Physical therapy in patients with rheumatoid arthritis and axial spondyloarthritis: the patients’ perspective

Figures & data

Table 1. Characteristics of patients with rheumatoid arthritis or axial spondyloarthritis with no, short-term, or long-term individual physical therapy (PT).

	Rheumatoid arthritis					Axial spondyloarthritis
				Individual PT (N = 163)					Individual PT (N = 77)
	Total group (N = 257)	No individual PT (N = 94)	Individual PT (N = 163)	Short-term PT* (N = 35)	Long-term PT* (N = 128)	Total group (N = 94)	No individual PT (N = 17)	Individual PT (N = 77)	Short-term PT* (N = 13)	Long-term PT* (N = 64)
Age (years)	54.7 ± 12.3	53.7 ± 12.9	55.3 ± 11.9	55.8 ± 11.8	55.1 ± 12.0	47.0 ± 12.9	43.0 ± 12.4	47.8 ± 12.9	44.1 ± 8.9	48.6 ± 13.5
Sex, female	246 (96)	87 (93)	159 (98)	35 (100)	124 (97)	81 (86)	13 (77)	68 (88)	12 (92)	56 (88)
Paid employment if < 66 years	(n = 180)	(n = 69)	(n = 111)	(n = 25)	(n = 86)	(n = 81)		(n = 64)	(n = 11)	(n = 53)
	96 (53)	47 (68)	49 (44)	12 (48)	37 (43)	52 (64)	12 (71)	40 (63)	6 (55)	34 (64)
Educational level†	(n = 233)	(n = 91)	(n = 142)	(n = 30)	(n = 112)	(n = 86)		(n = 69)	(n = 11)	(n = 58)
Low	58 (25)	20 (22)	38 (27)	9 (30)	29 (26)	11 (13)	3 (18)	8 (12)	2 (18)	6 (10)
Medium	93 (40)	44 (48)	49 (35)	12 (40)	37 (33)	31 (36)	3 (18)	28 (41)	4 (37)	24 (41)
High	77 (33)	23 (25)	54 (38)	9 (30)	45 (40)	42 (49)	10 (59)	32 (46)	4 (37)	28 (48)
Other	5 (2)	4 (4)	1 (1)	0 (0)	1 (1)	2 (2)	1 (6)	1 (2)	1 (9)	0 (0)
Married or cohabitating	(n = 234)	(n = 92)	(n = 142)	(n = 30)	(n = 112)	(n = 86)		(n = 69)	(n = 11)	(n = 58)
	156 (67)	66 (72)	90 (63)	20 (67)	70 (63)	64 (74)	9 (53)	55 (80)	8 (73)	47 (81)
Treatment by rheumatologist
Currently	243 (95)	87 (93)	156 (96)	33 (94)	123 (96)	87 (93)	15 (88)	72 (94)	13 (100)	59 (92)
In the past	8 (3)	3 (3)	5 (3)	1 (3)	4 (3)	7 (7)	2 (12)	5 (7)	0 (0)	5 (8)
Never	6 (2)	4 (4)	2 (1)	1 (3)	1 (1)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
Comorbidities
Any	98 (38)	36 (38)	62 (38)	11 (31)	51 (40)	30 (32)	5 (29)	25 (33)	4 (31)	21 (33)
1	35 (14)	10 (11)	25 (15)	3 (9)	22 (17)	12 (13)	2 (12)	10 (13)	2 (15)	8 (13)
2	39 (15)	17 (18)	22 (14)	3 (9)	19 (15)	9 (10)	3 (18)	6 (8)	0 (0)	6 (9)
3	13 (5)	6 (6)	7 (4)	4 (11)	3 (2)	6 (6)	0 (0)	6 (8)	2 (15)	4 (6)
≥ 4	11 (4)	3 (3)	8 (5)	1 (3)	7 (5)	3 (3)	0 (0)	3 (4)	0 (0)	3 (5)
EQ-5D-5L	(n = 223)	(n = 80)	(n = 143)	(n = 31)	(n = 112)	(n = 83)	(n = 14)	(n = 69)	(n = 11)	(n = 58)
	0.62 ± 0.3	0.66 ± 0.2	0.60 ± 0.2	0.60 ± 0.3	0.60 ± 0.2	0.60 ± 0.2	0.69 ± 0.3	0.59 ± 0.2	0.50 ± 0.2	0.60 ± 0.2
EQ-VAS	(n = 223)	(n = 80)	(n = 143)	(n = 31)	(n = 112)	(n = 83)	(n = 14)	(n = 69)	(n = 11)	(n = 58)
	63.5 ± 15.6	67.6 ± 16.8	61.2 ± 14.4	63.8 ± 16.5	60.5 ± 13.7	61.8 ± 16.6	73.4 ± 17.2	59.4 ± 15.5	56.9 ± 13.3	59.9 ± 16.0
Additional insurance for physical therapy
Yes	220 (86)	68 (72)	152 (93)	29 (83)	123 (96)	81 (86)	10 (59)	71 (92)	12 (92)	59 (92)
If yes, number of sessions per year
< 6	3 (1)	3 (4)	0 (0)	0 (0)	0 (0)	2 (2)	1 (10)	1 (1)	0 (0)	1 (2)
6–9	30 (14)	17 (25)	13 (9)	3 (10)	10 (8)	10 (12)	3 (30)	7 (10)	3 (25)	4 (7)
10–15	32 (15)	8 (12)	24 (16)	11 (38)	13 (11)	7 (9)	1 (10)	6 (9)	2 (17)	4 (7)
16–25	55 (25)	16 (24)	39 (26)	8 (28)	31 (25)	27 (33)	2 (20)	25 (35)	6 (50)	19 (32)
≥ 26	78 (36)	10 (15)	68 (45)	6 (21)	62 (50)	28 (35)	1 (10)	27 (38)	0 (0)	27 (46)
Unlimited	8 (4)	3 (4)	5 (3)	0 (0)	5 (4)	3 (4)	0 (0)	3 (4)	0 (0)	3 (5)
Unknown	14 (6)	11 (16)	3 (2)	1 (3)	2 (2)	3 (4)	2 (20)	1 (1)	1 (8)	0 (0)
Missing	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	1 (1)	0 (0)	1 (1)	0 (0)	1 (2)

Data are shown as mean ± sd or n (%). The number of patients (n) is reported if it deviates from the total number of patients.

*Short-term PT, patients with PT for < 3 months; Long-term PT, patients with PT for ≥ 3 months alternate periods.

†Low, primary school or lower vocational education; Medium, lower general secondary school or intermediate vocational education; High, higher general secondary school, higher vocational education, or university.

EQ-5D-5L, 5-level EuroQol 5 Dimensions; EQ-VAS, EuroQol visual analogue scale.

Table 2. Characteristics of short-term and long-term individual physical therapy (PT) in patients with rheumatoid arthritis or axial spondyloarthritis.

	Rheumatoid arthritis (N = 144*)		Axial spondyloarthritis (N = 71*)
	Short-term (N = 31)	Long-term (N = 113)	Short-term (N = 11)	Long-term (N = 60)
Duration of PT, short-term
0–4 weeks	11 (35)		2 (18)
5–8 weeks	13 (42)		3 (27)
9–12 weeks	7 (23)		6 (55)
Duration of PT, long-term
3–6 months		19 (17)		12 (20)
6–9 months		10 (9)		6 (10)
9–12 months		12 (11)		2 (3)
12–24 months		9 (8)		6 (10)
> 24 months		63 (56)		34 (57)
Average frequency of PT
< 1 per week	2 (6)	36 (32)	1 (9)	19 (32)
1 per week	22 (71)	53 (47)	9 (82)	31 (52)
2 per week	7 (23)	20 (18)	1 (9)	5 (8)
≥ 3 per week	0 (0)	2 (2)	0 (0)	0 (0)
Varying	0 (0)	2 (2)	0 (0)	5 (8)
Satisfaction with number of PT treatments
Yes	12 (39)	53 (47)	4 (36)	23 (38)
Too few	12 (39)	47 (42)	7 (64)	32 (53)
Too many	1 (3)	5 (4)	0 (0)	3 (5)
Other†	6 (19)	8 (7)	0 (0)	2 (3)
Location of PT treatment
At the practice	30 (97)	106 (94)	11 (100)	58 (97)
At home	0 (0)	1 (1)	0 (0)	1 (2)
Both at the practice and at home	0 (0)	4 (4)	0 (0)	1 (2)
Other^‡	1 (3)	2 (2)	0 (0)	0 (0)
Reasons for receiving PT (multiple answers possible)
Pain	27 (87)	107 (95)	11 (100)	59 (98)
Stiffness or limited range of motion of joints	28 (90)	112 (99)	11 (100)	59 (98)
Fatigue	15 (48)	62 (55)	7 (64)	36 (60)
Muscle weakness	27 (87)	79 (70)	5 (45)	32 (53)
Decreased overall fitness and endurance	17 (55)	74 (65)	4 (36)	36 (60)
Balance problems	14 (45)	50 (44)	3 (27)	24 (40)
Limitations in daily activities	23 (74)	69 (61)	6 (55)	39 (65)
Restrictions in paid employment	9 (29)	43 (38)	7 (64)	34 (57)
Restrictions in unpaid employment (volunteer activities)	4 (13)	22 (19)	1 (9)	15 (25)
Restrictions in hobbies, sports, social activities	27 (87)	84 (74)	6 (55)	45 (75)
Other^§	1 (3)	5 (4)	0 (0)	0 (0)
Impairment(s), limitation(s), and/or restriction(s) related to RMD	31 (100)	109 (96)	10 (91)	57 (95)
Content of PT: exercises
Active exercise therapy (multiple answers possible)	26 (84)	97 (86)	8 (73)	52 (87)
Aerobic exercises	10 (32)	47 (42)	3 (27)	21 (35)
Muscle strengthening exercises – legs	17 (55)	61 (54)	4 (36)	24 (40)
Muscle strengthening exercises – arms	15 (48)	62 (55)	5 (45)	27 (45)
Range of motion exercises – legs and arms	21 (68)	75 (66)	6 (55)	37 (62)
Range of motion exercises – neck and back	14 (45)	78 (69)	6 (55)	46 (77)
Active exercises – functional activities	15 (48)	51 (45)	4 (36)	21 (35)
Balance exercises	10 (32)	46 (41)	3 (27)	18 (30)
Specific active exercise therapy (multiple answers possible)	2 (6)	32 (28)	3 (27)	18 (30)
Breathing exercises	0 (0)	12 (11)	2 (18)	10 (17)
Relaxation techniques	1 (3)	12 (11)	2 (18)	7 (12)
Hydrotherapy	2 (6)	15 (13)	0 (0)	7 (12)
Content of PT: manual treatment (multiple answers possible)	18 (58)	101 (89)	9 (82)	56 (93)
Massage	13 (42)	76 (67)	9 (82)	45 (75)
Passive mobilization – legs and arms	11 (35)	69 (61)	7 (64)	34 (57)
Passive mobilization – neck and back	11 (35)	65 (58)	6 (55)	45 (75)
Content of PT: physical modalities (multiple answers possible)	10 (32)	72 (64)	6 (55)	36 (60)
Heat therapy	0 (0)	10 (9)	1 (9)	3 (5)
Cold therapy	0 (0)	2 (2)	0 (0)	1 (2)
Kinesiotaping	4 (13)	56 (50)	5 (45)	25 (42)
Electrotherapy	1 (3)	13 (12)	2 (18)	2 (3)
Dry needling	8 (26)	28 (25)	3 (27)	19 (32)
Content of PT: counselling/education (multiple answers possible)	28 (90)	83 (73)	10 (91)	48 (80)
Exercises to perform at home	23 (74)	77 (68)	7 (64)	45 (75)
Physical activity promotion – activity tracker	2 (6)	17 (15)	0 (0)	3 (5)
Physical activity promotion – personal programme	12 (39)	45 (40)	5 (45)	27 (45)
Oral information	14 (45)	62 (55)	4 (36)	35 (58)
Written information	2 (6)	13 (12)	2 (18)	6 (10)
Website/online information	3 (10)	17 (15)	2 (18)	6 (10)
Contact therapist by e-mail/app/website	3 (10)	32 (28)	4 (36)	21 (35)

Data are shown as n (%). *Total number of responders deviates from Table 1, as not all responders answered the follow-up questions about short-term and long-term individual PT.

RMD, rheumatic and musculoskeletal diseases.

Other: ^†still under treatment (n = 3), coronavirus disease 2019 (COVID-19) pandemic (n = 4), medical complications (n = 1), no clear interpretation of the answer (n = 6). ^‡outside because of COVID-19 (n = 1), combination of treatment in the practice and by video calling (n = 2). §specific joint, i.e. hip and shoulder (n = 2), lymph oedema (n = 2), general inflammation (n = 2), hypermobility (n = 1).

Data availability statement

The data underlying this article will be shared upon reasonable request to the corresponding author.