Barriers and facilitators of vigorous cardiorespiratory training in axial Spondyloarthritis: Surveys among patients, physiotherapists, rheumatologists

OBJECTIVE Vigorous cardio-respiratory training (vCRT) in patients with axial Spondyloarthritis (axSpA) is effective, safe and feasible, however not yet adopted in axSpA exercise programmes. We therefore aimed to explore the barriers and facilitators for vCRT among patients, physiotherapists (PTs) and rheumatologists. METHODS "Stakeholder-specific surveys examined perceptions of barriers and facilitators to vCRT organized under categories identified by Grol & Wensing. Respondents chose the 3 most important barrier and facilitator categories and rated individual items on a 4-point scale. Frequencies and proportions were calculated; ratings between active and inactive patients were compared." RESULTS Patients (n= 575, response rate 34%): the top-3 barrier categories included 'low motivation' (n=317=/59%),' unsuccessful timing in daily routine' (n=292/55%) and 'hindering disease symptoms' (n=272/51%). The top-3 facilitator categories were 'high motivation' (n=248/47%), 'good organisational conditions' (n=217/41%), 'facilitating disease symptoms' (n=209/40%). More inactive than active patients chose 'low motivation' as barrier (p=0.01). PTs (n= 40, response rate 48%): The top-3 barrier categories included 'heterogeneous group composition' (n=26/70%), 'difficult organisational conditions' (n=19/51%) and 'low motivation' (n=19/51%). The PTs' top-3 facilitator categories were 'knowledge' (n=20/54%), 'homogeneous group composition' and 'high perceived motivation' (both n=17/46%). Rheumatologists (n=73, response rate 17%; with 54 (74%) answering barrier items and 68 (93%) answering facilitator items): Strongest barriers included 'not enough information' (n=25/47%) and 'anticipated /perceived disinterest of patient (n=27/50%). Strongest facilitators included 'exercise important topic even in limited consultation time' (n=65/96%) and 'clear evidence for effectiveness of flexibility exercises' (n=62/91%). CONCLUSION The identified facilitators and barriers will guide the development of stakeholder-specific implementation strategies. This article is protected by copyright. All rights reserved