16 minute read
SpA can ruin lives
Delayed diagnosis of axial spondyloarthritis can ruin lives
Ministers are being urged to support measures to end the 8.5-year delay to diagnosis for people with inflammatory arthritis.
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If left untreated, axial SpA can result in significant health issues such as spinal fusion HEALTH ministers are being urged to support measures that can radically improve the lives of people with axial spondyloarthritis (axial SpA), a painful and progressive form of inflammatory arthritis. Currently, the average delay to diagnosis for this condition is 8.5 years. The National Axial Spondyloarthritis Society (NASS) is working to see the diagnosis delay reduced to just 12 months.
Around 1 in 200 adults in the UK live with axial SpA. The condition affects young people, with symptoms often starting in their early teens. If left untreated, it can result in significant health issues such as spinal fusion, as well as damage to joints ligaments, tendons and mental health.
NASS proposes concrete steps that would enable thousands of people who are yet to be diagnosed with the condition to get the right care faster: l increase public awareness of axial SpA with a campaign backed by public health bodies so that people consult a GP or primary care professional as soon as they notice symptoms l provide Clinical Commissioning Groups with a clear and simple inflammatory back pain pathway to ensure swift referrals directly to rheumatology and encourage increased awareness of the condition among GPs and other primary care professionals.
Dr Dale Webb, Chief Executive of NASS, said: “Far too many young people wait years for a diagnosis and treatment. This inhibits normal life and risks permanent disabilities. Faster diagnosis, with the right pathways to care, would transform lives and save the economy money.
“The Government needs to act now so that the public know about the condition and can seek medical advice at the earliest opportunity and to ensure that primary care professionals identify and refer patients quickly to rheumatology for diagnosis. No-one should be locked out of life because of a delay in getting a diagnosis.”
Paul Curry, who lives with axial SpA, said: “I waited for more than 10 years to be diagnosed with axial SpA. While I waited, my spine fused and I gave up any hope of a career in professional sport. When I received a diagnosis, at last I knew the pain was out of my control and could be treated.”
Exercise is the best way to help yourself
Regular exercise is the single most important thing you can do to help yourself. The more flexible you are the easier it is to do everyday tasks, and the more mobility you have the easier it is to do things. Exercise can result in less stiffness and pain at night and improve sleep quality.
The focus for exercise for people with axial SpA is on improving or maintaining: l range of movement in the joints l posture control l muscle strength l muscle length l lung capacity l balance l cardiovascular fitness.
Whipps Cross University Hospital’s Early Inflammatory Back Pain Service, run by Barts Health NHS Trust, has produced a video of specific exercises to help you maintain and improve flexibility and strength.
https://nass.co.uk www. whippscrossrheumatology. co.uk
Deciding on the best approach for diagnosing and managing ME
NICE has published its draft updated guideline on the diagnosis and management of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
The draft guideline recognises that ME/CFS, which is estimated to affect more than 250,000 people in England and Wales, is a complex, multi-system, chronic medical condition where there is no “one size fits all” approach to managing symptoms. It stresses the need for a tailored, individualised approach to care that allows joint decision making and informed choice.
Because of the harms reported by people with ME/CFS, as well as the committee’s own experience of the effects when people exceed their energy limits, the draft guideline says that any programme based on fixed incremental increases in physical activity or exercise, for example graded exercise therapy (GET) should not be offered for the treatment of ME/CFS.
Energy envelope
Instead, it highlights the importance of ensuring that people remain in their “energy envelope” when undertaking activity of any kind and recommends that a physical activity programme, in particular, should only be considered for people with ME/CFS in specific circumstances.
The draft guideline also emphasises that Much of the distress is due to the difficulties in recognising, acknowledging
Exercise is not a treatment or cure for ME/CFS
cognitive behavioural therapy (CBT) is not a treatment or cure for ME/CFS. However, as a supportive therapy which aims to improve wellbeing and quality of life, the draft guideline says CBT may be useful in supporting people who live with ME/CFS to manage their symptoms.
Paul Chrisp, director of the Centre for Guidelines at NICE, said: “ME/CFS can cause profound, long-term illness and disability, and much of the distress surrounding it is caused by difficulties in and accepting the condition the condition and its impact. This has been compounded further by a lack of effective treatments, wide variation in access to services, and by controversy over the use of graded exercise therapy and CBT that has served only to alienate many people with ME/CFS and, in some cases, undermine the confidence of those caring for them.
“The recommendations in this draft guideline have been developed by an independent committee that was guided not just by the clinical evidence, but also by the experience and testimony of people with ME/CFS.”
Adam Lowe, a lay member of the guideline committee, said:“ME/CFS patients have been voicing their concerns about graded exercise therapy for a long time, and the evidence presented to the committee supported these recognising, acknowledging and accepting
concerns.
“One of the key points in the draft guideline is that exercise is not a treatment or cure for ME/CFS and should not be presumed to be safe for those with this disabling and often neglected illness. The approach it recommends is a pragmatic one which allows patients to self-manage themselves, within their daily limits, while using readily available interventions to address the most serious of their symptoms first.”
Specialist team
The draft guideline recommends reducing the time from four months to three months that a person needs to have persistent symptoms before a diagnosis of ME/CFS can be confirmed. It says that people should then be directed to a specialist team (in the case of children this should be a paediatric specialist team) experienced in the management of ME/CFS to confirm their diagnosis and develop a personalised management plan. This will enable people to access care earlier and could potentially improve longer-term outcomes. www.nice.org.uk
Workplace MSDs: health monitoring can help
The HSE’s body mapping tool asks about musculoskeletal disorders, such as aches or pains, you may have had recently.
The following tips may help reduce your back pain and speed up your recovery, says the NHS: l stay as active as possible and try to continue your daily activities – this is one of the most important things you can do, as resting for long periods is likely to make the pain worse l try exercises and stretches for back pain; other activities such as walking, swimming, yoga and pilates may also be helpful l take anti-inflammatory painkillers, such as ibuprofen – remember to check the medicine is safe for you to take and ask a pharmacist if you’re not sure l use hot or cold compression packs for short-term relief – you can buy these from a pharmacy – or a hot water bottle or a bag of frozen vegetables wrapped in a cloth or towel will work just as well.
It also helps if you stay optimistic and recognise that your pain should get better. People who manage to stay positive despite their pain tend to recover quicker.
If the pain is severe or gets worse over time, it is advisable to see a doctor or other healthcare professional. www.nhs.uk HEALTH monitoring can help reduce MSDs in the workplace. In law, you do not have to do this, but it is often useful to collect this information so that you are aware of any health issues your workers have and to monitor trends. For example, it can prove helpful when you introduce a new task or change an existing process. It also helps to check any controls you put in place are preventing problems starting or getting worse.
You may need to take advice, for example from an occupational health provider, about setting up and managing your health monitoring system. They will recommend consulting workers so that the benefits are understood and to be clear about what should be done.
Set up a simple reporting method so the information goes to the person who will take action. You could consider using a body map to help individuals or groups pinpoint where their symptoms are. Review sickness absence records/fit notes and any occupational health advice; investigate any clusters of problems or changes in reporting rates you find; and ask workers if their work caused the problem or makes it worse and to identify those tasks.
The results of your health monitoring can help you look at whether your risk management system for MSDs is working, whether the actions you have taken have been effective and that risks have been reduced to as low as reasonably practicable, and whether the findings
Tips that might relieve your back pain
suggest a need for new control measures.
Workplace MSDs: health monitoring can help
Providing support for workers
PEOPLE with MSDs usually recover completely if the problem is spotted early and treated appropriately, says the HSE. But there is an increased risk of their problem coming back, even if the symptoms have gone. As well as health monitoring, there are other things you can do to manage these conditions.
Manage sickness absence and return to work, for example by making adjustments to the way they work. If the person has been off work, they may be able to return before all their symptoms have completely cleared up, as long as this is not against medical advice. Occupational health providers can support your workers and help you manage musculoskeletal disorders. They can: l assess symptoms and may diagnose a specific condition l ask about work tasks to try and identify anything contributing to the problem l provide fitness-to-work advice, including any restrictions needed l provide treatment recommendations, such as physiotherapy l visit the workplace to provide further advice l help to review risk assessments and workplace controls.
Consider each person on a case-by-case basis. It may be necessary to change a worker’s duties if a task is causing an MSD or making it worse. They may need to stop doing some tasks temporarily to help them recover. Sometimes, they may not be able to return to a particular task.
www.hse.gov.uk
Exclusion of workers with RMDs ‘will have huge economic impact across Europe’
IT IS estimated that more than 100 million European citizens, many of whom are young and working age, currently suffer with rheumatic and musculoskeletal diseases (RMDs). They are the main occupational disease, accounting for around 60% of all health problems in the workplace and are a major cause of sick leave and premature retirement.
The pandemic has compounded the challenges faced by this vulnerable group in different ways. Some have greater vulnerability to Covid-19 due to being treated with immunosuppressants and steroids or have a common co-morbidity, such as cardiovascular disease, that signify higher risk. RMD sufferers have also been affected by reduced access to medication, or the reprioritisation of healthcare facilities away from people with chronic conditions.
Job access and security is also a highly significant concern as RMD sufferers may face potential workplace absenteeism during a global downturn.
The European League Against Rheumatism (EULAR) believes it is vital that the EU member states address the hidden costs of workplace exclusion for people suffering one of the many diseases under the RMD umbrella.
Speaking during a recent online panel discussion, Professor Iain McInnes, EULAR President, said: “For many people living with RMDs, job insecurity and unemployment are a daily reality that much of the rest of society only experiences in times of crisis.
“The pandemic has created new workplace barriers for Europeans with RMDs, but it has also highlighted the opportunities flexible working patterns and digital workplace and healthcare solutions can offer this community.”
The exclusion of RMD patients from the workplace costs Europe an estimated €163bn a year. The short-term impact of the Covid-19 pandemic, with the longer-term trend of an ageing European population, are expected to dramatically increase this impact without urgent action.
EULAR says Europe needs policies and programmes that create an open, positive and supportive culture between patients, colleagues, and employers, including strong protection against workplace discrimination. It also needs to create ergonomic workplaces to increase comfort and reduce risk of accidents and flares, as well as to promote flexible work schedules and tele-working. www.eular.org
The latest figures showing the recorded prevalence of 21 conditions, from hypertension to osteoporosis and rheumatoid arthritis have been published by NHS Digital.
THE prevalence data is collated in the Quality and Outcomes Framework (QOF)1. It has been collected from 96.2% of general practices in England and can be broken down to regional and general practice level. It identifies how the recorded incidence of these conditions has changed since the previous year.
Conditions are grouped into categories: cardiovascular; respiratory; lifestyle; highdependency and other long-term conditions; mental health and neurology; musculoskeletal; fertility, obstetrics and gynaecology; and quality improvement.
The prevalence of some conditions is measured as a proportion of the total number of people registered at a surgery, whereas others are age specific. The publication also provides information on the activity of GPs in relation to 26 measures overall – this is expressed as achievement.
Measures, called indicators, are agreed as part of the GP contract negotiations every year. These indicators have points attached that are given to GP practices based on how they are doing against these measures. You can see how a GP practice has performed against the measures.
Stress in nursing at ‘alarmingly high’ levels, says report
FOLLOWING the recent focus on the incidence of back pain in nursing (TalkBack autumn), a new report raises concerns about the high rates of stress and burnout in the profession.
The report, The Courage of Compassion, produced by the King’s Fund for the RCN Foundation, states that staff stress, absenteeism and turnover in the professions have reached alarmingly high levels, and this has been compounded by the COVID-19 pandemic.
It calls for new minimum standards to improve working conditions and a review of 12-hour shifts to address exhaustion and burnout among nurses and midwives.
Susan Masters, RCN Director of Nursing, Policy and Public Affairs, said: “Today, there are approximately 50,000 registered nurse vacancies in the NHS in the UK, impacting patient safety, and morale and wellbeing in the profession at a time when these are crucial.
“At present, really ambitious and well-qualified young people are struggling with gruelling shifts, staff shortages and poor pay. They feel they have no choice but to leave a career they should love – at a huge cost to patient care. Politicians and officials need to grasp the nettle before we lose even more.”
The report sets out eight key recommendations to support the wellbeing of nurses and midwives across the UK, including those working in adult social care, GP practices, community care and other settings.
Among the recommendations is an urgent call for a review of how 12-hour shifts affect staff mental health and wellbeing and patient safety. Although some staff prefer them as they allow for more flexible working patterns, evidence shows that 12-hour shifts are associated with poor sleep and wellbeing among staff and lower quality of care for patients.
Susan Masters added: “While we understand that some of our members prefer 12-hour shifts, such as those with caring responsibilities or long commutes, we also recognise the challenges these shifts can bring. We would welcome a full review of them, and their impact on nursing staff and patient care.
“Where 12-hour shifts are used, employers should offer appropriate support with respect to staff health and wellbeing, including adequate rest breaks, careful rostering and internal rotations.”
Other recommendations in the report include suggestions to improve working conditions, shift patterns, workplace culture, team-working, support for new staff, supervision and learning opportunities.
www.kingsfund.org.uk www.rcn.org.uk
You can find out how common certain conditions are in your area and, for example, compare this against the national average.
Some 6,720 practices were included in the 2019-20 Quality and Outcomes Framework. The highest recorded prevalence rates were for hypertension (14.1%), depression (11.6%) and obesity (10.5%). The greatest change in QOF prevalence was for depression (0.8 percentage points higher than in the previous year). https://digital.nhs.uk 1) Quality and Outcomes Framework (QOF) – Prevalence,
Achievements and Personalised Care Adjustments Report,
England 2019-20 HEADACHES are one of the most common health complaints, with most people experiencing them at some point in their life. The Royal College of Chiropractors’ Health Policy Unit has published a new quality standard which covers the chiropractic assessment and management of adult patients presenting with headache.
Chiropractors regularly see patients that present with headache, often having not been seen by any other healthcare professional, and with no diagnosis having been made. Chiropractors have the skills and competencies to assess patients in order to diagnose most primary headaches, identify secondary headaches that require further investigation and, importantly, recognise the red flags that indicate a medical emergency.
As well as having a role in the management of some primary headaches and a few secondary headaches (in particular cervicogenic headaches), chiropractors also play an important public health role in providing support and advice to patients, signposting and making appropriate referrals.
There are a wide range of different patient presentations associated with headache and the management in each case will be different, requiring an individualised approach. The quality statements that comprise the new Headaches Quality Standard are therefore general but, nevertheless, provide aspirational but achievable markers of high-quality, cost effective patient care.
Given the chronic nature of many headaches, where appropriate, the Headaches Quality Standard should be read in conjunction with the chiropractic quality standards on “Chronic Pain” and “Supportive Self-Management in Chronic Care”, both also published by the RCC. Set measures are agreed as part of the GP contract negotiations every year
Image: racool_
Headaches – a new quality standard for chiropractors
Image: kjpargeter/freepik
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Incidence of headaches
In the UK, migraine headache occurs in 15% of the adult population, with around 200,000 individual episodes estimated every day, resulting in high levels of disability and work absence, as well as having a significant impact on the wider economy. Episodic tension-type headaches affect 80% of people at some time and are chronic (having more days with a headache than without one) in up to 3% of the population. Medication overuse headache is the third most common cause of headache, affecting up to 2% of adults. Despite these figures, headache is under-estimated, underdiagnosed and under-treated, and remains a major public health concern.
https://rcc-uk.org/
l MSK conditions: Chronic Low Back
Pain, Acute Low Back Pain, Acute
Neck Pain, and Osteoporosis are other quality standards published by the Royal College of Chiropractors.
These can be downloaded from the website.
