057. Physical activity in young people's rheumatology consultations: A pilot study investigating stakeholders' assessment and knowledge within the Sheffield Paediatric and Adolescent Rheumatology Service

Abstract

Background: The benefits of a physically active lifestyle and negative effects of sedentary behaviour are well evidenced, including for children and young people (CYP) with juvenile idiopathic arthritis (JIA). Despite this, levels of activity among CYP in the UK are low, with only 21% of boys and 16% of girls reaching minimum government recommendations (as recently encapsulated in a Public Health England infographic), recommending 1 hour of moderate to vigorous activity a day for children aged 5-18 years. This service evaluation was completed as part of a BMedSci pilot and feasibility project and assessed levels and experiences of self-reported physical activity (PA) in patients with JIA in a paediatric and adolescent rheumatology service. Aims: Within a Paediatric and Adolescent Rheumatology Service: To investigate HCP's assessment of patients' PA, and to assess stakeholder knowledge of PA. Methods: Mixed methods (qualitative and quantitative) approach with 3 phases. Literature review detailing the evidence base surrounding PA and translation into clinical practice; quantitative assessment through, a. Notes Audit (n = 50) of how PA is documented in young people (YP's) rheumatology consultations. b. Questionnaires addressed to patients and their parents/carers (n = 33) and healthcare professionals (HCP's) (n = 16), to investigate reported PA assessment in consultations and patient knowledge regarding PA. Thirdly, qualitative semi-structured interviews with patients and their parents/carers (n = 3), and a focus group with HCP's, explore results from Phase 2 and barriers/facilitators to PA participation. Results: PA was not well documented in YP's rheumatology consultations; notes and letters alluded to general mention of PA, but documented few specifics (e.g. type, amount, advice). Questionnaires (response rate = 89%) reported slightly higher levels of assessment but lack of use of the Public Health England infographic and government guidelines in consultations. Quantitative and qualitative evaluation demonstrated gaps in knowledge of PA reported by all stakeholders. Emerging qualitative themes included barriers to PA such as good and bad days in JIA, influence from family/peers and school related factors. HCP's reported lack of confidence in providing advice to patients and divergence in their experience of patients' approaches to PA and the perceived effect of this, on addressing and promoting PA in clinic. Conclusions: This study emphasised a limited reported assessment of PA in YP's rheumatology consultations, and a need to better educate stakeholders to further embed PA in routine healthcare for CYP with JIA in one centre. Feedback from participants and reflective evaluation of the study process provided valuable insight into the important contribution that stakeholders can make to facilitate these changes. The study showed the mixed methods approach to be feasible and, even at small scale, to provide useful insights to inform local service improvement. The small-scale, single-centre nature of this study were important limitations to be addressed in a larger study.