The EJES-3D tool for personalized prescription of exercise in axial spondyloarthritis through multimedia animations: pilot study
To develop and evaluate a web application based on multimedia animations, combined with a training program, to improve the prescription of exercises in spondyloarthritis (SpA). After a review of exercises included in the main clinical trials and recommendations of international societies, a multidisciplinary team—rehabilitators, rheumatologists, physiotherapists, computer scientists and graphic designers—developed a web application for the prescription of exercises (EJES-3D). Once completed, this was presented to 12 pairs of rehabilitators–rheumatologists from the same hospital in a workshop. Knowledge about exercise was tested in rheumatologists before and 6 months after the workshop, when they also evaluated the application. The EJES-3D application includes 38 multimedia videos and allows prescribing predesigned programs or customizing them. A patient can consult the prescribed exercises at any time from a device with internet connection (mobile, tablet, or computer). The vast majority of the evaluators (89%) were satisfied or very satisfied and considered that their expectations regarding the usefulness of the web application had been met. They highlighted the ability to tailor exercises adapted to the different stages of the disease and the quality and variety of the videos. They also indicated some limitations of the application and operational problems. The EJES-3D tool was positively evaluated by experts in SpA, potentially the most demanding group of users with the most critical capacity. This allows a preliminary validation of the contents, usefulness, and ease of use. Analyzing and correcting the errors and limitations detected is allowing us to improve the EJES-3D tool.
KeywordsExercise therapy Spondylarthritis Patient education Patient compliance
MTF, RA, FGP, MAPM, JAC, and PZ designed the tool and contributed to the validation study. ABRC and LC conducted the validation study, including analysis; AU, CJRL, CC, CFC, EDM, EG, JLAV, JCTA, LFL, VNC, and XJ performed the validations by recruiting patients and answering the surveys. All authors contributed to the manuscript and accepted the last version.
Merck Sharp and Dohme Spain funded the training meeting and the methodological support for the surveys.
Compliance with ethical standards
Conflict of interest
This document does not recommend drugs or specific instruments from which the participants or the financer could economically benefit from their exploitation.
- 1.Ward MM, Deodhar A, Akl EA, Lui A et al (2016) American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Care Res (Hoboken) 68(2):151–166CrossRefGoogle Scholar
- 3.NICE (2017) Spondyloarthritis in over 16s: diagnosis and management. NICE guideline (NG65). https://www.nice.org.uk/guidance/ng65 (Last updated June 2017). Accessed Mar 2018
- 10.Curbelo Rodriguez R, Zarco Montejo P, Almodovar Gonzalez R, Florez Garcia M et al (2016) Barriers and facilitators for the practice of physical exercise in patients with spondyloarthritis: qualitative study of focus groups (EJES-3D). Reumatol Clin. https://doi.org/10.1016/j.reuma.2016.03.004 PubMedCrossRefGoogle Scholar
- 17.Feldwieser FM, Sheeran L, Meana-Esteban A, Sparkes V (2012) Electromyographic analysis of trunk-muscle activity during stable, unstable and unilateral bridging exercises in healthy individuals. Eur Spine J 21(Suppl 2):S171-186Google Scholar
- 22.Regel A, Sepriano A, Baraliakos X, van der Heijde D et al (2017) Efficacy and safety of non-pharmacological and non-biological pharmacological treatment: a systematic literature review informing the 2016 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis. RMD Open 3(1):e000397CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Levitova A, Hulejova H, Spiritovic M, Pavelka K et al (2016) Clinical improvement and reduction in serum calprotectin levels after an intensive exercise programme for patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis. Arthritis Res Ther 18(1):275CrossRefPubMedPubMedCentralGoogle Scholar