EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome.

OBJECTIVE: To develop recommendations for cardiovascular risk (CVR) management in gout, vasculitis, systemic sclerosis (SSc), myositis, mixed connective tissue disease (MCTD), Sjögren's syndrome (SS), systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). METHODS: Following European League against Rheumatism (EULAR) standardised procedures, a multidisciplinary task force formulated recommendations for CVR prediction and management based on systematic literature reviews and expert opinion. RESULTS: Four overarching principles emphasising the need of regular screening and management of modifiable CVR factors and patient education were endorsed. Nineteen recommendations (eleven for gout, vasculitis, SSc, MCTD, myositis, SS; eight for SLE, APS) were developed covering three topics: (1) CVR prediction tools; (2) interventions on traditional CVR factors and (3) interventions on disease-related CVR factors. Several statements relied on expert opinion because high-quality evidence was lacking. Use of generic CVR prediction tools is recommended due to lack of validated rheumatic diseases-specific tools. Diuretics should be avoided in gout and beta-blockers in SSc, and a blood pressure target <130/80 mm Hg should be considered in SLE. Lipid management should follow general population guidelines, and antiplatelet use in SLE, APS and large-vessel vasculitis should follow prior EULAR recommendations. A serum uric acid level <0.36 mmol/L (<6 mg/dL) in gout, and disease activity control and glucocorticoid dose minimisation in SLE and vasculitis, are recommended. Hydroxychloroquine is recommended in SLE because it may also reduce CVR, while no particular immunosuppressive treatment in SLE or urate-lowering therapy in gout has been associated with CVR lowering. CONCLUSION: These recommendations can guide clinical practice and future research for improving CVR management in rheumatic and musculoskeletal diseases.

Cost-effectiveness of the HiBalance training program for elderly with Parkinson's disease: analysis of data from a randomized controlled trial.

OBJECTIVE:: To determine the cost-effectiveness of the HiBalance training program for managing Parkinson's disease (PD)-related balance and gait disorders. DESIGN:: Cost comparison design following the randomized controlled trial comparing a novel balance training intervention with care as usual. SUBJECTS:: A total of 100 participants with mild-moderate PD were randomized to either the intervention ( n = 51) or the control group ( n = 49). INTERVENTION:: A 10-week (three times per week), group-based, progressive balance training program, led by two physical therapists. MAIN OUTCOMES:: All program costs were collected for both groups. Cost-utility was evaluated using quality-adjusted life years (QALYs) and cost-effectiveness measures were the Mini Balance Evaluation Systems Test (Mini-BESTest; assessing balance performance) and gait velocity. Incremental cost-effectiveness ratios were calculated and a probabilistic sensitivity analysis was conducted. RESULTS:: The between-group difference in QALYs was 0.043 (95% confidence interval (CI): 0.011-0.075), favoring the intervention group. Between-group differences in balance performance and gait velocity were 2.16 points (95% CI: 1.19-3.13) and 8.2 cm/second (95% CI: 2.9-13.6), respectively, favoring the intervention group. The mean cost per participant in the intervention group was 16,222 SEK (€1649) compared to 2696 SEK (€274) for controls. The estimated incremental cost-effectiveness ratios were 314,558 SEK (€31,969) for an additional QALY, 6262 SEK (€631) for one point improvement in balance performance, and 1650 SEK (€166) for 1 cm/second increase in gait velocity. Sensitivity analyses indicated a high probability (85%) of program success. CONCLUSION:: In terms of QALYs, the HiBalance program demonstrated a high probability of cost-effectiveness in the short-term perspective when considering the willingness-to-pay thresholds used in Europe.

Mapping a measure of physical ability for persons with long-term musculoskeletal pain to the ICF and ICF Core Sets.

BACKGROUND: Test Instrument for Profile of Physical Ability (TIPPA) is used in the Swedish sickness certification process for patients with long-term musculoskeletal pain. The aim was to explore the content of TIPPA in the context of work-ability assessments. METHODS: The full protocol of TIPPA was linked to the in relation to the International Classification of Functioning, Disability and Health (ICF) and evaluated in relation to the ICF Core Sets for Chronic Widespread Pain (CWP). RESULTS: Twenty-two unique meaningful concepts were identified in TIPPA. Eighteen of those could be linked to ICF, yielding 27 third-level ICF-categories. Ten of these categories fitted the domains of 'body function', 16 were 'activity and participation', while one was related to 'environmental factors'. Perspective and aim varied between the parts of the test. When assessed against Brief ICF Core Set for CWP, TIPPA covered three of nine 'body function' categories and 2 out of 10 'activity and participation' categories. The coverage of the subgroup 'activity' was two out of five. TIPPA did not cover three categories, i.e. 'd175 solving problems', 'd230 carrying out daily routine' and 'd240 handling stress and other psychological demands', in the subgroup of 'activity'. CONCLUSIONS: TIPPA could be a useful measure for the assessment of physical ability. However, additional condition-specific items/measures are required to obtain full coverage of core aspects of functioning and disability in a comprehensive work-ability assessment for patients with long-term musculoskeletal pain.

2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis.

Regular physical activity (PA) is increasingly promoted for people with rheumatic and musculoskeletal diseases as well as the general population. We evaluated if the public health recommendations for PA are applicable for people with inflammatory arthritis (iA; Rheumatoid Arthritis and Spondyloarthritis) and osteoarthritis (hip/knee OA) in order to develop evidence-based recommendations for advice and guidance on PA in clinical practice. The EULAR standardised operating procedures for the development of recommendations were followed. A task force (TF) (including rheumatologists, other medical specialists and physicians, health professionals, patient-representatives, methodologists) from 16 countries met twice. In the first TF meeting, 13 research questions to support a systematic literature review (SLR) were identified and defined. In the second meeting, the SLR evidence was presented and discussed before the recommendations, research agenda and education agenda were formulated. The TF developed and agreed on four overarching principles and 10 recommendations for PA in people with iA and OA. The mean level of agreement between the TF members ranged between 9.8 and 8.8. Given the evidence for its effectiveness, feasibility and safety, PA is advocated as integral part of standard care throughout the course of these diseases. Finally, the TF agreed on related research and education agendas. Evidence and expert opinion inform these recommendations to provide guidance in the development, conduct and evaluation of PA-interventions and promotion in people with iA and OA. It is advised that these recommendations should be implemented considering individual needs and national health systems.

2016 update of the EULAR recommendations for the management of early arthritis.

OBJECTIVES: Since the 2007 recommendations for the management of early arthritis have been presented, considerable research has been published in the field of early arthritis, mandating an update of the 2007 European League Against Rheumatism (EULAR) recommendations for management of early arthritis. METHODS: In accordance with the 2014 EULAR Standardised Operating Procedures, the expert committee pursued an approach that was based on evidence in the literature and on expert opinion. The committee involved 20 rheumatologists, 2 patients and 1 healthcare professional representing 12 European countries. The group defined the focus of the expert committee and target population, formulated a definition of 'management' and selected the research questions. A systematic literature research (SLR) was performed by two fellows with the help of a skilled librarian. A set of draft recommendations was proposed on the basis of the research questions and the results of the SLR. For each recommendation, the categories of evidence were identified, the strength of recommendations was derived and the level of agreement was determined through a voting process. RESULTS: The updated recommendations comprise 3 overarching principles and 12 recommendations for managing early arthritis. The selected statements involve the recognition of arthritis, referral, diagnosis, prognostication, treatment (information, education, pharmacological and non-pharmacological interventions), monitoring and strategy. Eighteen items were identified as relevant for future research. CONCLUSIONS: These recommendations provide rheumatologists, general practitioners, healthcare professionals, patients and other stakeholders with an updated EULAR consensus on the entire management of early arthritis.

Promotion of health-enhancing physical activity in rheumatoid arthritis: a comparative study on healthcare providers in Italy, The Netherlands and Sweden.

The objectives of this study were to compare attitudes, practice of advice, perceived competencies and educational needs related to health-enhancing physical activity (HEPA) in rheumatoid arthritis (RA) among Dutch, Italian and Swedish healthcare providers (HCP) and to explore associations between these factors and age, gender and HEPA levels of HCP. Questionnaires were sent to 2939 HCP, members of their national rheumatology organizations. HEPA was assessed with the Short Questionnaire to Assess Health-Enhancing Physical Activity or the International Physical Activity Questionnaire; attitudes, practice of advice, perceived competencies and educational needs with a 23-item questionnaire. Overall response rate was 33 %. Ninety-five percent of HCP agreed that HEPA is an important health goal in RA. More Swedish HCP had positive attitudes to the attainability and safety of HEPA in RA. There were no differences between countries in practice of advice on HEPA to patients with RA in general or to those with recent onset disease, but more Italian HCP were reluctant to advise HEPA to patients with established disease. Of the total HCP, 36 to 60 % used public health guidelines to advise on HEPA, with Dutch HCP taking less advantage. Still they estimated a higher proportion of patients with RA to follow such advice. Italian HCP perceived their competencies the highest, but were also more interested in education to promote HEPA. Gender, age and HEPA performance had no association with attitudes toward HEPA, while a number of associations were found between these factors and practice of advice and perceived competencies. The differences found between HCP in the three countries might indicate the need for educational initiatives to improve HEPA promotion.

Time to Rethink Intended Learning Outcomes for Sustainable Development? A Qualitative Exploration and Reflection of Course Syllabuses in Swedish Undergraduate Physiotherapy Education.

OBJECTIVE: Several calls to action for the implementation of education for sustainable development in health profession education have been put forth during the last few years. The aim was therefore to explore and describe sustainability-focused intended learning outcomes (SD-ILOs) in curricula of undergraduate physiotherapy education in Sweden. METHODS: Using a deductive, descriptive, and qualitative approach, SD-ILOs in programs (n = 8) and course syllabuses (n = 143) from eight higher education institutions providing physiotherapy undergraduate education in Sweden were analyzed. SD-ILOs were described based on the subject content or condition, level of cognitive processes, sustainability learning dimensions, and key sustainability competencies. RESULTS: Six of the eight physiotherapy programs provided course syllabuses with SD-ILOs. However, only 3% (n = 36) of all ILOs were sustainability-focused. A larger part of the SD-ILOs, 78% (n = 28) was described within the cognitive dimension of learning, and 80% (n = 27) were linked to either the cognitive process 'understanding' or 'analyzing'. The most frequently identified key competency in the SD-ILOs was 'systems-thinking' n = 10 (28%), and 30% (n = 11) lacked key competency. CONCLUSION: There is an urgent need for rapid initiatives to enhance sustainable development education in Swedish undergraduate physiotherapy education. Pedagogical approaches that cover not only cognitive dimensions of learning for sustainable development but also socio-emotional and behavioral dimensions, as well as more complex cognitive learning processes must also be developed. The current lack of key sustainability competencies further emphasizes the necessity to enrich physiotherapy curricula with action-oriented learning to develop powerful future sustainability agency within healthcare and the public health arena.

Correction: Monitoring independence in daily life activities after trauma in humanitarian settings: Item reduction and assessment of content validity of the Activity Independence Measure-Trauma (AIM-T).

[This corrects the article DOI: 10.1371/journal.pgph.0001334.].

Correction: Assessing independence in mobility activities in trauma care: Validity and reliability of the Activity Independence Measure-Trauma (AIM-T) in humanitarian settings.

[This corrects the article DOI: 10.1371/journal.pgph.0001723.].

Validity and reliability of the Swedish version of the Patient Specific Functional Scale in patients treated surgically for carpometacarpal joint osteoarthritis.

DESIGN: Cross-sectional clinical measurements. INTRODUCTION: Activity limitation is often persistent after surgically treated carpometacarpal (CMC) joint osteoarthritis (OA). PURPOSE: To describe content and concurrent validity, test-retest reliability and internal consistency of the Swedish version of the Patient Specific Functional Scale (PSFS) in patients with surgically treated CMC joint OA. METHODS: Fifty-eight patients were assessed ten weeks after surgical treatment of CMC joint OA. PSFS, the shorter version of Disabilities of the Arm, Shoulder and Hand (Quick DASH), EuroQol-5Dimensions (EQ-5D), pain intensity, joint movement of CMC joint, grip and pinch strength were assessed. Classification of activities was done according to the International Classification of Functioning, Disability and Health (ICF). Spearman correlation, intra-class correlation coefficient (ICC) and Kappa were calculated to assess validity, test-retest reliability and internal consistency. The PSFS was administered twice, 2-3 days apart. RESULTS: All of the activity limitations stated in the PSFS could be classified according to the activity component in the ICF. Significant correlations for the PSFS were obtained with pain at rest (r(s) = -0.36) and the Quick DASH (r(s) = -0.28). Test-retest reliability was good, ICC (0.79) and the three items of the PSFS correlated 0.69-0.83 with the total score of PSFS. CONCLUSION: Content validity was excellent, concurrent validity was low-moderate, as in earlier studies. The PSFS could be a valuable supplement to existing measures in measuring activity limitations in individuals with surgically treated CMC joint OA. LEVEL OF EVIDENCE: Not applicable.

"It's Like Listening to the Radio with a Little Interference": A Qualitative Study Describing Pain Management among Patients with Psoriatic Arthritis.

Pain is one of the most important areas to focus on in the assessment and treatment of psoriatic arthritis (PsA), and treatment should be individualized and based on the needs of the patient. Therefore, our aim was to explore and describe the management of pain among patients with PsA. We conducted semi-structured interviews with 11 participants with PsA (3 men and 8 women) and used qualitative content analysis to analyze the text. The results showed a main overarching theme of meaning and three subthemes. They were 'Taking charge of life despite the constant murmur of pain' through 'Sorting out vulnerability', 'Reaching acceptance and engagement', and 'Directing focus to change'. Nine categories further described the components of pain management: 'face uncertainty for the future, 'consider restrictions', 'illuminate the invisible', 'increase awareness', 'find a permissive environment and social support', 'enhance inner endurance', 'reformulate emotions and thoughts', 'use distracting activities', and 'adjust activities'. The action components of pain management interpreted from a theoretical perspective highlight the importance for the patients of attaining the satisfaction of three basic psychological needs, i.e., competence, autonomy, and relatedness. Health professionals therefore need to increase the skills required for needs-supportive behaviors as well as facilitating spouse and peer support in the management of pain in PsA.

Mapping information regarding the work-related disability of depression and long-term musculoskeletal pain to the International Classification of Functioning, Disability and Health and ICF Core Sets.

Introduction: The International Classification of Functioning, Disability and Health is the WHO coding scheme for functioning-related data. Clear and unambiguous information regarding patients' work-related disabilities is important not only for the assessment of entitlement to paid sickness benefits but also for planning rehabilitation and return to work. The objective was to validate the content of ICF and ICF Core Sets for information on work-related disability in sick leave due to depression and long-term musculoskeletal pain. Specific aims: To describe to what extent (1) such data could be linked to ICF and (2) the result of the ICF linking in terms of ICF categories was represented in relevant ICF Core Sets. Methods: An ICF-linking study following the ICF-linking rules. A random sample of sick leave certificates issued in primary care for either depression (n = 25) or long-term musculoskeletal pain (n = 34) was collected from a community with 55,000 inhabitants in Stockholm County, Sweden. Results: The results of the ICF linking consisted of codings for (1) ICF categories and (2) other health information not possible to link to ICF. The ICF categories were compared to ICF Core Sets for coverage. The majority of the meaning units, 83% for depression and 75% for long-term musculoskeletal pain, were linked to ICF categories. The Comprehensive ICF Core Set for depression covered 14/16 (88%) of the ICF categories derived from the ICF linking. The corresponding figures were lower for both the Brief ICF Core Set for depression 7/16 (44%) and ICF Core Set for disability evaluation in social security 12/20 (60%). Conclusion: The results indicates that ICF is a feasible code scheme for categorising information on work-related disability in sick leave certificates for depression and long-term musculoskeletal pain. As expected, the Comprehensive ICF Core Set for depression covered the ICF categories derived from the certificates for depression to a high degree. However, the results indicate that (1) sleep- and memory functions should be added to the Brief ICF Core Set for depression, and (2) energy-, attention- and sleep functions should be added to the ICF Core Set for disability evaluation in social security when used in this context.

Assessing independence in mobility activities in trauma care: Validity and reliability of the Activity Independence Measure-Trauma (AIM-T) in humanitarian settings.

The importance of measuring outcomes after injury beyond mortality and morbidity is increasingly recognized, though underreported in humanitarian settings. To address shortcomings of existing outcome measures in humanitarian settings, the Activity Independence Measure-Trauma (AIM-T) was developed, and is structured in three subscales (i.e., core, lower limb, and upper limb). This study aimed to assess the AIM-T construct validity (structural validity and hypothesis testing) and reliability (internal consistency, inter-rater reliability and measurement error) in four humanitarian settings (Burundi, Iraq, Cameroon and Central African Republic). Patients with acute injury (n = 195) were assessed using the AIM-T, the Barthel Index (BI), and two pain scores. Structural validity was assessed through confirmatory factor analysis. Hypotheses were tested regarding correlations with BI and pain scores using Pearson correlation coefficient (PCC) and differences in AIM-T scores between patients' subgroups, using standardized effect size Cohen's d (d). Internal consistency was assessed with Cronbach's alpha (α). AIM-T was reassessed by a second rater in 77 participants to test inter-rater reliability using intraclass correlation coefficient (ICC). The results showed that the AIM-T structure in three subscales had an acceptable fit. The AIM-T showed an inverse weak to moderate correlation with both pain scores (PCC<0.7, p≤0.05), positive strong correlation with BI (PCC≥0.7, p≤0.05), and differed between all subgroups (d≥0.5, p≤0.05). The inter-rater reliability in the (sub)scales was good to excellent (ICC 0.86-0.91) and the three subscales' internal consistency was adequate (α≥0.7). In conclusion, this study supports the AIM-T validity in measuring independence in mobility activities and its reliability in humanitarian settings, as well as it informs on its interpretability. Thus, the AIM-T could be a valuable measure to assess outcomes after injury in humanitarian settings.

Monitoring independence in daily life activities after trauma in humanitarian settings: Item reduction and assessment of content validity of the Activity Independence Measure-Trauma (AIM-T).

A standardized set of measures to assess functioning after trauma in humanitarian settings has been called for. The Activity Independence Measure for Trauma (AIM-T) is a clinician-rated measure of independence in 20 daily activities among patients after trauma. Designed in Afghanistan, it has since been used in other contexts. Before recommending the AIM-T for wider use, its measurement properties required confirmation. This study aims at item reduction followed by content validity assessment of the AIM-T. Using a two-step revision process, first, routinely collected data from 635 patients at five facilities managing patients after trauma in Haiti, Burundi, Yemen, and Iraq were used for item reduction. This was performed by analyzing inter-item redundancy and distribution of the first version of the AIM-T (AIM-T1) item scores, resulting in a shortened version (AIM-T2). Second, content validity of the AIM-T2 was assessed by item content validity indices (I-CVI, 0-1) based on structured interviews with 23 health care professionals and 60 patients in Haiti, Burundi, and Iraq. Through the analyses, nine pairs of redundant items (r≥0.90) were identified in the AIM-T1, leading to the removal of nine items, and resulting in AIM-T2. All remaining items were judged highly relevant, appropriate, clear, feasible and representative by most of participants (I-CVI>0.5). Ten items with I-CVI 0.5-0.85 were revised to improve their cultural relevance or appropriateness and one item was added, resulting in the AIM-T3. In conclusion, the proposed 12-item AIM-T3 is overall relevant, clear, and representative of independence in daily activity after trauma and it includes items appropriate and feasible to be observed by clinicians across different humanitarian settings. While some additional measurement properties remain to be evaluated, the present version already has the potential to serve as a routine measure to assess patients after trauma in humanitarian settings.

Inflammatory Arthritis and the Effect of Physical Activity on Quality of Life and Self-Reported Function: A Systematic Review and Meta-Analysis.

OBJECTIVE: Although physical activity is an evidence-based intervention that reduces disease-related symptoms and comorbidity in rheumatoid arthritis (RA), the effect of physical activity on self-reported function and quality of life (QoL) has not yet been analyzed. The present study synthesizes the evidence for the effectiveness of physical activity on QoL and self-reported function in adults with RA, spondyloarthritis (SpA), and psoriatic arthritis (PsA). METHODS: The databases PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify relevant randomized controlled trials (RCTs). Screening, risk of bias assessment (using the RoB 2.0 tool), and data extraction were independently performed by 2 or more of the authors. Meta-analyses were conducted with a random-effects model. RESULTS: Systematic review included 55 RCTs, and meta-analysis included 37 RCTs. Of the 55 studies included, 76%, 20%, and 4% were designed to investigate RA, SpA, and PsA, respectively. In the RA studies, effects of physical activity on QoL and function were found compared to the group of inactive controls; no effects were found compared to the group of active controls. In the SpA studies, the effects of physical activity on QoL were in favor of the control group. Effects of physical activity on function were found compared to the group of inactive controls and sustained in fatigue and pain when compared to the group of active controls. In the PsA studies, no effects on QoL were found, but effects on function were noted when compared to the group of inactive controls. The effect size was below 0.30 in the majority of the comparisons. CONCLUSION: Physical activity may improve QoL and self-reported function in individuals with RA, SpA, and PsA. However, larger trials are needed, especially in SpA and PsA.

Physical activity in patients with rheumatoid arthritis - an agile lifelong behaviour: a qualitative meta-synthesis.

BACKGROUND: Physical activity (PA) in rheumatoid arthritis (RA) is considered a cornerstone in the treatment. To highlight aspects involved in supporting a positive PA behaviour, it is important to understand the patients' perceptions of the phenomenon. OBJECTIVE: The aim of this qualitative meta-synthesis was to explore and synthesise patient perceptions of PA in RA. METHODS: A purposeful search was conducted across three online databases (PubMed, CINAHL and Web of Science). The methodological quality of the included studies was appraised, and data were extracted and analysed using an interpretive inductive thematic synthesis. RESULTS: Fifteen studies met the inclusion criteria and were included. PA was identified as an agile lifelong behaviour, with one main theme: The disease as a persistent catalyst for or against PA illustrating how the constant presence of the disease itself underlies the entire process of a life with or without regular PA. Seven subthemes: 'considering aggravated symptoms', 'acknowledging the impact on health', 'becoming empowered and taking action', 'keeping informed to increase awareness', 'creating body awareness', 'dealing with social support' and 'feeling satisfied with circumstances and achievements' were interpreted as facilitators and/or challenges. CONCLUSION: This synthesis has identified PA as an agile lifelong behaviour in which the disease pervades all aspects of an individuals' perception of PA. Placed in a theoretical context, our findings outline a model for tailoring PA support to the drivers and determinants of a certain individual, which will improve clinical practice for the benefit of both health professionals and patients with RA.

Exploring the Perth Hamstring Assessment Tool and Lower Extremity Functional Scale in a Proximal Hamstring Avulsion Cohort: A Cross-sectional Study.

BACKGROUND: The goal of treatment for a proximal hamstring avulsion (PHA) is an objectively restored muscle and a subjectively satisfied, pain-free patient at follow-up. Different self-reported and performance-based outcome measures have been used to evaluate recovery, but their validity is poorly investigated. PURPOSE: To investigate (1) the correlation between the commonly used self-reported outcome measurements, the Perth Hamstring Assessment Tool (PHAT) and the Lower Extremity Functional Scale (LEFS); (2) to what extent these scores can be explained by physical dysfunction as measured by performance-based tests; (3) whether performance-based tests can discriminate between the injured and uninjured extremity; and (4) which activity limitations are perceived by patients several years after the injury. STUDY DESIGN: Cohort study (Diagnosis); Level of evidence, 3. METHODS: We included a consecutive series of patients treated for or diagnosed with PHA in our department between 2007 and 2016 having at least 2 tendons avulsed from the ischial tuberosity. Participants attended 2 study visits, answered questionnaires (PHAT, LEFS, and Patient-Specific Functional Scale [PSFS]), and performed physical performance-based tests (single-leg hop tests, single-step down test, and isometric and isokinetic strength tests). RESULTS: A total of 50 patients were included (26 men [52%], 24 women [48%]; mean age, 50.9 years [SD, 9.8 years]). The mean follow-up time was 5.5 years (SD, 2.7 years), and 74% had been surgically treated. The correlation between PHAT and LEFS was strong (r = 0.832) and statistically significant (P < .001). Seven of the performance-based tests exhibited a statistically significant but weak correlation with LEFS (0.340-0.488) and 3 of the tests to PHAT (-0.304 to 0.406). However, only peak torque could significantly discriminate between the extremities. The activity limitation most commonly mentioned in PSFS was running (16 patients [32%]). CONCLUSION: Although PHAT and LEFS correlated strongly, the correlations between functional tests and the patient-reported outcome scores were weak, and most functional tests failed to discriminate between the injured and uninjured lower extremity in patients with PHA 5 years after injury. In general, patients alleged few activity limitations, but running difficulty was a common sequela after PHA.

Position Statement on Exercise Dosage in Rheumatic and Musculoskeletal Diseases: The Role of the IMPACT-RMD Toolkit.

There is convincing evidence to suggest that exercise interventions can significantly improve disease-related outcomes as well as comorbidities in rheumatic and musculoskeletal diseases (RMDs). All exercise interventions should be appropriately defined by their dose, which comprises of two components: a) the FITT (frequency, intensity, time and type) and b) the training (ie, specificity, overload, progression, initial values, reversibility, and diminishing returns) principles. In the published RMD literature, exercise dosage is often misreported, which in "pharmaceutical treatment terms", this would be the equivalent of receiving the wrong medication dosage. Lack of appropriately reporting exercise dosage in RMDs, therefore, results in limited clarity on the effects of exercise interventions on different outcomes while it also hinders reproducibility, generalisability and accuracy of research findings. Based on the collective but limited current knowledge, the main purpose of the present Position Statement is to provide specific guidance for RMD researchers to help improve the reporting of exercise dosage and help advance research into this important field of investigation. We also propose the use of the IMPACT-RMD toolkit, a tool that can be used in the design and reporting phase of every trial.

Prevention and adherence in Rheumatic and Musculoskeletal disease.

Rheumatic and Musculoskeletal Diseases (RMDs) are chronic conditions that affect a substantial number of people. RMDs are significantly related to co-morbidity. Therefore, focusing on prevention in RMDs is of importance to promote and maintain health. Prevention includes primary-, secondary-, tertiary-, and clinical prevention. Primary prevention aims to prevent the onset of disease before the disease process begins, secondary prevention includes detecting and reducing disease and risk factors at the earliest possible point, and tertiary prevention aims to limit the influence of a recognized or verified disease and to address or reduce further development or worsening of the disease, including physical and psychosocial disability. Clinical prevention attempts to integrate prevention into the disease management to limit disease progression and prevent complications and relapse. This chapter will focus on the evidence for prevention and highlight how innovations and trends can contribute by using digital technologies as an example.

Implementation of Physical Activity into routine Clinical pracTice in Rheumatic Musculoskeletal Disease: The IMPACT-RMD study protocol and rationale.

BACKGROUND: Physical activity is an important intervention for improving disease-related symptoms and systemic manifestations in rheumatic and musculoskeletal disease (RMDs). However, studies suggest that RMD patients report that the lack of individualized and consistent information about physical activity from managing doctors and healthcare professionals, acts as a barrier for engagement. On the other hand, managing doctors and healthcare professionals report lack of knowledge in this area and thus lack of confidence to educate and advise RMD patients about the beneficial effects of physical activity. The aim of the present study therefore, is to develop two e-Learning courses for RMD doctors and health professionals: a) the first one to provide consistent information about the collective benefits of physical activity in RMDs and b) the second on how to implement physical activity advice in routine clinical practice. METHODS: An international collaboration of seven countries, consisting of one academic institution and one patient organization from each country, will co-develop the two e-Learning courses. The final e-Learning courses will primarily target to improve - through physical activity advice - RMD symptoms which are important for patients. DISCUSSION: The main result of this study will be to co-develop two e-Learning courses that can be used by managing RMD doctors and healthcare professionals to be made aware of the overall benefits of physical activity in RMDs as well as how to implement physical activity advise within their practice.