To develop and evaluate a web application based on multimedia animations, combined with a training program, to improve the prescription of exercises in spondyloarthritis (SpA). After a review of exercises included in the main clinical trials and recommendations of international societies, a multidisciplinary team-rehabilitators, rheumatologists, physiotherapists, computer scientists and graphic designers-developed a web application for the prescription of exercises (EJES-3D). Once completed, this was presented to 12 pairs of rehabilitators-rheumatologists from the same hospital in a workshop. Knowledge about exercise was tested in rheumatologists before and 6 months after the workshop, when they also evaluated the application. The EJES-3D application includes 38 multimedia videos and allows prescribing predesigned programs or customizing them. A patient can consult the prescribed exercises at any time from a device with internet connection (mobile, tablet, or computer). The vast majority of the evaluators (89%) were satisfied or very satisfied and considered that their expectations regarding the usefulness of the web application had been met. They highlighted the ability to tailor exercises adapted to the different stages of the disease and the quality and variety of the videos. They also indicated some limitations of the application and operational problems. The EJES-3D tool was positively evaluated by experts in SpA, potentially the most demanding group of users with the most critical capacity. This allows a preliminary validation of the contents, usefulness, and ease of use. Analyzing and correcting the errors and limitations detected is allowing us to improve the EJES-3D tool.

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BackgroundDespite the growing body of evidence to support the importance of exercise in the management of ankylosing spondylitis (AS), fewer than one-quarter of patients with AS exercise frequently. Several factors could explain it, including the lack of related specific knowledge among many rheumatologists or patient's barriers to exercise. Therefore, we need a broad and multidisciplinary approach in order to design an effective strategy to prescribe and monitor physical exercise in SpA patients.Objectives1) To establish recommendations on exercise for SpA patients; 2) to provide motivational actions and facilitators for an active exercise prescription by rheumatologists; 3) to provide motivational actions and facilitators to improve patients adherence to exercise.MethodsA guided discussion group of rheumatologists with expertise on SpA was organized on issues the rheumatologists considered important when indicating and evaluating the effect of physical exercise in SpA patients, as well as on their current knowledge on this field and potential gaps or needs. The results of a systematic literature review about factors that improve adherence to exercise, the results of two discussion groups of patients (to explore barriers and facilitators to exercise), and the results of a focus group of exercise specialists (to define effective exercises for SpA patients and how messages should be given in order to be more effective) were presented and discussed.ResultsThe following consensus recommendations were drawn out:How to prescribe. SpA patients should be prescribed aerobic exercise of moderate intensity the same as general population and exercise programs similar to the American College of Sports Medicine recommendations, adapted to patients and disease characteristics. Although there is little limitation evidence to support it, it is important to do some type of aerobic exercise at all disease stages. Besides, in cases of ankylosis, forced stretching can be dangerous and are unuseful. Exercises in painful areas should be avoided in phases of activity and postural education must be provided.How to motivate rheumatologists. The following points were proposed: To agree on physical exercise with exercise specialists, to increase knowledge about the evidence based benefits of exercise in SpA and training on exercise. Including all these recommendations in a specifically designed website with a frequently asked questions section, explaining basics of exercise, and examples of the exercises they are prescribing might also help.How to motivate patients: The following points were agreed: to spend more time in daily practice for exercise issues, to provide positive and personalized messages without mentioning directly neither the structural damage of the disease nor depressing information, but being realistic, to explain properly the exercises the patient must not do. It was also argued that patients' associations can be effective promoters.ConclusionsRheumatologists believe that they require more knowledge about exercise in orde...

BackgroundNon-adherence to exercise is not uncommon in spondyloartritis (SpA). The extent to which patients with SPA are adhering to exercise as remains unclear. Understanding patient perceptions about the benefits and barriers to exercise could aid in focusing nonpharmacological strategies to improve outcomes.ObjectivesTo explore barriers and facilitators of patients with SpA to exercise.MethodsTwo discussion groups were organized, both recorded and analyzed using specific software for qualitative analysis of speech. The analysis was developed to identify the factors that influence exercise adherence as well as to describe relationships between them. The results were synthesized as follows 1) Segmentation according to thematic criteria, 2) Categorization according to situations, relationships, opinions, feelings or others, 3) Codification of the different categories and 4) Interpretation of results.ResultsWe found 4 different stages of coping with the exercise or physical activity in SpA: 1) the onset of the disease, in which patients feel scared but receptive; 2) the stabilization phase: important increase of self-confidence and interest in patients' associations and exercise specialists; 3) expert-patient phase: the patient is typically relaxed; 4) disease flares. The following table shows main facilitators and barriers identified.FacilitatorsBarriersKnowledge on physical exercise physician's, physiotherapists and patient)Information about benefits, limits, possibilities, risks, etc.Misunderstanding and inconsistency between messages given by doctors, physiotherapists and specialists in sport.Become aware of positive effectsFear of structural damage and pain worseningPainAccessibility (places and time expenditure)Role of associationsLack of access, expensive or facilities have inconvenient schedulesRegularity/HabitInactivity periods because of holidays or flaresEarly startAbsence of supporting messages and reinforcement by the doctorPositive previous experienceBad previous experiencesIneffectiveness of pharmacotherapyExercise adaptation to patient and disease characteristicsFlaresFatigueDifficulty and intensity of exerciseA good monitor or equipmentA bad monitorSocial aspects of exercise, physical activity and sportBoredom or depressionActive copingComplicated livesIsolation In addition, a series of neutral or discordant factors including stress, time, and exercise at home or paying for exercising were also identified.ConclusionsApart from recognizing that some personal factors should be modified, patients generally demand more knowledge and learning about physical exercise and about the pros and cons of it in the context of their disease. Consistency of messages received and better monitors accompanying them in their disease-and-exercise-coping process are important facilitators to exercise adherence. Patients' associations can disseminate much more information, in addition to support and provide advice to patients based on their prior experience.AcknowledgementsFunded by an unrestricted grant from Merck Sharp...