E. Lubrano et al., AN AUDIT OF ANTHROPOMETRIC MEASUREMENTS BY MEDICAL AND PHYSIOTHERAPY STAFF IN PATIENTS WITH ANKYLOSING-SPONDYLITIS, Clinical rehabilitation, 12(3), 1998, pp. 216-220
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.