P46 Establishing a self management aquatic programme in adolescents with musculoskeletal pain and disability

Abstract

Background: The paediatric rheumatology and chronic pain teams in Oxford provide highly specialised rehabilitation services with interventions ranging from one-to-one therapy to intensive inpatient rehabilitation programmes. It was identified that further ongoing community based support would be beneficial for the maintenance of physical fitness and wellbeing. We aimed to create an innovative approach to community based self-management group aquatic therapy for adolescents aged 11-18; bringing together the technical expertise of a social enterprise group with established success in delivering community group aquatic therapy for adults using digital technology, clinical expertise from the Oxford clinical teams, and research experience from Oxford Brookes University. We aimed to develop a self-management aquatic therapy programme for adolescents with musculoskeletal pain and disability using individualised digital prescription programmes. Methods: The specialist physiotherapists identified patients that were actively under their care between the ages of 11-18 year. The group had a range of diagnoses but all had the common finding of ongoing musculoskeletal pain and disability. The level of function required to take part was agreed as, independently mobile, able to get in and out of pool without assistance, independent dressing (parents will not be permitted to stay at pool side). It was acknowledged that some patients may be inappropriate for group work including those with specific behavioural difficulties. Results: Outline of the programme: Patients were invited to attend a six week aquatic self management group under the supervision of our physiotherapists. The patients had all been assessed by the specialist physiotherapists and identified as being appropriate for the programme. The physiotherapists selected exercises from the Fluid Motion digital rehabilitation package in order to create an individualised programme for each participant. The paediatric rheumatology hydrotherapy pool was used. This was identified as an appropriate place to run the pilot programme with a view to hosting future programmes in community pools. 5-6 patients were in each group. The physiotherapist was in the pool for each session to provide support. Patients were provided with a personal tablet device and introduced to their individualised programme before entering the pool. The patients used the tablets during each session and provided real time feedback on their experiences of the exercises to inform progression of their personalised programme and development of the artificial intelligence (AI) software. Reassessment was carried out in the final session. All patients committed to participate in six sessions. Assessing the intervention: Pre and post course assessments were completed: Oxford Centre for Children and Young People in Pain questionnaire (child and parent versions), PEDSQL, EQ5D-Y, and a questionnaire to assess attitudes to self-management and aquatic therapy. Physical assessments included: sit to stand, step ups, and 1min cardio wall. Conclusion: We identified a need to provide ongoing support for young people with musculoskeletal pain and disability once the input of highly specialised services was no longer indicated and recognised the potential for supervised self management group aquatic therapy. We present our experience of designing an adolescent group selfmanagement programme using digital technology that can be easily utilised by young people during their therapy sessions and provide real time feedback to progress their therapy and develop AI technology. Further development of the initiative to deliver this programme in a community setting is anticipated.