Background: The main treatments for ankylosing spondylitis (AS) are physical (exercise and stretching), and one way of measuring the effectiveness of these therapies is to record spinal movements in a standardized way. Patients are often seen in both medical (rheumatology) and physiotherapy clinics where duplicate information on their progress may be obtained. The purpose of this study was to assess the completeness of data collection for patients attending both medical and physiotherapy clinics.
Design: An audit of data recorded in medical and physiotherapy notes.
Subjects: Patient records identified either from computerized databases (Huddersfield and Bradford) or from a clinic at which only AS patients attended (Leeds). Data from attendances over a defined period were retrieved and recorded on a standard form. All patients thus identified were then cross-matched against those patients attending for physiotherapy during the same period and, where a match occurred, the same data were retrieved from the physiotherapy notes. MINIMUM DATA SET FOR AUDIT: Before data collection started all participants agreed on the minimum data set required for adequate monitoring of patients with AS. The anthropometric measurements included height, chest expansion, cervical rotation, tragus to wall, modified Schober's flexion, extension, lumbar side flexion, intermalleolar abduction, and interfingertip abduction.
Results: Of 182 medical notes screened, 46 patients had not been seen in the defined period, leaving 136 notes to be reviewed. Of these, 52 patients had been seen in physiotherapy in the same period. In general, measurements were infrequently found in medical notes (only chest expansion in 58%, Schober's flexion in 48% and tragus to wall in 47% were measured with any regularity by medical staff). In contrast, corresponding data from physiotherapy notes were more complete (Schober's flexion and lumbar side flexion in 96%, height in 87%, intermalleolar distance in 87% and cervical rotation in 83%).
Conclusions: Follow-up and monitoring of AS patients in these medical clinics is clearly inadequate. Physiotherapy-led clinics have already been started in one of the study hospitals and the other centres are reviewing their arrangements for AS follow-up, including the possibility of a combined approach to patient management.