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Physical activity (PA) is a key strategy for improving symptoms in people with rheumatic and musculoskeletal diseases (RMDs). The aim of this study was to investigate and rank the importance of known barriers and facilitators for engaging in PA, from the perspective of people living with RMD. Five hundred thirty-three people with RMD responded to a survey (nine questions) disseminated by the People with Arthritis and Rheumatism (PARE) network of the European Alliance of Associations for Rheumatology (EULAR). The survey required participants to rank — based on their perceived importance — known PA barriers and facilitators from the literature, and specifically RMD symptoms as well as healthcare and community factors that may affect PA participation. Of the participants, 58% reported rheumatoid arthritis as their primary diagnosis, 89% were female, and 59% were between 51 and 70 years of age. Overall, participants reported fatigue (61.4%), pain (53.6%) and painful/swollen joints (50.6%) as the highest ranked barriers for engaging in PA. Conversely, less fatigue (66.8%) and pain (63.6%), and being able to do daily activities more easy (56.3%) were identified as the most important facilitators to PA. Three literature identified PA barriers, i.e., general health (78.8%), fitness (75.3%) and mental health (68.1%), were also ranked as being the most important for PA engagement. Symptoms of RMDs, such as pain and fatigue, seem to be considered the predominant barriers to PA by people with RMD; the same barriers are also the ones that they want to improve through increasing PA, suggesting a bi-directional relationship between these factors.Key Points• Symptoms of rheumatic and musculoskeletal disease (RMD) are the predominant barriers for lack of physical activity engagement.• RMD symptoms are the factors that people with RMDs want to improve when engaging in PA.• The barriers that stop people living with RMDs to do more PA are the ones that can be significantly improved through PA engagement.

Objectives Self-monitoring of physical activity (PA) has the potential to contribute to successful behaviour change in PA interventions in different populations, including people with inflammatory joint diseases (IJDs). The objectives of this study were to describe the use and knowledge of self-report-based and device-based PA measures in people with IJDs in four European countries, and to explore if the use of such devices, sociodemographic or disease-related variables were associated with adherence to the recommendations of at least 150 min of moderate to vigorous PA per week.

Background: The context of education in the health professions has been influenced by the same tendencies of development of knowledge and technology that society faces. It is therefore important that educational institutions are capable of promoting an evolutionary profile of professionals that is adapted to the needs of the future society. Purpose: One of the aims of the European Network of Physioth erapy in Higher Education (ENPHE) is to bring together and enhance collaboration between european institutes and physiotherapy educational institutions in the european region in order to encourage and support standards of high quality education in physiotherapy in accordance with the recommendations of the World Confederation for Physical Therapy (WCPT and ER-WCPT). Methods: In the context of the ENPHE group “Facilitation of Learning” and based on the literature, an online questionnaire was constructed regarding teaching approaches. After a pilot study within 5 institutions, the final version of the survey was disseminated during the ENPHE 2018 seminar. Results: We h ad 143 survey responses from 19 countrys, most of the respondents were fulltime lecturers (54%) at Bachelor´s level (89%). The responses indicated that the most commonly used Learning. Approaches included, Problem Solving (86%) and Content Focus activities (83%) using mainly lectures (78%) and practical training in class (83%) and the most popular tools used were aimed to facilitate retrieving, recalling or recognising knowledge (97%), using written (86%) and/or practical examination (77%) as assessment strategies. Conclusion(s): The results still reflect a classic approach to teaching and learning as shown by the selection of approaches, tools and assessment strategies. Implications: The results have provided some insight and also could guide the ENPHE in devising strategies to facilitate the use of more student inclusive and active learning strategies in Physiotherapy education. N/A

Purpose The context of education in the health professions has been influenced by the same tendencies of development of knowledge and technology that society faces. It is therefore important that educational institutions are capable of promoting an evolutionary profile of professionals that is adapted to the needs of the future society. Subjects Lecturers from Higher education institutions belonging to the ENPHE Network Material / Methods In the context of the ENPHE group “Facilitation of Learning” and based on the literature, an online questionnaire was constructed regarding teaching approaches. After a pilot study within 5 institutions, the final version of the survey was disseminated during the ENPHE 2018 seminar and until July 2018 by email. Results We had 143 survey responses from 19 country's, most of the respondents were fulltime lecturers (54%) at Bachelor´s level (89%). The responses indicated that the most commonly used Learning Approaches included, Problem Solving (86%) and Content Focus activities (83%) using mainly lectures (78%) and practical training in class (83%) and the most popular tools used were aimed to facilitate retrieving, recalling or recognizing knowledge (97%), The use written (86%) and/or practical examination (77%) as assessment strategies. Conclusions The results still reflect a classic approach to teaching and learning as shown by the selection of approaches, tools and assessment strategies. Educational relevance. The results have provided some insight and also could guide ENPHE devising strategies to facilitate the use of more student inclusive and active learning strategies in Physiotherapy education. N/A

Background and Purpose: Due to the long life expectancy after treatment, the risk of late effects after radiotherapy (RT) are of particular importance for patients with Hodgkin lymphoma (HL). Both deep inspiration breath hold (DIBH) and proton therapy have been shown to reduce the dose to normal tissues for mediastinal HL, but the impact of these techniques in combination is unknown. The purpose of this study was to compare the life years lost (LYL) attributable to late effects after RT for mediastinal HL using intensity modulated radiation therapy (IMRT) in free breathing (FB) and DIBH, and proton therapy in FB and DIBH. Materials and Methods: Plans for each technique were created for 22 patients with HL. Doses were extracted and the risk of late effects and LYL were estimated. Results: We found that the use of DIBH, proton therapy, and the combination significantly reduced the LYL compared to IMRT in FB. The lowest LYL was found for proton therapy in DIBH. However, when IMRT in DIBH was compared to proton therapy in FB, no significant difference was found. Conclusions: Patient-specific plan comparisons should be used to select the optimal technique when comparing IMRT in DIBH and proton therapy in FB.

WNT/β-catenin signalling is crucial for intestinal homoeostasis. The intestinal epithelium and stroma are the major source of WNT ligands but their origin and role in intestinal stem cell (ISC) and epithelial repair remains unknown. Macrophages are a major constituent of the intestinal stroma. Here, we analyse the role of macrophage-derived WNT in intestinal repair in mice by inhibiting their release using a macrophage-restricted ablation of Porcupine, a gene essential for WNT synthesis. Such Porcn-depleted mice have normal intestinal morphology but are hypersensitive to radiation injury in the intestine compared with wild-type (WT) littermates. Porcn-null mice are rescued from radiation lethality by treatment with WT but not Porcn-null bone marrow macrophage-conditioned medium (CM). Depletion of extracellular vesicles (EV) from the macrophage CM removes WNT function and its ability to rescue ISCs from radiation lethality. Therefore macrophage-derived EV-packaged WNTs are essential for regenerative response of intestine against radiation.

Background Activity pacing is a recommended non-pharmacological intervention for the management of rheumatic and musculoskeletal diseases in international clinical guidelines. In clinical practice, activity pacing aims at adapting daily activities, and is often an important component of self-management programs. However, despite its wide endorsement in clinical practice, to date activity pacing is still a poorly understood concept. \ud Objectives To achieve consensus by means of an international Delphi exercise on the most important aspects of activity pacing as an intervention within non-pharmacological rheumatology care. \ud Methods An international, multidisciplinary expert panel comprising 60 clinicians and/or healthcare providers experienced with activity pacing across 12 different countries participated in a Delphi survey. Over four Delphi rounds, the panelists identified and ranked the most important goals of activity pacing, behaviours of activity pacing (the actions people take to meet the goal of activity pacing), strategies to change behaviour in activity pacing (for example goal setting) and contextual factors that should be acknowledged when instructing activity pacing. Besides, topics for future research on activity pacing were formulated and prioritized. \ud Results Of the 60 panelists, nearly two third (63%) completed all four Delphi rounds. The panel prioritized 9 goals, 11 behaviours, 9 strategies to change behaviour and 10 contextual factors of activity pacing. These items were integrated into a consensual list containing the most important aspects of activity pacing interventions in non-pharmacological rheumatology care. Furthermore, the Delphi panel prioritized 9 topics for future research on activity pacing which were included in a research agenda. This agenda highlights that future research should focus on the effectiveness of activity pacing interventions and on appropriate outcome measures to assess its effectiveness, as selected by 64% and 82% of the panelists, respectively. \ud Conclusions The diversity and number of items included in the consensual list developed in the current study reflect the heterogeneity of the concept of activity pacing. This study is an important first step to achieve better transparency and homogeneity within the concept of activity pacing for clinical practice and research.