AN AUDIT OF ANTHROPOMETRIC MEASUREMENTS BY MEDICAL AND PHYSIOTHERAPY STAFF IN PATIENTS WITH ANKYLOSING-SPONDYLITIS

Background: The main treatments for ankylosing spondylitis (AS) are ph ysical (exercise and stretching), and one way of measuring the effecti veness of these therapies is to record spinal movements in a standardi zed way. Patients are often seen in both medical (rheumatology) and ph ysiotherapy 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 physiothera py clinics. Design: An audit of data recorded in medical and physiothe rapy notes. Subjects: Patient records identified either from computeri zed databases (Huddersfield and Bradford) or from a clinic at which on ly AS patients attended (Leeds). Data from attendances over a defined period were retrieved and recorded on a standard form. All patients th us identified were then crossmatched 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 dat a set for audit: Before data collection started all participants agree d on the minimum data set required for adequate monitoring of patients with AS. The anthropometric measurements included height, chest expan sion, cervical rotation, tragus to wall, modified Schober's flexion, e xtension, lumbar side flexion, intermalleolar abduction, and interfing ertip abduction. Results: Of 182 medical notes screened, 46 patients h ad not been seen in the defined period, leaving 136 notes to be review ed. Of these, 52 patients had been seen in physiotherapy in the same p eriod. In general, measurements were infrequently found in medical not es (only chest expansion in 58%, Schober's flexion in 48% and tragus t o wall in 47% were measured with any regularity by medical staff). In contrast, corresponding data from physiotherapy notes were more comple te (Schober's flexion and lumbar side flexion in 96%, height in 87%, i ntermalleolar distance in 87% and cervical rotation in 83%). Conclusio ns: Follow-up and monitoring of AS patients in these medical clinics i s clearly inadequate. Physiotherapy-led clinics have already been star ted in one of the study hospitals and the other centres are reviewing their arrangements for AS follow-up, including the possibility of a co mbined approach to patient management.