Background: The integration of physical activity interventions within rheumatology clinical practice represents a pivotal approach to enhance patient outcomes and general health in patients with inflammatory arthritis (IA). Despite the substantial evidence supporting the efficacy of physical activity and exercise interventions in enhancing overall fitness, alleviating symptoms, improving quality of life and positively impacting cardio-metabolic biomarkers in patients with IA [1,2], a general gap persists between research findings and their implementation in real-world clinical settings. This underscores the necessity for comprehensive implementation research studies, which should include identifying and addressing barriers to promotion of physical activity. Ultimately, these efforts can facilitate the successful adoption of evidence-based physical activity strategies in rheumatology clinical practice.

Objectives: As a first step in an implementation process, this study aims to describe the facilitators and barriers to implementation of physical activity guidance in patients with inflammatory arthritis in four rheumatology outpatient clinics in the Capital Region of Denmark.

Methods: Data collection included ten days of observations of clinical practice, involving patients’ routine consultations with physicians and nurses in the four rheumatology clinics. Additionally, 12 individual, semi-structured interviews with physicians, nurses and clinical leaders, respectively. The first author conducted all observations and interviews throughout 2022 and early 2023. To guide the data collection, coding and interpretation, the Theoretical Domains Framework (TDF) [3] was employed. This framework proposes 14 psychological and organizational domains relevant to clinical behavior change. Observational and interview data were summarized through field notes and transcripts, and the analysis was conducted using template analysis, following Brooks and King [4].

Results: A total of 44 observations of routine consultations across the four clinics and 12 interviews with a diverse group comprising nurses (n=4), physicians (n=4) and clinical leaders (n=4) were conducted. The TDF guided the identification of barriers and facilitating factors that need to be targeted at different levels for successful implementation of physical activity guidance. Barriers described by nurses and physicians were especially related to the TDF domains of ‘skills’, ‘competencies’ and ‘professional role/identity’. This underscored the necessity for targeted training among health professionals in providing sufficient guidance. It also highlighted their perception of responsibility in discussing physical activity with patients. A primary barrier described by clinical management, was related to the TDF domain of ‘environmental context and resources’, concerning the potential lack of physical and clinical resources in providing the guidance. A mutual facilitator among informants was related to the ‘optimism’ domain in TDF, revealing shared beliefs about the possibility and potential of physical activity guidance as part of rheumatology routine care.

Conclusion: This study provided valuable knowledge about factors to address in the ongoing implementation project across four rheumatology outpatient clinics. Current implementation activities are specifically directed towards supporting and training health professionals in providing appropriate physical activity guidance. These activities also include discussions related to professional roles and responsibilities.

REFERENCES: [1] Hu H, Xu A, Gao C, et al. (2021) DOI: 10.1111/jan.14574.

[2] Sveaas S, Smedslund G, Hagen K, Dagfinrud H (2017) DOI: 10.1136/bjsports-2016-097149.

[3] Atkins L, Francis J, Islam R, et al. (2017) DOI: 10.1186/s13012-017-0605-9.

[4] Brooks J, McCluskey S, Turley E, King N. (2015) DOI: 10.1080/14780887.2014.955224.

Acknowledgements: We would like to thank all involved health professionals and clinical managers across the Center of Rheumatology and Spine Diseases, Copenhagen, Denmark.

Disclosure of Interests: None declared.