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Abstract

Background/Aims

The Bath Ankylosing Spondylitis Metrology Index (BASMI) is used in the monitoring of those living with axial spondyloarthritis (axSpA); it is the recommended and validated measure of movement in this patient group. As a physical outcome measure its use has been challenging during the COVID-19 pandemic. The aim of this project is to assess the current application of the BASMI in axSpA services across the UK.

Methods

A survey was devised to explore when the BASMI is used, by whom and the reasons for its use. The AStretch committee reviewed and re-drafted the questions. The survey was shared across multiple platforms and email professional distribution lists, and was open 2nd-12th October 2021.

Results

74 UK healthcare professionals completed the survey. It is mostly physiotherapists who undertake the BASMI (69%); some other clinicians also measure: nurses (10%), medics (9%), physiotherapy support workers (10%), healthcare support workers (2%). Confidence in performing the BASMI averaged at 3.5/5. The majority of respondents record the BASMI in the electronic record (73%); app-based solutions are developing (7%) and paper-only recording diminishing (20%). When asked about frequency, most respondents (73%) recorded “it depends”, implying that the BASMI is used on an individual patient basis. Table 1 presents data with regards to why the BASMI is undertaken, scored by participant ranking, and free text responses about reasons for use.

P265 Table 1:
Open in new tab

Participant ranking score summation for “reason to use the BASMI” and free text “reasons for use of the BASMI”

ItemOverall RankTotal Score *
For all newly diagnosed patients1555
To help us devise a bespoke exercise plan2513
To address poor movement or function3498
To address/encourage adherence to exercise/advice4451
It’s part of their on-going management5391
Delay to diagnosis affecting start of treatment and therefore movement restrictions apparent6356
Guidelines suggest yearly monitoring7332
As an outcome measure pre- and post-hydrotherapy8295
To address an increase in pain levels9277
For patient preference10265
Rheumatology team asked for it11202
For research purposes/as a part of a clinical trial12155
ItemOverall RankTotal Score *
For all newly diagnosed patients1555
To help us devise a bespoke exercise plan2513
To address poor movement or function3498
To address/encourage adherence to exercise/advice4451
It’s part of their on-going management5391
Delay to diagnosis affecting start of treatment and therefore movement restrictions apparent6356
Guidelines suggest yearly monitoring7332
As an outcome measure pre- and post-hydrotherapy8295
To address an increase in pain levels9277
For patient preference10265
Rheumatology team asked for it11202
For research purposes/as a part of a clinical trial12155

*Score is a weighted calculation. Items ranked first are valued higher than the following ranks, the score is a sum of all weighted rank counts.

FREE TEXT REASONS FOR THE USE OF THE BASMI

Helpful to patients to objectively understand their movement. Newly diagnosed-baseline score at initial assessment. Pre/post hydrotherapy. To encourage a home exercise programme. Most objective of PROMs for axSpA. Provides an indication on posture and flexibility. Objective measure that we can compare over time. To monitor any subclinical restrictions creeping in over time. Started biologics- see if improving/new baseline. Pre-commencing biologic. Provides the basis on which to base a specific exercise programme. Patient request. To support new patients in identifying issues. To assess the progression of the disease over time. Key objective measure of spinal movement.

P265 Table 1:
Open in new tab

Participant ranking score summation for “reason to use the BASMI” and free text “reasons for use of the BASMI”

ItemOverall RankTotal Score *
For all newly diagnosed patients1555
To help us devise a bespoke exercise plan2513
To address poor movement or function3498
To address/encourage adherence to exercise/advice4451
It’s part of their on-going management5391
Delay to diagnosis affecting start of treatment and therefore movement restrictions apparent6356
Guidelines suggest yearly monitoring7332
As an outcome measure pre- and post-hydrotherapy8295
To address an increase in pain levels9277
For patient preference10265
Rheumatology team asked for it11202
For research purposes/as a part of a clinical trial12155
ItemOverall RankTotal Score *
For all newly diagnosed patients1555
To help us devise a bespoke exercise plan2513
To address poor movement or function3498
To address/encourage adherence to exercise/advice4451
It’s part of their on-going management5391
Delay to diagnosis affecting start of treatment and therefore movement restrictions apparent6356
Guidelines suggest yearly monitoring7332
As an outcome measure pre- and post-hydrotherapy8295
To address an increase in pain levels9277
For patient preference10265
Rheumatology team asked for it11202
For research purposes/as a part of a clinical trial12155

*Score is a weighted calculation. Items ranked first are valued higher than the following ranks, the score is a sum of all weighted rank counts.

FREE TEXT REASONS FOR THE USE OF THE BASMI

Helpful to patients to objectively understand their movement. Newly diagnosed-baseline score at initial assessment. Pre/post hydrotherapy. To encourage a home exercise programme. Most objective of PROMs for axSpA. Provides an indication on posture and flexibility. Objective measure that we can compare over time. To monitor any subclinical restrictions creeping in over time. Started biologics- see if improving/new baseline. Pre-commencing biologic. Provides the basis on which to base a specific exercise programme. Patient request. To support new patients in identifying issues. To assess the progression of the disease over time. Key objective measure of spinal movement.

Conclusion

A large sample size was recruited for this survey, implying a good level of interest in better understanding the current application of the BASMI. It is evident clinicians use the BASMI on newly-diagnosed patients as a priority in their assessment and shared-decision making. Other aspects such as addressing poor movement and adherence to exercise are ranked highly. The reported reasons for BASMI use are varied, and its application not standardised across UK rheumatology teams. This might reflect the diverse trajectory of axSpA and the importance of seeing patients as individuals. How and why we undertake physical outcome measures is crucial for consideration as we currently consider remote versus face-to-face consult pathways for our axSpA cohort. There is enough evidence here to recommend ongoing, regular application of the BASMI in a traditional face-to-face setting.

Disclosure

K. Weight: None. W.J. Gregory: Honoraria; W.G. has received speaker, conference registration and advisory board fees from Abbvie, Pfizer Novartis and UCB. H. Chambers: None. E. Clarke: Honoraria; E. C. has received speaker fees from Novartis UK. M. Daly: None. A. Davie: None. J.C. Elkins: None. S. Gaikwad: None. H. Harrison: None. C. Longton: Shareholder/stock ownership; C.L. is a shareholder in Astra Zeneca. Honoraria; C.L. has received speaker fees from Novartis. M. Martin: Honoraria; M.M. has received speaker, conference registration and advisory board fees from Abbvie, Novartis (not since 2018). Grants/research support; M.M. received grant monies from the National Axial Spondyloarthritis Society in 2017. M. Motion: None. S. Voules: None. M. McDonald: None. C. Jeffries: Honoraria; C.J. has received speaker, conference registration and advisory board fees from Abbvie, Pfizer, Novartis and UBC.

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© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: [email protected].
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