AN IMPLEMENTATION STUDY OF THE RHEUMATOID ARTHRITIS PATIENTS IN TRAINING-PROGRAMME (RAPIT)

F.J. van der Giesen , M. Munneke , Z. De Jong , M. Hopman-Rock , P.L.C. van Riel , W. van Lankveld , J.M.W. Hazes , A.J. Peeters , H.K. Ronday , T.P.M. Vliet Vlieland Department of Rheumatology, Leiden University Medical Center, Leiden, Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, TNO Quality of Life, Netherlands Organisation for Applied Scientific Research - TNO, Leiden, Department of Rheumatology, Radboud University Nijmegen Medical Centre, Research and Development, Sint Maartenskliniek, Nijmegen, Department of Rheumatology, University Medical Center Rotterdam, Rotterdam, Department of Rheumatology, Reinier de Graaf Gasthuis, Delft, Department of Rheumatology, HagaHospital, Den Haag, NetherlandsObjective: To assess the feasibility of the implementation of an intensive group exercise therapy programme which proved to be effective in a randomised controlled trial1.Methods: In 4 Dutch regions implementation was initiated according to a protocol, including recruitment and training of physical therapists, information materials for referring rheumatologists, recruitment of patients and obtainment of reimbursement from regional health insurance companies. Four regional implementation committees (including physical therapists, rheumatologists, patients and health insurance companies) adapted the protocol to the local situation. The physical therapists' training included a 3-day course, an intervention guideline, treatment record forms and patient recruitment materials. Moreover, quality audits were scheduled. Evaluation included 4 domains of the RE-AIM-model2: the number and adherence of participants (Reach; attendance rates), readiness for adopting the programme in real life (Adoption; reimbursement by health insurance companies and number of providers), the extent to which the intervention guideline was followed (Implementation; audit) and providers' willingness to continue providing the programme (Maintenance; interview).Results: Twenty-six physical therapists from 14 practices were recruited and completed the training course. In total, 158 RA patients were recruited (16 groups in 12 practices) over a period of 16 months. After a median follow-up duration of 12 months 38 patients (24%) had left the programme. All 10 insurance companies who were active in the 4 regions agreed to fund the programme for a maximum of 12 months, provided that the transfer to regular sports and physical activity was explicitly promoted. The audits showed sufficient quality in 10/12 practices. All 14 providers were willing to continue with the programme in the future.Conclusion: The setting up of intensive exercise groups, including the recruitment and training of providers, in 4 regions in the Netherlands was feasible. Patient recruitment appeared to be a bottleneck in the implementation process. The relatively low usage rates and high proportion of patients who left the programme prematurely warrant additional research into barriers for participation.This study is financially supported by the Dutch Arthritis Association (IMP-03-1).References: 1. de Jong Z, Munneke M, Zwinderman, et al. Is a long-term high-intensity exercise program effective and safe in patients with rheumatoid arthritis? Results of a randomized controlled trial. Arthritis Rheum. 2003;48:2415-24.2. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89:1322-7.Citation: Ann Rheum Dis, volume 66, supplement II, year 2007, page 3Session: Evidence based practice in non-pharmacological care – from vision to reality