271 Anational survey of NHS hydrotherapy provision for the management of axialspondyloarthritis: the physiotherapist and patient perspective

Abstract

Background: Hydrotherapy is recommended by the National Institute for Health and Care Excellence (NICE) as an adjunctive therapy in the management of axial spondyloarthritis (AS). Access and provision of NHS hydrotherapy services are variable with pool closures nationwide. The impact on service delivery is poorly understood. The aims of this survey are to map the current provision of NHS hydrotherapy services for AS across the United Kingdom and to capture the patients' experience of hydrotherapy. Methods: Two online surveys were distributed in September 2017 via email, with social media updates, to the physiotherapy membership of AStretch, the British Society for Spondyloarthritis (BritSpA) and the Aquatic Therapy Association of Chartered Physiotherapists (ATACP). A patient survey was distributed to the membership of the National Ankylosing Spondylitis Society (NASS) (closing date 31 October 2017). Results: Physiotherapist survey: To date 144 physiotherapists have responded with 123 (85%) reporting referral access to an NHS hydrotherapy service. The most frequent AS hydrotherapy service model was six weekly sessions with 45% offering AS group hydrotherapy. 31 (32%) reported a fast-access referral pathway for those in flare, 26% offering this access via self-referral and 25% via a telephone helpline. 38% of physiotherapists reported barriers to provision. High demand, lack of capacity due to staffing and use of pools by non-NHS groups, impacted on waiting times. One in five hydrotherapy services reported a current threat of closure. Patient survey: To date 256 patients have responded (41% male; average age and disease duration 49 years and 12 years respectively). 166 (70%) have accessed NHS hydrotherapy with reported benefits including pain relief, improvement in mood and quality of life, stiffness and flare management. Access is largely initiated by rheumatology team referral (65%), with an additional 26 (17%) patients self-referring. 29% stated they could access hydrotherapy when in a flare. Barriers to NHS hydrotherapy included long waiting times and a restriction on the number of sessions offered. 26 (13%) have used a pay as you go hydrotherapy service in an NHS facility. Of the respondents who attend a NASS self-help group, 84% have access to hydrotherapy through the group, 71% being provided in a NHS facility. Conclusion: Patients reported similar benefits of hydrotherapy to those stated in the NICE guidance (NG65, 2017), further supporting the best practice recommendations. The survey suggests hydrotherapy services need to continue to be deliverable within the financial restraints of the NHS. However, variability in provision and a 'postcode' impact on access to NHS hydrotherapy exists for AS patients due to pool closures. Hydrotherapy service design to increase pool utilization such as fast-access pathways for flare management, group exercise, and promotion of self-management and pay-as-you-go services may go some way to meet demand and broaden participation whilst ensuring sustainability of services.