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ObjectiveThe musculoskeletal features of systemic sclerosis (SSc) are a major cause of disability, causing limitations to movement and function. The study aim was to compare the effects of daily hand exercises with or without daily home wax bath hand treatment in patients with SSc.DesignAssessor-blinded randomised controlled trial of parallel group design.SettingSingle participating centre, undertaken in secondary care and in participants homes.Participants36 participants with hand skin tightening of SSc, two participants lost to follow up.InterventionsParticipants were randomised into wax bath versus no wax bath groups. Both groups in addition performed regular hand exercises as part of standard care. The study period was 9 weeks, with further measures of outcome undertaken at 18 weeks.Main outcome measuresThe primary outcome measure was the Hand Mobility in Scleroderma test (HAMIS). Secondary outcomes measures were the Scleroderma Health Assessment Questionnaire, grip and pinch strength and the Cochin Hand Function Scale.ResultsBetween group comparisons of HAMIS scores showed no evidence of effectiveness of the wax bath treatment at 9-week follow up (adjusted difference in means (95% CI) experimental-control −1.47 (−3.55 to 0.61), P = 0.16) or at 18-week follow up (adjusted difference in means (95% CI) experimental-control 1.94 (−1.07 to 4.95), P = 0.20). Analysis of secondary outcomes also showed no evidence for effectiveness of the wax bath treatment at either 9 or 18 weeks.ConclusionOur findings suggest that the addition of regular wax bath treatment confers no additional beneficial effect to standard care with daily home exercises.

Background/Aims Rheumatology physiotherapy is a specialist area requiring specific skills and knowledge. At all levels of practice, physiotherapists play an essential role in patient management. There is not yet any profession-specific competency guidance in this area. The aim of this paper is to describe the processes undertaken in creating and reviewing a national rheumatology physiotherapy competency framework suitable for all levels of practice. Methods A national survey of rheumatology physiotherapy practice was completed in October 2019. At the end of the survey participants were invited to be involved in the development of a rheumatology physiotherapy competency and capabilities framework. Forty-seven physiotherapists expressed an interest and were invited to comment, critique and feedback on a draft rheumatology specialist competency framework document that had been developed in parallel to the survey. Results Twenty-five physiotherapists provided feedback on Version 1 of the draft framework. Responses were received from bands 6 - 8 post holders and from NHS and private provider work settings. Involvement was sought and received from the four nations of the UK: England, Northern Ireland, Scotland and Wales. For the 465 competencies within the draft framework, over 1,000 comments were received. These comments were reviewed and amalgamated into a Version 2 framework. Agreement level of the expert reviewers’ opinions on these competencies was generally high. In addition to competency statement specific feedback, general comments on content, aims, impacts and utility of the document were also received which informed the revisions undertaken. Version 2 reflects the expert input and constructive, excellent advice received. Themes within general comments included: defining expert speciality practice; focus on what is unique about Rheumatology for a physiotherapist; impacts and considerations from location of service delivery, e.g. primary versus secondary care, urban versus rural, large teaching hospital versus district general hospital; rotational versus non-rotational posts; enough authority of the final framework to support the need for funding in training and development, as well as leading to new roles; breadth and variability required within single post-holders; addressing blurred lines, unrecognised capabilities and supporting career progression; justification for working at a higher level than given credit. Conclusion There is a strong desire amongst the rheumatology physiotherapy profession to progress this project and to engage with and support the development of a national rheumatology physiotherapy competency framework. Many specialist physiotherapists have contributed their expertise in their own time to agree competency statements. The process has ratified the further development and future publication of this framework. Disclosure W.J. Gregory: Honoraria; W.G. has received honoraria from Abbvie, Pfizer and UCB. H. Chambers: None. C. McCrum: Honoraria; C.McC. has received honoraria from Novartis.

Background/Aims Accurate methods of muscle strength assessment are vital in the care of patients with idiopathic inflammatory myopathy (IIM). Manual muscle testing (MMT) is limited in quantification of strength and has a demonstrated 'ceiling effect'. Recent research has indicated that hand-held dynamometry (HHD) may provide a user-friendly and patient-acceptable method to quantify muscle strength without a ceiling effect. This study aims to demonstrate routine clinical application of HHD and explore the ability to predict physical function and patient-rated impact in a tertiary IIM cohort. Methods Data was collected from adult IIM patients attending a UK tertiary centre between 2016 and 2019. Bilateral HHD of knee extension, shoulder abduction and grip strength were measured by a single specialist physiotherapist. Data was also collected on function (Health Assessment Questionnaire [HAQ]), muscle strength (MMT-8) and global activity (patient global visual analogue scale [VAS]). Generalised linear modelling, adjusted for age and sex was used to quantify associations between HHD values of each movement and HAQ score, MMT-8 score and patient global activity VAS. Results Data was collected on 57 patients (60% female) with a mean age of 56 years (SD 13), mean HAQ of 1 (SD 0.85), and mean MMT-8 of 75 (SD 6) out of a maximum score of 80. Summary values of each collected measurement and modelling results are displayed in Table 1. All HHD measurements significantly correlated with HAQ, MMT-8 and patient global VAS scores. The greatest magnitude of association was seen with shoulder abduction. The collection of strength measures by the HHD method was tolerable and time-efficient for patient and clinician. Patient feedback on being able to see their objective strength measures on the HHD was also encouragingly positive, boosting their intrinsic motivation to take part in rehabilitation. P150 Table 1:Summary HHD strength values and modelling resultsMeasurement using HHDMean (SD) (kg)Association with HAQ - Coef (p-value)Association with MMT-8 - Coef (p-value)Association with patient global VAS - Coef (p-value)Grip strength22.98 (12.41)-0.04 ( Conclusion This study indicates that HHD may provide an inexpensive, user-friendly method of strength assessment in IIM patients, providing accurate insights into function, strength and global activity. Undertaking HHD in clinic and by a specialist physiotherapist allows for stratified, personalised rehabilitation intervention. Following future validation, HHD could form a method of objective muscle strength assessment, thus focusing IIM clinical care and research. Disclosure W.J. Gregory: Honoraria; W.G. has received honoraria from Abbvie, Pfizer and UCB. A. Oldroyd: None. H. Chinoy: None.

Background The physiotherapy AStretch committee promote excellence and education in axial spondyloarthritis. One channel for providing this is though the bi-annual conference. An average of 50 delegates attend these conferences. The planned 2018 conference was deferred and we took the opportunity to replace this with a digital version. A mid-November date was agreed for 'go live' of the digital conference; this was advertised on the AStretch website and on our social media channels in advance. Digital resources in the form of presentations and interviews were accessed via our website with some resources additionally held on our YouTube page. Conference access was open for a month from the 'go live' date. This papers aim is to evaluate engagement with our first digital AStretch Conference. Methods Qualitative and quantitative data was captured from YouTube, Twitter, Facebook and our AStretch emails from the 'go live' date until 1 month after. The quantitative data captured were the numbers of YouTube watches, twitter impressions, twitter engagements and the numbers of Facebook likes, comments and shares. In addition, qualitative data by means of free-text comments were recorded. Results We had several live questions on the night; answered across the team. There were 7,600 impressions on twitter with a 4.7% engagement rate, 137 link clicks, 41 retweets and 105 likes. The YouTube channel averaged 80 watches per video. Facebook had 54 likes, 6 comments and 18 shares. Examples of comments: “this has been excellent, well done to all involved”, “absolutely brilliant...a great CPD event”, “EULAR talk was great...interviews were good too”, “my NASS physios loved it”, and “what a great evening”. Conclusion We have shown that there is a high level of interest in a digital version of our AStretch conference. We have reached more people via this digital version of the conference than our average attendance at the in-person conference. We have observed far reaching engagement and sharing of knowledge in a cost-neutral and user-convenient method, which has the potential to ultimately improve patient care nationally and internationally. Disclosures W.J. Gregory: Honoraria; W.G. has received speaker fees from Novartis and received Conference attendance fees from Pfizer. J. Martindale: Honoraria; JM has received honoraria from Abbvie Ltd, Novartis, Pfizer and UCB. Grants/research support; JM has received a research grant from Pfizer. M. Martin: Honoraria; MM has received honoraria from Novartis and Abbvie. Grants/research support; MM has received a research grant from NASS. M. McDonald: None.

Background The Axial Spondyloarthritis Specialist Interest Group North-west (ASSIGNw) is a regional network of physiotherapists with special interest in axial spondyloarthritis. The group meets to share best practice and provide a forum for professional support. The National Axial Spondyloarthritis Society (NASS) ‘Aspiring to Excellence’ campaign highlights the need for co-production and sharing of expertise as being imperative to the improvement of care for all this group of patients. A consensus sharing exercise was performed within the group to look at addressing this. Following discussions, there was an aim to create a ‘top tips’ for practice guidance for sharing with colleagues both in the group, and nationally. Methods During the March 2019 meeting, each member was invited to share their top tips for practice. After this sharing exercise, two members of the group reviewed and themed the suggestions. This thematic analysis was then shared by email to all group members to allow for further contributions. An additional opportunity within our next group meeting was used to ratify the themes and provide group endorsement. Results Suggestions for top tips for practice included ‘Do’s and Don’ts’ and fell into 2 main categories: patient care and service delivery. ‘Do’s for patients’ related to ‘Communicate and educate’ focusing on therapists communication, the importance of explaining diagnosis, giving reassurances and signposting patients to appropriate educational materials. The ‘Assessment’ theme included suggestions to acknowledge importance of therapeutic relationship building, using detailed history compilation to learn the patients’ journey, co-morbidities, sleep hygiene and fatigue, and the impacts these have on quality of life. In contrast, ‘Don’t’s for patients’ warned of ‘Being aware’ emphasising the difficulty of arriving at a diagnosis and the pitfalls with con-concomitant chronic widespread pain or Fibromyalgia. ‘Do’s for service’ describes the ‘Communicate with all’ theme highlighting the need to be all inclusive with every member of the service, liaising both with internal and external stakeholders but more importantly focusing upon the needs of patient and the services responsiveness to changes in these. ‘Don’t's for service’ were themed as ‘Silent Gremlins’ warning colleagues to be aware of invisible undercurrents or issues within practice or services and being unafraid to identify weaknesses within the service. Examples included poor booking systems or analysing the ‘one time it went wrong’ when it mainly goes ‘right’ experiences. Conclusion We have described a short consensus sharing exercise in which experienced clinicians on a regional basis have been able to contribute their views on what works well and what doesn’t work well for both patients and practice. This work has produced a brief guide or ‘sharing tool’ which can be built upon to help experienced and more importantly less experienced colleagues to develop their practice. Disclosures W.J. Gregory: Honoraria; W.G. has received speaker fees from Novartis and received Conference attendance fees from Pfizer. J.S. Brazendale: None. C. Longton: Honoraria; C.L. has received sponsorship support from Novartis, Pfizer and UCB. N. Marshall: None. J. Martindale: Honoraria; JM has received honoraria from Abbvie Ltd, Novartis, Pfizer and UCB. Grants/research support; JM has received a research grant from Pfizer.

Background:A European Alliance of Associations for Rheumatology (EULAR) initiative in 2019 saw the first-ever publication of Core Competencies for Health Care Professionals (HCPs) working in Rheumatology (Edelaar et al 2019). This document sets the tone for how HCPs in Rheumatology should be working. One of the listed research agenda items created as a part of this project was to define discipline-specific competencies related to each of the HCPs unique roles in the multidisciplinary team.Objectives:In response to this call for discipline-specific application, a recent national survey of physiotherapists working in rheumatology in the UK included a section looking at the comfort these clinicians feel in the day-to-day application of these Core Competencies.Methods:In late 2019, an internet-based survey was emailed, and shared via other digital platforms, aiming to target all UK-based rheumatology physiotherapists. Other areas were covered and have been published (Gregory, Burchett and McCrum 2021), but there are unpublished data from Question 8 on this survey which involved listing the EULAR HCP Core Competencies and asking responders to rate on a 5-point Likert scale their comfort with these statements in relation to their day-to-day practice.Results:Ninety-seven UK-based physiotherapists working at least some of their job in rheumatology completed the survey. Overall the EULAR HACP core competency statements with the highest scores were statements 2 and 5; those statements with the lowest comfort response were statements 4 and 6.Statement 2 relates to assessment and statement 5 to non-pharmacological management; it is in line with the traditional physiotherapy job role that these are the two areas identified by survey responders as their strongest areas.Statement 4 relates to pharmacological management, and as this is not a formal part of expected specialist rheumatology physiotherapist job role at banding levels below band 8, this result was lower level of comfort probably to be expected. Statement 6 relates to patient education and whilst this is clearly a big part of the physiotherapist role, we expect the lower score here represents respondents awareness that broader disease education may sit better with other members of the rheumatology multi-disciplinary team.Conclusion:Written for all HCPs, the competency statements do show less comfort on this survey of physiotherapists with regards to less profession-specific statements, namely medication management and disease education. Team working means these areas will be picked up by other rheumatology HCPs.Generally there is a good amount of familiarity with and comfort in application of these new core competencies. An alternative conclusion is that the EULAR working group creating the competencies achieved a strong understanding of the HCP roles and the competencies are hence seen to fit well in this survey. As per the concluding statements of the 2019 EULAR core competencies document, there does remain a requirement to work on profession specific competencies in rheumatology.References:[1]Edelaar L, Nikiphorou E, Fragoulis GE, et al. 2019 EULAR recommendations for the generic core competences of health professionals in rheumatology. Annals of the Rheumatic Diseases 2020;79:53-60.[2]Gregory, W.J., Burchett, S. and McCrum, C. (2021), National survey of the current clinical practices of the UK rheumatology physiotherapists: A short report. Musculoskeletal Care. https://doi.org/10.1002/msc.1516Disclosure of Interests:William J. Gregory Speakers bureau: Speaker fees from Novartis and Abbvie., Consultant of: Advisory boards for Pfizer and Novartis., Sharon Burchett: None declared, Carol McCrum Speakers bureau: Speaker fees from Novartis

Objectives: Our aim was to describe the burden of early dcSSc in terms of disability, fatigue and pain in the European Scleroderma Observational Study cohort, and to explore associated clinical features.Methods: Patients completed questionnaires at study entry, 12 and 24 months, including the HAQ disability index (HAQ-DI), the Cochin Hand Function Scale (CHFS), the Functional Assessment of Chronic Illness Therapy-fatigue and the Short Form 36 (SF36). Associates examined included the modified Rodnan skin score (mRSS), current digital ulcers and internal organ involvement. Correlations between 12-month changes were also examined.Results: The 326 patients recruited (median disease duration 11.9 months) displayed high levels of disability [mean (S.D.) HAQ-DI 1.1 (0.83)], with ‘grip’ and ‘activity’ being most affected. Of the 18 activities assessed in the CHFS, those involving fine finger movements were most affected. High HAQ-DI and CHFS scores were both associated with high mRSS (ρ = 0.34, P < 0.0001 and ρ = 0.35, P < 0.0001, respectively). HAQ-DI was higher in patients with digital ulcers (P = 0.004), pulmonary fibrosis (P = 0.005), cardiac (P = 0.005) and muscle involvement (P = 0.002). As anticipated, HAQ-DI, CHFS, the Functional Assessment of Chronic Illness Therapy and SF36 scores were all highly correlated, in particular the HAQ-DI with the CHFS (ρ = 0.84, P < 0.0001). Worsening HAQ-DI over 12 months was strongly associated with increasing mRSS (ρ = 0.40, P < 0.0001), decreasing hand function (ρ = 0.57, P < 0.0001) and increasing fatigue (ρ = −0.53, P < 0.0001).Conclusion: The European Scleroderma Observational Study highlights the burden of disability in early dcSSc, with high levels of disability and fatigue, associating with the degree of skin thickening (mRSS). Impaired hand function is a major contributor to overall disability.

Jennifer Stockdale, Jane Martindale, Rachel Evans, William Gregory, Jenny Ratcliffe and Lynne Goodacre Physiotherapy, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool, Physiotherapy, Wrightington, Wigan and Leigh NHS Trust, Wigan, Physiotherapy, Southport and Ormskirk NHS Trust, Southport, Physiotherapy, Salford Royal NHS Foundation Trust, Salford, Physiotherapy, East Cheshire NHS Trust, Macclesfield and Research and Development, NHS Research and Development North West, Manchester, UK