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Effectiveness of Physical Therapy In Ankylosing Spondylitis: A Randomized Controlled Study

Year 2021, Volume: 12 Issue: 42, 44 - 50, 15.04.2021
https://doi.org/10.17944/mkutfd.843202

Abstract

Objective: To evaluate the effects of physical therapy on pain, disease activity, functional and emotional status and quality of life in patients with ankylosing spondylitis (AS).
Material and Method: The study included 31 patients diagnosed with AS. The physical therapy group received 15 sessions of physical therapy (hotpack, ultrasound, TENS and hydrotherapy) exercise and the control group received only a home exercise program. All patients were evaluated with a Visual Analog Scale (VAS) for pain, the Bath Ankylosing Spondylitis Functional Index (BASFI) for functional status, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for disease activity and Bath Ankylosing Spondylitis Metrology Index (BASMI) for spinal mobility measurements before therapy, then after 2 and 6 weeks. The Beck Depression Inventory (BDI) and Short Form 36 (SF-36) were completed by all patients at baseline and after 6 weeks.
Results: With the exception of lateral flexion, tragus wall distance measurements for spinal mobility and BDI scores, significant improvements were determined in all the other parameters in the physical therapy group in the second week (p<0.05). In the 6th week, this improvement was not maintained for intermalleolar distance, cheek manubrium distance, cervical rotation, finger floor distance and BASFI. Significant improvements were determined in the mental capacity and social function subgroups of SF-36 at 6 weeks compared to baseline (p<0.05). Significant improvements were determined in the 2nd and 6th weeks in respect of VAS at rest and the general health subgroup of SF-36 in the physical therapy group compared to the control group.
Conclusion: Physical therapy may have benefical effects on pain, spinal mobility and quality of life in patients with AS.

References

  • Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet. 2017;390(10089):73-84. https://doi.org/10.1016/S0140-6736(16)31591-4
  • Braun J, Sieper J. Ankylosing spondylitis. Lancet 2007;369:1379-90 https://doi.org/10.1016/S0140-6736(07)60635-7
  • Van Der Heijde, Désirée, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Annals of the rheumatic diseases, 2017, 76.6: 978-991. https://doi.org/10.1136/annrheumdis-2016-210770
  • Dougados M, Dijkmans B, Khan MA et al.Conventional treatments for ankylosing spondylitis. Ann Rheum Dis 2002;61:40-50 https://doi.org/10.1136/ard.61.suppl_3.iii40
  • Braun J and Baraliakos X. Treatment of ankylosing spondylitis and other spondyloarthritides. Current Opinion in Rheumatology 2009;21:324-334 https://doi.org/10.1097/BOR.0b013e32832c6674
  • Regel A, Sepriano A, Baraliakos X, et al. 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 2017;3:e000397. https://doi.org/10.1136/rmdopen-2016-000397
  • Fragoulis GE, Siebert S. Treatment strategies in axial spondyloarthritis: what, when and how?. Rheumatology (Oxford). 2020;59 (Suppl4):iv79-iv89. https://doi.org/10.1093/rheumatology/keaa435
  • Chen FC, Jin ZL, Wang DF. A retrospective study of transcutaneous electrical nerve stimulation for chronic pain following ankylosing spondylitis. Medicine (Baltimore). 2018 Jul;97(27):e11265 https://doi.org/10.1097/MD.0000000000011265
  • Karamanlıoğlu, Duygu Şilte, et al. Effectiveness of ultrasound treatment applied with exercise therapy on patients with ankylosing spondylitis: a double-blind, randomized, placebo-controlled trial. Rheumatology international, 2016, 36.5: 653-661 https://doi.org/10.1007/s00296-016-3441-3
  • Sari H, Cakmak B, Can G. Impact of physical therapy agents on quality of life and emotional status in ankylosing spondylitis. Turk J Phys Med Rehab 2003;49:8-12.
  • Dagfinrud H, Kvien tK, Hagen KB. Physiotherapy interventions for ankylosing spondylitis. cochrane Database Syst Rev 2008;23(1):cD002822 https://doi.org/10.1002/14651858.CD002822.pub3
  • Kraag G., Stokes B,Groh J et al.The effects of comprehensive home physiotherapy and supervision on patients with ankylosing spondylitis.A randomized controlled trial. The Journal of Rheum 1990;17(2):228-33.
  • Hidding A, Van der Linden S, Boers M.Is group physical therapy superior to individualized therapy in ankylosing spondylitis? A randomized controlled trial. Arthritis Care Res 1993;6:117-25. https://doi.org/10.1002/art.1790060303
  • Hidding A, van der Linden S, Gielen X, et al. Continuation of group physical therapy is necessary in ankylosing spondylitis: results of a randomized controlled trial. Arthritis Care Res 1994;7(2):90-6 https://doi.org/10.1002/art.1790070208
  • Analay Y, Özcan E, Karan A.The effectiveness of intensive group exercise on patients with ankylosing spondylitis.Clin Rehabil 2003 Sep;17(6):631-6. https://doi.org/10.1191/0269215503cr658oa
  • Helliwell PS, Abbott CA, Chamberlain MA. A randomized trial of three different physiotherapy regimens in ankylosing spondylitis. Physiotherapy 1996;82:85-90 https://doi.org/10.1016/S0031-9406(05)66956-8
  • Van Tubergen A, Landewe R, van der Heijde D et al. Combined spa-exercise therapy is effective in patients with ankylosing spondylitis: a randomized controlled trial. Arthritis Rheum 2001;45:430-8 https://doi.org/10.1002/1529-0131(200110)45:5<430::AID-ART362>3.0.CO;2-F
  • Altan L, Bingöl U, Aslan M, Yurtkuran M. The effect of balneotherapy on patients with ankylosing spondylitis. Scand J Rheumatol. 2006 Jul-Aug;35(4):283-9 https://doi.org/10.1080/03009740500428806
  • Dundar U, Solak O, Toktas H, Demirdal US, Subasi V, Kavuncu V, Evcik D. Effect of aquatic exercise on ankylosing spondylitis: a randomized controlled trial. Rheumatol Int. 2014 Nov;34(11):1505-11. https://doi.org/10.1007/s00296-014-2980-8
  • Liang Z, Fu C, Zhang Q, et al. Effects of water therapy on disease activity, functional capacity, spinal mobility and severity of pain in patients with ankylosing spondylitis: a systematic review and meta-analysis. Disabil Rehabil. 2019;29:1-8 https://doi.org/10.1080/09638288.2019.1645218

Ankilozan Spondilitte Fizik Tedavinin Etkinliği: Randomize Kontrollü Bir Çalışma

Year 2021, Volume: 12 Issue: 42, 44 - 50, 15.04.2021
https://doi.org/10.17944/mkutfd.843202

Abstract

Amaç: Ankilozan spondilitli hastalarda fizik tedavinin ağrı, fonksiyon, hastalık aktivitesi, emosyonel durum ve yaşam kalitesi üzerine etkisini değerlendirmek.

Materyal ve Metod: Çalışmaya Selçuk Üniversitesi Meram Tıp Fakültesi Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı Kliniğinde takip edilen, AS tanısı konulan 31 hasta alındı. Hastaların rutin fizik muayene, kas-iskelet sistemi muayenesi ve nörolojik muayenesi yapıldı. Hastalar randomize olarak fizik tedavi grubu ve kontrol grubu olarak ikiye ayrıldı. Fizik tedavi grubuna 15 seans fizik tedavi (sıcak paket, ultrason, TENS, hidroterapi), egzersiz ve medikal tedavi verildi. Kontrol grubuna sadece ev egzersiz programı ve medikal tedavi verildi. Her iki gruba da tedavi öncesi, 2. ve 6. haftalarda ağrı için vizüel analog skala (VAS) gece ve istirahat, fonksiyon için Ankilozan Spondilit Fonksiyon İndeksi (BASFİ), hastalık aktivitesi için Ankilozan Spondilit Hastalık Aktivite İndeksi (BASDAİ), spinal mobilite için modifiye schober, el parmak zemin mesafesi, lateral fleksiyon, servikal rotasyon, intermalleolar mesafe, tragus duvar mesafesi ve Ankilozan Spondilit Metroloji İndeksi (BASMİ), göğüs eksansiyonu, çene manubrium mesafesi ölçüldü. Tedavi öncesi ve 6. hafta Beck depresyon ölçeği ve SF-36 formu dolduruldu.

Bulgular: Fizik tedavi grubunda spinal mobilite ölçümlerinden lateral fleksiyon, tragus duvar mesafesi ve beck depresyon ölçeği dışındaki tüm parametrelerde 2. haftada anlamlı düzelme saptadık (p<0,05). Bu düzelme, 6. haftada intermalleolar mesafe, el parmak zemin mesafesi, çene manubrium, servikal rotasyon ve BASFİ dışındaki tüm parametrelerde devam etti. Tedavi grubunda SF-36’nın sosyal fonksiyon ve mental kapasite alt grubunda tedavi öncesi ve 6. hafta arasında anlamlı düzelme saptadık (p<0,05). Gruplar arasında VAS (istirahat) 2. hafta ve 6. hafta ve SF-36’nın genel sağlık alt grubunda tedavi grubunda anlamlı düzelme vardı.

Sonuç: Fizik tedavi AS’li hastalarda ağrı, spinal mobilite ve yaşam kalitesi üzerine etkilidir.

References

  • Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet. 2017;390(10089):73-84. https://doi.org/10.1016/S0140-6736(16)31591-4
  • Braun J, Sieper J. Ankylosing spondylitis. Lancet 2007;369:1379-90 https://doi.org/10.1016/S0140-6736(07)60635-7
  • Van Der Heijde, Désirée, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Annals of the rheumatic diseases, 2017, 76.6: 978-991. https://doi.org/10.1136/annrheumdis-2016-210770
  • Dougados M, Dijkmans B, Khan MA et al.Conventional treatments for ankylosing spondylitis. Ann Rheum Dis 2002;61:40-50 https://doi.org/10.1136/ard.61.suppl_3.iii40
  • Braun J and Baraliakos X. Treatment of ankylosing spondylitis and other spondyloarthritides. Current Opinion in Rheumatology 2009;21:324-334 https://doi.org/10.1097/BOR.0b013e32832c6674
  • Regel A, Sepriano A, Baraliakos X, et al. 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 2017;3:e000397. https://doi.org/10.1136/rmdopen-2016-000397
  • Fragoulis GE, Siebert S. Treatment strategies in axial spondyloarthritis: what, when and how?. Rheumatology (Oxford). 2020;59 (Suppl4):iv79-iv89. https://doi.org/10.1093/rheumatology/keaa435
  • Chen FC, Jin ZL, Wang DF. A retrospective study of transcutaneous electrical nerve stimulation for chronic pain following ankylosing spondylitis. Medicine (Baltimore). 2018 Jul;97(27):e11265 https://doi.org/10.1097/MD.0000000000011265
  • Karamanlıoğlu, Duygu Şilte, et al. Effectiveness of ultrasound treatment applied with exercise therapy on patients with ankylosing spondylitis: a double-blind, randomized, placebo-controlled trial. Rheumatology international, 2016, 36.5: 653-661 https://doi.org/10.1007/s00296-016-3441-3
  • Sari H, Cakmak B, Can G. Impact of physical therapy agents on quality of life and emotional status in ankylosing spondylitis. Turk J Phys Med Rehab 2003;49:8-12.
  • Dagfinrud H, Kvien tK, Hagen KB. Physiotherapy interventions for ankylosing spondylitis. cochrane Database Syst Rev 2008;23(1):cD002822 https://doi.org/10.1002/14651858.CD002822.pub3
  • Kraag G., Stokes B,Groh J et al.The effects of comprehensive home physiotherapy and supervision on patients with ankylosing spondylitis.A randomized controlled trial. The Journal of Rheum 1990;17(2):228-33.
  • Hidding A, Van der Linden S, Boers M.Is group physical therapy superior to individualized therapy in ankylosing spondylitis? A randomized controlled trial. Arthritis Care Res 1993;6:117-25. https://doi.org/10.1002/art.1790060303
  • Hidding A, van der Linden S, Gielen X, et al. Continuation of group physical therapy is necessary in ankylosing spondylitis: results of a randomized controlled trial. Arthritis Care Res 1994;7(2):90-6 https://doi.org/10.1002/art.1790070208
  • Analay Y, Özcan E, Karan A.The effectiveness of intensive group exercise on patients with ankylosing spondylitis.Clin Rehabil 2003 Sep;17(6):631-6. https://doi.org/10.1191/0269215503cr658oa
  • Helliwell PS, Abbott CA, Chamberlain MA. A randomized trial of three different physiotherapy regimens in ankylosing spondylitis. Physiotherapy 1996;82:85-90 https://doi.org/10.1016/S0031-9406(05)66956-8
  • Van Tubergen A, Landewe R, van der Heijde D et al. Combined spa-exercise therapy is effective in patients with ankylosing spondylitis: a randomized controlled trial. Arthritis Rheum 2001;45:430-8 https://doi.org/10.1002/1529-0131(200110)45:5<430::AID-ART362>3.0.CO;2-F
  • Altan L, Bingöl U, Aslan M, Yurtkuran M. The effect of balneotherapy on patients with ankylosing spondylitis. Scand J Rheumatol. 2006 Jul-Aug;35(4):283-9 https://doi.org/10.1080/03009740500428806
  • Dundar U, Solak O, Toktas H, Demirdal US, Subasi V, Kavuncu V, Evcik D. Effect of aquatic exercise on ankylosing spondylitis: a randomized controlled trial. Rheumatol Int. 2014 Nov;34(11):1505-11. https://doi.org/10.1007/s00296-014-2980-8
  • Liang Z, Fu C, Zhang Q, et al. Effects of water therapy on disease activity, functional capacity, spinal mobility and severity of pain in patients with ankylosing spondylitis: a systematic review and meta-analysis. Disabil Rehabil. 2019;29:1-8 https://doi.org/10.1080/09638288.2019.1645218
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Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Articles
Authors

Ayşe Ünal Enginar 0000-0003-0273-6268

Hatice Uğurlu This is me 0000-0001-6728-232X

Publication Date April 15, 2021
Submission Date December 19, 2020
Acceptance Date April 8, 2021
Published in Issue Year 2021 Volume: 12 Issue: 42

Cite

Vancouver Ünal Enginar A, Uğurlu H. Effectiveness of Physical Therapy In Ankylosing Spondylitis: A Randomized Controlled Study. mkutfd. 2021;12(42):44-50.