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PROFESSIONAL ISSUES
ARTHRITIS: THE PHYSIOTHERAPISTS
WHO TREAT IT
Physios vital to managing arthritis
Physical activity is key to
quality of life for people
with arthritis, and, “We
should be the lead people
in managing this,” Peter
Larmer insists.
Peter came to this conclusion through
hard experience. With an arthritic hip,
replaced last year, he realised that his
GP could offer medication (not always
appropriate, and not in his case) and
referral to an orthopaedic surgeon
for replacement – but had few other
options and was not able to offer any
advice on exercise, where there is good
evidence of effectiveness.
He’s Dr Peter Larmer, Head of the
School of Physiotherapy at AUT
University, and he’s now on the
Board of Arthritis New Zealand. AUT
physiotherapy students are now
learning a different model for dealing
with arthritis, and seeing the new team
model exemplified in the AUT clinics.
See May 2011 Physio Matters p.24-25.
“The focus has changed,” Peter says.
“Instead of incidental treatment when
someone with arthritis happens to
come to a physio for treatment, we’re
focusing on long-term engagement
with people who have arthritis.
“We need to engage with them before
their arthritis gets so bad that they
break down and can’t cope. We can’t
prevent arthritis, but we have a strong
role in preventing disability.”
Physiotherapists are the ideal people to
monitor people’s physical impairment
level, Peter emphasises. “This is our
area of expertise, and I don’t think
we should be shy about saying that.
We modify their exercise programme
so that they can learn to be active
within their limits. We present different
options for exercise, like swimming,
cycling, or yoga. We educate them
about all the known health benefits of
exercise, and in particular weight loss
to avoid overloading joints. We need to
establish a different relationship with
our clients. We should recall them in six
months’ or a year’s time to see whether
they’re maintaining their status or
getting worse. This should be standard
practice. We can then say, ‘You’re
doing well with this,’ or ‘You’re getting
stiffer here so you need to work on
these areas and alter this aspect.’
“As soon as someone is diagnosed
with arthritis, a physio should be part
of their management.”
Peter is delighted to have Physiotherapy
New Zealand working in with the
awareness raising efforts of Arthritis
New Zealand, and he urges individual
physiotherapists to display information
about the campaign in clinics and
departments. “When patients come in
and see that, they realise that physios
have a role in managing arthritis.”
Physiotherapists have the training
and skills to manage arthritis, Peter
says, but a nationwide educational
package would help update them on
evidence-based research and achieve
consistent management.
The physiotherapist’s disease
Before modern anti-inflammatory
medications and newer biological
drugs, ankylosing spondylitis (AS) was
often known as “the physiotherapist’s
disease”. Although medications have
advanced and the medical management
of patients with AS is now much
more sophisticated than previously,
there is no doubt that physiotherapy
still makes a huge difference to the
lives of those with the disease. International
best practice guidelines highlight
the need for a combined approach to
treatment of AS incorporating both
medical and exercise-based therapy for
optimal patient outcomes.
Physiotherapy and NSAIDs (nonsteroidal
anti-inflammatory drugs) are
first-line management for ankylosing
spondylitis which must be used before
patients can be considered for the new
(and very expensive) biological drugs.
Even for a patient on one of these new
medications, exercising to maintain
their range of motion remains essential.
Inflammatory arthritis also increases a
person’s risk of cardiovascular disease
and osteoporosis, making regular
activity even more important.
Chronic inflammation in the spinal
joints and ligament attachments can
lead to joint deformity and eventually
fusion if left untreated. “If we can get
people stretching their spinal joints
and ligaments regularly, this helps to
counteract any thickening which occurs
as part of the inflammatory process
of AS,” says Jo Rae of the Wellington
Regional Rheumatology Unit based at
Hutt Hospital. Exercises that strengthen
the postural muscles of the spine
are also important to reduce excessive
mechanical loading on inflamed
spinal joints.
Ankylosing Spondylitis Clinic
Jo and a nurse run a clinic where
patients with ankylosing spondylitis
attend for up to an hour every six or
06 | PHYSIO MATTERS AUGUST 2011