster, 2 Therapy Department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, 3National Ankylosing Spondylitis Society, London and 4Active Ageing Research Group, University of Cumbria, Lancaster, UNITED KINGDOM
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Background: A significant portion of ankylosing spondylitis (AS) patients develop chronic progressive disease and disability due to spinal inflammation leading to fusion, often with thoracic kyphosis. This development can interfere with static postural stability, mobility, flexibility, gait and musculoskeletal strength, potentially increasing the risk of falling. In the UK, there is currently paucity of knowledge of the extent, frequency and implications of falling for this population. Our aim was to examine whether falling and fear of falling was a problem in AS patients in the UK, while exploring possible contributory factors. Methods: During the month of August 2016, the National Ankylosing Spondylitis Society (NASS) conducted an anonymous on line poll of its members. The survey included demographic details, knowledge of diagnosis of osteoporosis, walking aide use, confidence in turning, frequency of, reasons for and consequences of falling. Results: In total 178 members of NASS completed the survey (60% female, 40% male, age range 19 to 84 years). 42% were diagnosed with AS less than 5 years ago, 16% between 5 and 10 years ago, 16% between 10 to 20 years ago and 26% more than 20 years ago. 52% did not have osteoporosis, 36% were unsure, 6% had osteopenia and 6% osteoporosis. 44% used various walking aides with varying frequency of use from 24% constantly, 17% most of the time, 33% some of the time and 26% infrequently. 12% of respondents rated their ability to look straight ahead as poor and 54% had difficulty turning their head and body. A large percentage (72%) felt safe while turning while 24% felt they were unsafe. Importantly, 55% had experienced at least one fall since their diagnosis with 65 (37%) people falling between 1 to 5 times, 19 (11%) falling between 5 to 10 times and 13 (7%) more than 10 times. The main reasons given for falling included poor balance (38%), AS pain and stiffness (19%), weakness (16%), tripping (10%), slippery floor (10%), poor proprioception (4%) and alcohol (3%). Of the 96 people who had fallen, 28 people (28%) had attended hospital with 21 (21%) experiencing fractures with 6 people requiring surgery. Conclusion: As one in two AS patients have fallen at least once since their diagnosis, it appears that falling in AS patients warrants further research, due to the potentially devastating consequences of falling. The contributory factors, such as balance, AS symptomology (especially pain and weakness) and functional ability must be quantified to enable better understanding of the risk in this population. This would allow for further research in predicting who may be most at risk of falling and stratify appropriate clinical interventions to reduce this risk. Disclosure statement: The authors have declared no conflicts of interest.
E72. WHICH SET OF INFLAMMATORY BACK PAIN SCREENING QUESTIONS ARE BEST AT IDENTIFYING AXIAL SPONDYLOARTHRITIS IN PATIENTS PRESENTING WITH CHRONIC LOW BACK PAIN TO NON-RHEUMATOLOGISTS? A REVIEW OF THE EVIDENCE Christopher Bellis1 and Bernard Gibbon2 1 Rheumatology Department, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham and 2School of Health Sciences, University of Liverpool, Liverpool, UNITED KINGDOM Background: Patients with axial spondyloarthritis (AxSpA) often suffer from lengthy delays before they are diagnosed. Referral recommendations have been developed to improve referrals from primary care to rheumatology services and reduce delays in the diagnosis of axial spondyloarthritis. These referral recommendations stipulate that patients should be referred if they have been symptomatic of chronic low back pain for 3 months and if they developed their symptoms when
