2.23 Rehabilitation for rheumatic diseases 703030 Effects of selective rehabilitation on neck pain due to cervical spondylosis – a clinical trial MD ABDUS SHAKOOR BSM Medical University, Dhaka, Bangladesh Background: Pain in the neck is a common complains of the patients attending the hospi- tal. One of the most common causes of pain and disability in the neck and arm is cervical spondylosis (CS). Cervical traction is widely used in treating various types of neck disorders; opinions are divergent on methods of application. But rehabilitation treatment may play an important role to improve the condition. Objectives: To find out the effects of selective rehabilitation on CS. Methods: A total of 150 patients of chronic CS were included for the clinical trial. They were divided into two groups: Group-A: in this group 72 patients were treated with selective rehabilitation that is - exercise, cervical collar, neck support, manual cervical traction at home, warm moist compression and instruction in posture. Group-B: in this group 78 patients were treated with NSAIDs only. The results were expressed as mean Æ SD and the level of significant expressed by P-value unless otherwise stated. Student’s ‘t’ test was done to test the hypothesis. Results: There was significant improvement in both the group after treatment (P = 0.001). But in comparison between two groups, at the time of first visit, there was no significant improvement between two groups and up to 5th weak (P > 05). Significant improvement was seen in Group-B than Group-A after 6 weeks treatment (P = 0.03). This result indicates that the improvement of the patient with CS was seen more in selective rehabilitation group after 6 weeks than NSAIDs group. Conclusions: Rehabilitation treatment can be used effectively for the treatment of CS. And thus the side effects of NSAIDs may be reduced. Conflict of interest: There is no conflict of interest in this study. But we are greateful to the patients who give informed consent and participated in the study. References: 1. Bajaj P et al. Osthoarthritis and its association with muscle hyperalgia: an experimental controlled study. Pain 2001; 93:107–114. 2. Barry M et al. Pain in the neck, shoulder and arm. B M J 1995; 310:183–186. 3. Shakoor MA et al. Effect of Cervical Traction and Exercise therapy on in Cervical Spondy- losis. Bangladesh Medical Research Council (BMRC) Bulletin. 2002; 28 (2): 61–69. 703181 Development of lifestyle suitable for rheumatoid arthritis sufferers P SHANKPAL Health Alert Organization of India [NGO], India Background: There have been few long-term follow-up studies of the impact of health professional-led arthritis education programmes (AEPs). The Lifestyle Management for Arthritis Programme is a modular, educational-behavioural programme led by occupational and physiotherapists. There is always considered to be a ‘window of opportunity’ to improve QOL and treatment outcomes by lifestyle modifications inflammatory arthritis. Objectives: 1. To explore past trial participants’ perspectives about lifestyle modification, which elements they considered most helpful, how it may have helped and which aspects were least helpful, in order to assist in programme development. 2. This study was set up to describe relative merits of this model of care [lifestyle modifica- tion]. Methods: A qualitative study was conducted with a purposive sample of participants from the trial of this program (i.e. 5 years post-trial; n = 42, 31 males, 11 females, age 37– 55 years). Semi-structured interviews were conducted to capture participants’ opinions, thoughts, feelings and experiences. Interviews were tape recorded and transcribed verbatim. Transcripts were analysed using thematic analysis. Relevant publications were retrieved by Google search. Only community-based surveys conducted in Asia were included. A pooled prevalence with 95% confidence interval was calculated. Results: All participants had inflammatory, rheumatoid or psoriatic arthritis with disease duration of 2 years. Thirty-eight patients complained of (i) fatigue (ii) joint pain [3] disability. Prevalence of rheumatoid arthritis, ankylosing spondylitis, and undifferentiated spondylarthr- opathy is 0.74%, 0.81% and 0.60%, respectively. Patients cited wide range of practical changes made at home, work and leisure. They voiced they were still using many fatigue and joint protection strategies taught, hand and general exercises and relaxation. (i) Looking at things differently (ii) effective teaching strat- egies: particularly the small group teaching (28 people). Eleven participants had not found it easy to maintain walking programme or continue Yoga due to limited motivation, suit- able classes or increasing lower limb pain. Stress management was also less used. (iv) Improving the programme: Suggestions included specific sessions for partners/family to attend; and ‘‘booster’’ sessions to ensure participants were still using methods correctly, for updates and continued motivation, especially to exercise. Mean global health utility scores ranged from 0.58 (EQ-5D VAS) to 0.63 (SF-6D). Gender, age, educational level, type of work (manual/non-manual workers), place of residence (urban/rural) influenced the HRQOL of RA patients. Increased age, pain and disease severity were found to decrease HRQOL. Severity of physical function and RA symptoms, affection, social activity, support from family and friends and capability of working are factors that influence the HRQOL of RA patients. Conclusions: There is limited data on the long term cost effectiveness of lifestyle changes suitable for rheumatoid arthritis sufferers. Eight years after the programme, participants still reported sustaining using self-management strategies, finding joint protection and fatigue management especially helpful. Many had difficulty maintaining exercise regimens. Partici- pants voiced that they still recalled content and considered it relevant- even if not at the time that it had been since or would be in future. We will next review programme content and consider recommended modifications. Based on experiences, we all must collaborate at APLAR-2012 for development and evaluation of care models by lifestyle modifications. 703853 Home care-rehabilitation under the universal health care in Japan M TANAKA Maki Tanaka Orthopedic Clinic, Japan Background: The population in Japan is aging more quickly than that of other countries. Twenty-three percent people are over 65 years-old and 2.6 million older adults live in den- sely populated Tokyo in 2011. Musculoskeletal disorders (e.g. osteoporosis, osteoarthritis and rheumatoid arthritis) often spoil activities of daily living of elderly people. Rehabilitation is crucial for the health expectancy of such patients. Objectives: Rehabilitation (both in the clinic and at patients’ home) are available under the universal health coverage in Japan; most elderly people pay 10% of the fee schedule price. I researched in patients who had home care-rehabilitation managed by my clinic located central part of Tokyo and considered its role in rapidly aging societies. Methods: Twenty-eight patients (10 male and 18 female, average mean age 81.2 years) were assessed in this study. Every rehabilitation was performed for around 40 min by physi- cal therapists qualified in Japan. Barthel Index (B.I.) was evaluated at baseline, 60 and 150 days. Results: Primary diseases which caused physical defects were 2 rheumatoid arthritis, 2 osteonecrosis, 4 osteoarthritis (2 knee joints and 2 hip joints), 5 cerebrovascular diseases, and 8 insufficiency fractures (6 femoral neck and 2 vertebral compression fractures). Early (within 2 weeks after leaving hospitals) rehabilitation group (N = 9) showed sig- nificant increase in B.I. at both 60 days (P = 0.014) and 150 days (P = 0.009), whereas delayed rehabilitation (more than 2 months after leaving hospitals) group (N = 6) had no significant change. Increase in B.I. after high frequent (more than twice a week) therapy (N = 8) was significant at both 60 days (P = 0.025) and 150 days (P = 0.027). Conversely, no significant difference was observed after low frequent (less than once a week) therapy (N = 20). Conclusions: This study suggests adequate (early and high frequent) home care-rehabilita- tion is effective for the independent life of older adults. Japan’s universal health care, which guarantee this therapy at low cost with equity, is necessary to prevent a bedridden situation; therefore, we should make effort to maintain and improve this system for commitment to global aging even in financial difficulties. References: 1. Population census 2011. statistics bureau, ministry of internal affairs and communications 2. Shibuya K et al. Future of Japan’s system of good health at low cost with equity: beyond universal coverage. Lancet 2011; 378: 1265–73. International Journal of Rheumatic Diseases 2012; 15 (Suppl. 1): 139 Ó 2012 The Authors International Journal of Rheumatic Diseases Ó 2012 Asia Pacific League of Associations for Rheumatology and Blackwell Publishing Asia Pty Ltd