Physical Activity (PA) is one of the most important lifestyle factors influencing human health. The general and disease-specific health benefits of PA are well known to the general population and... Show morePhysical Activity (PA) is one of the most important lifestyle factors influencing human health. The general and disease-specific health benefits of PA are well known to the general population and to those people living with rheumatic musculoskeletal diseases (RMDs). The importance of PA as an intervention for the management of RMDs has been endorsed by various stakeholders, e.g. the World Health Organisation and the European Alliance of Associations for Rheumatology/EULAR. The early translation of research evidence into clinical care benefits patients with RMDs greatly.This thesis is focused on the effects and promotion of PA and exercise on people with RMDs, and particularly those with axial Spondyloarthritis (axSpA).The overall aim of this thesis was to document the journey from the development of the EULAR PA recommendations for people with RMDs (including axSpA) to the practical implementation of a concept for group exercise therapy for people with axSpA living in Switzerland that conforms to these recommendations. Show less
In many countries physiotherapy is often prescribed to PD patients, somewhere in the course of the disease. However, information about the use and efficacy of physiotherapy in PD is sparse, often... Show moreIn many countries physiotherapy is often prescribed to PD patients, somewhere in the course of the disease. However, information about the use and efficacy of physiotherapy in PD is sparse, often lacking. Therefore, the aims of this thesis are: (a) to gain better insight into the use and merits of physiotherapy for patients with PD and (b) to take a step forward in obtaining evidence-based physiotherapy for patients with PD. As a first step in this process, the efficacy of physiotherapy in PD was evaluated by means of a systematic review (Chapter 2). Secondly, the quality and quantity of current physiotherapy care in PD was evaluated by means of questionnaires sent to patients with PD and their physiotherapists (Chapter 3). Given the frequent use of physiotherapy and the lack of PD-specific expertise amongst therapists, an evidence-based guideline with practice recommendations was developed (Chapter 4). Next, we wished to examine how effective __best practice__ physiotherapy (as described in this new guideline) is for patients with PD. According to EBM recommendations, the results of an RCT provide the highest level of evidence. Therefore, we designed an RCT. To assess the feasibility of this RCT, we first performed a pilot RCT (Chapter 5). The goals of this pilot study were to examine the recruitment rate of patients, to determine the feasibility of the proposed outcome measures, to evaluate the new guideline as a tool to standardise the intervention within the experimental group and to estimate the effect size of the intervention in order to adequately power the RCT. Based on the results of this feasibility study, steps were taken to optimise two promising outcome measures: the Parkinson Activity Scale, evaluating limitations in ADL, and the Patient Specific Index, a patient preference outcome scale (Chapters 6 and 7). At the same time, the ParkinsonNet concept was developed as a novel approach to further improve the quality of physiotherapy in PD ParkinsonNet aims to improve PD-specific expertise among allied health professionals, to improve the referrals to physiotherapy by neurologists and to enhance communication between allied health professionals and neurologists. We then designed a trial to evaluate the implementation process this new ParkinsonNet concept, as well as the possible health benefits and associated costs (Chapter 8). Finally, an overview of the evolution of physiotherapy in PD was made (Chapter 9), which are presented with future challenges (Chapter 10). Show less
