AB1561-HPR PHYSIOTHERAPY FOR RHEUMATOID ARTHRITIS (RA) – PAST, PRESENT AND A POSSIBLE FUTURE?

Abstract

Background: Physiotherapy has a long tradition providing services to patients with RA. The main aim of physiotherapy is to improve patients' abilities to perform movements and physical activities through exercises and educating patients in self-management skills. For physiotherapy to proceed into future, it seems relevant to examine what shifts occurred in physiotherapy over time and why did they happen. Objective(s): Is to unpack the shifts in physiotherapy for patients with RA from 1980 until today. Method(s): Norwegian physiotherapy in rheumatology is used as case. The shifts are identifed with help of literature about history of medicine and physiotherapy in rheumatology and empirical physiotherapy research since the 1980s. The author draw on own experiences frst as a clinician and practice teacher for physiotherapy students in rheumatology, and later as a scientist and advisor for a multidisciplinary team in rheumatology. Result(s): Physiotherapy focuses on movement and function, which over time have consistently been understood in relationship to disease-induced alterations and biomechanics. Shifts in physiotherapists' remedial exercises have occurred over time as better disease control occurred and evidence showed that physical activities and exercise programmes had disease modifying effects and improved patients' functional capacity. In the 1980s, a move from earlier passive, joint protective movements with little weight load to cautious weight-bearing movements occurred, mostly as a response to improved disease-modifying drugs and joint surgery. In the 1990s, physiotherapy shifted from cautious weight-bearing movements to safely performed physical activity as a response to scientific findings showing beneficial effects on radiological, immunological, and physical function measures. In the 2 1. century, RA is identified earlier and increasing number of patients reach disease remission before irreversible occurs in the musculoskeletal system. Presently, a new shift in Norwegian physiotherapy is on the way. Adherence to EULAR guidelines 2018 on physical activity1 is moving physiotherapy from promoting exercises through engagement in self-determined physical activities into educating patients in performing structured intensive physical fitness training programmes for preventing future comorbidities. Conclusion(s): At the moment, it is a dilemma that the raising rate of patients successfully treated to disease remission is not accompanied with more patients remaining in volitional work in Norway2. Thus, there is a need in physiotherapy to critically scrutinize the meaning and signifcance of movements and functioning for the individual patient's own life purpose and the society's wish that people stay in paid work.