219. THE DEVELOPMENT OF AN ONLINE THERAPIST TRAINING COURSE TO DELIVER AN EVIDENCE-BASED EXERCISE PROGRAMME FOR PEOPLE WITH RHEUMATOID ARTHRITIS AFFECTING THE HANDS

Abstract

Background: The Strengthening and Stretching for the Rheumatoid Arthritis of the Hand (SARAH) programme is an individually tailored 12- week progressive exercise programme for people with hand problems due to rheumatoid arthritis (RA). The programme was found effective in improving hand function and quality of life outcomes in a large clinical trial and resulted in updating of NICE guidelines. To aid implementation of the SARAH programme into clinical practice, we have developed an online training course (iSARAH) for National Health Service (NHS) based physiotherapists and occupational therapists. Method(s): We surveyed 102 therapists who downloaded the SARAH materials from the Oxford Clinical Trials Research Unit website. The survey investigated the types of hand exercises prescribed to people with RA, outcome measures and if they have used the SARAH programme in their clinical practice. We constructed a prototype of iSARAH based on the trial protocol and survey feedback which was reviewed by 12 therapists and information technology experts and further developed. Currently, we are testing iSARAH usability in 10 therapists using a Think aloud protocol, semi-structured interview, and subjective reports on usefulness; ease of use; and confidence with Likert scales and Computer System Usability Questionnaire. Result(s): 35 therapists responded to the survey. The majority were from the UK (74%) and working (91%) in the National Health Service (NHS). Pain and self-reported function were the most commonly used outcomes in 94% and 80% of therapists respectively. Disease activity and activities of daily living were least evaluated (11% therapists). Active range of motion and strength exercises was routinely prescribed by 97% and 77% of therapists. An average of four review sessions once in two weeks was reported. 94% of therapists used exercise sheets to encourage adherence. 74% of therapists who downloaded the SARAH materials were using the programme. Perceived benefits, peer influence, need to change practice and the SARAH exercise materials facilitated the use of the programme. The main barriers were busy case load, forgetting, and lack of time. Not having appropriate patients, budget, lack of time, and prescription of similar hand exercises were some reasons reported by therapists who didn't use the SARAH programme. Information from the survey and discussion with stakeholders allowed us to design the key features of iSARAH. These included: a simple layout containing brief training modules, clear pictures and instructions, exercise videos, links for arthritis information, a resource library with downloadable materials, frequently asked questions section, course assessment, browser compatibility, and technical support. We will present iSARAH website, usability test findings and plans for implementation evaluation at Rheumatology 2017. Conclusion(s): The development of iSARAH will aid implementation of a clinically and cost effective exercise programme making it accessible to therapists and people with RA affecting the hands.