The effects of comprehensive home physiotherapy and supervision on patients with ankylosing spondylitis--a randomized controlled trial. The effectiveness of intensive group exercise on patients with ankylosing spondylitis Fifteen months' follow-up of intensive inpatient physiotherapy and exercise in ankylosing spondylitis Experts' beliefs on physiotherapy for patients with ankylosing spondylitis and assessment of their knowledge on published evidence in the field. Results of a questionnaire among international ASAS members. Home-based exercise therapy in patients with ankylosing spondylitis: effects on pain, mobility, disease activity, quality of life, and respiratory functions Effect of Pilates training on people with ankylosing spondylitis Comparison of group-based exercise versus home-based exercise in patients with ankylosing spondylitis: effects on Bath Ankylosing Spondylitis Indices, quality of life and depression Group treatment for pain and discomfort. A three-week multidisciplinary in-patient rehabilitation programme had positive long-term effects in patients with ankylosing spondylitis: randomized controlled trial. Outcome of an education and home-based exercise programme for patients with ankylosing spondylitis: a nationwide randomized study. Effects of home-based daily exercise therapy on joint mobility, daily activity, pain, and depression in patients with ankylosing spondylitis The effects of combined spa therapy and rehabilitation on patients with ankylosing spondylitis being treated with TNF inhibitors Efficacy of rehabilitation for patients with ankylosing spondylitis: comparison of a four-week rehabilitation programme in a Mediterranean and a Norwegian setting. Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores Is magnetotherapy applied to bilateral hips effective in Ankylosing spondylitis patients? A randomized, double-blind, controlled study Group education for people with arthritis. The Effectiveness of Exergames in Patients with Ankylosing Spondylitis: A Randomized Controlled Trial.
Fifty-three patients with ankylosing spondylitis ( AS ) were r and omly allocated ; 26 experimental patients received physiotherapy and disease education , 27 control patients received neither . The primary treatment outcome was change in spinal mobility measured at 4 months by fingertip-to-floor distance . Experimental patients had more improvement in fingertip-to-floor distance ( p2 less than 0.004 ) and in function ( p2 less than 0.001 ) than control patients . Physiotherapy with disease education is effective in the treatment of patients with AS Objective : To compare , in patients with ankylosing spondylitis ( AS ) , the effectiveness on pain , functional and psychological status of an intensive group exercise programme under the supervision of a physiotherapist and a home physiotherapy programme . Design : Fifty-one patients with AS were r and omly allocated into study and control groups . The study was design ed as a prospect i ve , double-blind study . Setting : Outpatient department , Istanbul Medical Faculty . Subjects : Patients who consulted with complaints of pain , morning stiffness and restricted range of movement with a confirmed diagnosis of ankylosing spondylitis . Interventions : Before exercise , both groups were given an education programme about AS . For group I patients an intensive exercise programme was organized under the supervision of a physiotherapist for six weeks . Group II patients had to practise exercises individually at home . Main outcome measures : Both groups were evaluated and compared for pain , functional and psychological status before treatment , at the end of treatment and three months after treatment using a visual analogue scale ( VAS ) for pain , Beck Depression Scale and Bath Ankylosing Spondylitis Functional Index ( BASFI ) . Results : Six patients withdrew , four from group I. Results from the remaining 45 showed more positive changes in the patients undertaking group exercise at six weeks and three months after treatment . Values showed a statistical significant difference in favour of group I. Conclusion : Group exercise in hospital may be more effective than home-based exercises at reducing impairment associated with ankylosing spondylitis Summary Long-term effects of three or four-week inpatient physiotherapy and exercise courses were studied in 141 adult patients with ankylosing spondylitis ( AS ) . Eight cervical and thoracolumbar range of motion ( ROM ) measurements and straight leg raise test , vital capacity ( VC ) and fitness index were measured at the beginning and end of an intensive course and 15 months later . All nine mobility measurements , vital capacity and fitness index were significantly improved after the course . Fifteen months later only chest expansion and vital capacity had significantly deteriorated from the baseline , while CR , FFD and fitness index were still significantly better . Disease duration did not influence treatment results .We conclude that it is possible by means of intensive rehabilitation courses to prevent for more than one year deterioration of spinal function and fitness in AS patients irrespective of disease duration AIM The aim of this study was to assess both the opinion of an international group of experts about the place and importance of physiotherapy in the management of ankylosing spondylitis ( AS ) as well as the awareness of the responders about scientific evidence on efficacy and cost-effectiveness of physiotherapy in AS . METHODS An e-mail question naire ' ' Experts ' Beliefs on Physiotherapy for Patients with Ankylosing Spondylitis ' ' has been sent to all 71 international ASsessment of Ankylosing Spondylitis ( ASAS ) members . Completion of the twenty-eight-item question naire was done through the ASAS website ( www.ASAS-group.org ) . RESULTS The number of responders was 53 ( response rate 73 % ) . Altogether 94 % of the responders regard themselves as experts in the field of clinical care for AS patients . There is almost unanimous ( 86 - 92 % ) consensus on the efficacy of physiotherapy ( widely defined , i.e. as physical therapy-including exercises , application of physical modalities and spa-therapy ) for patients with axial and peripheral joint manifestations of AS . Physiotherapy is considered to be indicated for both early AS ( less than 2 years after diagnosis ) ( 88 % ) and AS of longer duration ( 2 to 10 years ) ( 94 % ) , implying that this non-pharmaceutical intervention should be made available for or should be prescribed to AS patients . Also daily exercises at home are considered indicated for both early ( less than 2 years after diagnosis ) AS ( 90 % ) and AS of longer duration of disease ( 90 % ) . High-level evidence ( Cochrane review s or publications of one or more r and omized controlled clinical trials ) favoring efficacy of  physiotherapy  was considered available by 33 % of the participants , whereas 43 % replied ' ' no ' ' and 24 % did not know . Finally , excluding the costs of the intervention , 39 % of the participants reported that  Spa-therapy might reduce health care costs as usage of NSAIDs , physician visits and ability to work or sick leave , whereas 26 % said ' ' no ' ' and 35 % did not know . CONCLUSIONS The international ASAS experts hold a favorable opinion on the efficacy of physiotherapy in AS , including group exercises and spa therapy , almost irrespective of disease duration and type of articular involvement ( axial/peripheral ) . Awareness of published evidence on physiotherapy in AS is unsatisfactory The home-based exercise therapy recommended to the patients with ankylosing spondylitis ( AS ) is a simply applicable and cheap method . The aim of this study was to investigate the effects of home-based exercise therapy on pain , mobility , function , disease activity , quality of life , and respiratory functions in patients with AS . Eighty patients diagnosed with AS according to the modified New York criteria were included in the study .  Home-based exercise program including range of motion , stretching , strengthening , posture , and respiratory exercises was practically demonstrated by a physiotherapist . A training and exercise manual booklet was given to all patients . Patients following home-based exercise program five times a week at least 30 min per session ( exercise group ) for 3 months were compared with those exercising less than five times a week ( control group ) . Visual analog scale pain ( VASp ) values at baseline were significantly higher in the exercise group . The exercise group showed improvements in VASp , tragus – wall distance , morning stiffness , finger – floor distance , modified Schober 's test , chest expansion , the Bath Ankylosing Spondylitis Disease Activity Index , the Bath Ankylosing Spondylitis Functional Index , Ankylosing Spondylitis Quality of Life Question naire ( ASQoL ) , forced expiratory volume in first second , and forced vital capacity at third month . There was significant difference in ASQoL scores between the two groups in favor of the exercise group at third month . Regular home-based exercise therapy should be a part of main therapy in patients with AS . Physicians should recommend that patients with AS do exercise at least five times a week at least 30 min per session The objective of this study was to investigate the effects of Pilates on pain , functional status , and quality of life in patients with ankylosing spondylitis . The study was performed as a r and omized , prospect i ve , controlled , and single-blind trial . Fifty-five participants ( 30 men , 25 women ) who were under a regular follow-up protocol in our Rheumatology Clinic with the diagnosis of AS according to the modified New York criteria were included in the study . The participants were r and omly assigned into two groups : in group I , Pilates exercise program of 1 h was given by a certified trainer to 30 participants 3 times a week for 12 weeks , and in group II , design ed as the control group , 25 participants continued previous st and ard treatment programs . In groups , pre-(week 0 ) and post treatment ( week 12 and week 24 ) evaluation was performed by one of the authors who was blind to the group allocation . Primary outcome measure was functional capacity . Evaluation was done using the Bath Ankylosing Spondylitis Functional Index ( BASFI ) . Exploratory outcome measures were Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , Bath Ankylosing Spondylitis Metrology Index ( BASMI ) , Chest expansion , and ankylosing spondylitis quality of life ( ASQOL ) question naire . In group I , BASFI showed significant improvement at week 12 ( P = 0.031 ) and week 24 ( P = 0.007 ) . In group II , this parameter was not found to have significantly changed at week 12 and week 24 . Comparison of the groups showed significantly superior results for group I at week 24 ( P = 0.023 ) . We suggest Pilates exercises as an effective and safe method to improve physical capacity in AS patients . Our study is the first clinical study design ed to investigate the role of Pilates method in AS treatment . We believe that further research with more participants and longer follow-up periods could help assess the therapeutic value of this popular physical exercise method in AS The objective of this non-r and omised controlled trial was to evaluate the impact of group-based exercise programme and a home-based exercise programme on Bath Ankylosing Spondylitis Indices , depression and quality of life in patients with ankylosing spondylitis ( AS ) . Approximately 41 patients in a rehabilitation unit were divided into two groups , either group- or home-based exercise programme . Exercise sessions were performed three times a week for a period of 6 weeks . The patients were compared before and after the rehabilitation programme , with respect to Bath Ankylosing Spondylitis Functional Index ( BASFI ) , Bath Ankylosing Spondylitis Disease Assessment Index ( BASDAI ) , Bath Ankylosing Spondylitis Metrology Index ( BASMI ) , Beck Depression Inventory ( BDI ) and The Nottingham Health Profile ( NHP ) . A statistically significant improvement was observed on BASDAI , BASMI and energy , pain , reaction of emotional and sleep subscores of NHP in both exercise groups after the exercise programme ( p < 0.05 ) . No statistically significant changes were detected in BASFI , BDI and social and mobility subscores of NHP in both exercise groups ( p > 0.05 ) . No statistically significant differences were found between the two exercise programmes ( p > 0.05 ) . Group and home-based exercise programmes are efficient in improving symptoms and mobility and had an important effect on quality of life in patients with AS . Home-based exercise programme , as it is cheaper , more easily performed and efficient , may be preferable for the management programme in AS Rheumatic patients very often suffer from chronic pain and impairment and show psychological reactions as a consequence of their physical condition . These reactions may vary from psychophysiological symptoms to anger , anxiety , or depression . We developed a cognitive-behavioral treatment programme in a group setting format with components of relaxation , cognitive restructuring , and the promotion of well-being .  Subjects included in the study were given diagnoses of low back pain , tension headache , rheumatoid arthritis , and ankylosing spondylitis . Treatment effects in different diagnostic groups were compared to each other , supporting the assumption that pain reduction is greatest in low back pain and least in ankylosing spondylitis . Subjects with inflammatory rheumatic diseases showed some improvement in self-reported physical complaints and in their feelings of well-being OBJECTIVE To evaluate the mean overall effects over a 1-year period of a multidisciplinary in-patient rehabilitation programme for patients with ankylosing spondylitis . DESIGN Observer-blinded , r and omized controlled trial , with assessment s made after 4 and 12 months . PATIENTS Forty-six patients received a 3-week in-patient rehabilitation programme and 49 patients received treatment as usual .  METHODS Primary outcomes were disease activity measured with the Bath Ankylosing Spondylitis Disease Activity Scale ( BASDAI ) , and function measured with the Bath Ankylosing Spondylitis Functional Index ( BASFI ) . Secondary outcomes included well-being , spinal and hip mobility , and health-related quality of life measured with the Medical Outcome Study Short Form-36 . Overall treatment effects were estimated with Mixed models repeated measures analyses . RESULTS Significant overall treatment effects in favour of the rehabilitation group were found in the BASDAI score ( mean difference over the 1-year period -10.0 , 95 % confidence interval : -3.7 to -16.3 ) , in well-being ( -7.3 , 95 % confidence interval : -1.0 to -14.7 ) , and in the Medical Outcome Study Short Form-36 variables social functioning , role physical , role mental and bodily pain ( mean differences ranging from 5.8 ( pain ) to 10.7 ( role physical ) ) . CONCLUSION A 3-week in-patient rehabilitation programme had positive overall effects on disease activity , pain , function and well-being , and should be considered an important complement to medical disease management in persons with ankylosing spondylitis OBJECTIVES This study aims to assess the impact of a structured education and home exercise programme in daily practice patients with ankylosing spondylitis . METHODS A total of 756 patients with ankylosing spondylitis ( 72 % males , mean age 45 years ) participated in a 6-month prospect i ve multicentre controlled study , 381 of whom were r and omised to an education intervention ( a 2-hour informative session about the disease and the implementation of a non-supervised physical activity programme at home ) and 375 to st and ard care ( controls ) . Main outcome measures included Bath Ankylosing Spondylitis Disease Activity and Functional Index ( BASDAI , BASFI ) . Secondary outcome measures were 0 - 10 cm visual analog scale ( VAS ) for total pain , nocturnal pain and global disease activity and quality of life ( ASQoL ) , knowledge of disease ( self-evaluation ordinal scale ) and daily exercise ( diary card ) . RESULTS At 6 months , the adjusted mean difference between control and educational groups for BASDAI was 0.32 , 95 % confidence interval ( CI ) 0.10 - 0.54 , p=0.005 , and for BASFI 0.31 , 95%CI 0.12 - 0.51 , p=0.002 . Significant differences were found also in VAS for total pain , patient´s global assessment and in ASQoL. Patients in the education group increased their knowledge about the disease and its treatments significantly ( p<0.001 ) and practised more regular exercise than controls ( p<0.001 ) . CONCLUSIONS A structured education and home exercise programme for patients with ankylosing spondylitis in daily practice was feasible and helped to increase knowledge and exercise . Although statistically significant , the magnitudes of the clinical benefits in terms of disease activity and physical function were poor We investigated the effects of home-based daily exercise on joint mobility , functional capacity , pain , and depression in patients with ankylosing spondylitis ( AS ) . The patients were r and omly assigned to a wait-list control group or to an exercise-therapy group . The exercise-therapy group performed a 20-min exercise program once per day for 8 consecutive weeks . After 8 weeks , compared with the control group , the exercise group showed improvements in joint mobility ( cervical flexion , extension , shoulder flexion , abduction , hip abduction , and knee flexion ) , finger – floor distance , and functional capacity . Pain and depression scores were significantly lower after the exercise program in the exercise group than in the control group . These findings indicate that exercise therapy increases joint mobility and functional capacity , and decreases pain and depression in patients with AS .  Home-based exercise , which is easily accessible to patients , might be an effective intervention for AS Despite advances in pharmacological therapy , physical treatment continues to be important in the management of ankylosing spondylitis ( AS ) . The objective of the present study was to evaluate the effects and tolerability of combined spa therapy and rehabilitation in a group of AS patients being treated with TNF inhibitors . Thirty AS patients attending the Rheumatology Unit of the University of Padova being treated with TNF inhibitors for at least 3 months were r and omized and assessed by an investigator independent from the spa staff : 15 were prescribed 10 sessions of spa therapy ( mud packs and thermal baths ) and  rehabilitation ( exercises in a thermal pool ) and the other 15 were considered controls . The patients in both groups had been receiving anti-TNF agents for at least three months . The outcome measures utilized were BASFI , BASDAI , BASMI , VAS for back pain and HAQ . The evaluations were performed in all patients at the entry to the study , at the end of the spa treatment , and after 3 and 6 months . Most of the evaluation indices were significantly improved at the end of the spa treatment , as well as at the 3 and 6 months follow-up assessment s. No significant alterations in the evaluation indices were found in the control group . Combined spa therapy and rehabilitation caused a clear , long-term clinical improvement in AS patients being treated with TNF inhibitors . Thermal treatment was found to be well tolerated and none of the patients had disease relapse OBJECTIVE To investigate the sustained effect of a rehabilitation programme for patients with ankylosing spondylitis , and to compare the effect of this intervention given in a Mediterranean vs a Norwegian setting . METHODS A total of 107 patients with ankylosing spondylitis applying for rehabilitation were r and omized to a  4-week inpatient rehabilitation programme in a Mediterranean country or in Norway . The participants were evaluated clinical ly before and after the rehabilitation period ( week 0 and 4 ) and in week 16 . The ASsessment s in Ankylosing Spondylitis working group 's Improvement Criteria ( ASAS-IC ) , and tests of spinal mobility and physical capacity were used to measure treatment response . RESULTS An ASAS20 improvement was still present at week 16 in 50 % of the patients treated in a Mediterranean and 23 % in a Norwegian centre ( p = 0.006 ) . The tests of spinal mobility , physical capacity , and almost all patient 's assessment s of health status ( ASAS-IC components ) were still improved at week 16 after therapy in both climatic setting s. While the improvements in physical capacity were comparable , the spinal mobility and ASAS-IC components improved more , and improvements were sustained longer , after rehabilitation in a Mediterranean setting . CONCLUSION Patients with ankylosing spondylitis benefit from a 4-week rehabilitation programme in Norway , but even more so from a similar programme in a Mediterranean setting Background The Ankylosing Spondylitis Disease Activity Score ( ASDAS ) is a new composite index to assess disease activity in ankylosing spondylitis ( AS ) . It fulfils important aspects of truth , feasibility and discrimination . Criteria for disease activity states and improvement scores are important for use in clinical practice , observational studies and clinical trials and so far have not been developed for the ASDAS . Objective To determine clinical ly relevant cut-off values for disease activity states and improvement scores using the ASDAS . Methods For the selection of cut-offs data from the Norwegian disease modifying antirheumatic drug ( NOR-DMARD ) registry , a cohort of patients with AS starting conventional or biological DMARDs  , were used . Receiver operating characteristic analysis against several external criteria was performed and several approaches to determine the optimal cut-offs used . The final choice was made on clinical and statistical grounds , after debate and voting by Assessment of SpondyloArthritis international Society members . Crossvalidation was performed in NOR-DMARD and in Ankylosing Spondylitis Study for the Evaluation of Recombinant Infliximab Therapy , a data base of patients with AS participating in a r and omised placebo-controlled trial with a tumour necrosis factor blocker . Results Four disease activity states were chosen by consensus : inactive disease , moderate , high and very high disease activity . The three cut-offs selected to separate these states were : 1.3 , 2.1 and 3.5 units . Selected cut-offs for improvement were : change ≥1.1 units for clinical ly important improvement and change ≥2.0 units for major improvement . Results of the crossvalidation strongly supported the cut-offs . Conclusions Cut-off values for disease activity states and improvement using the ASDAS have been developed . They proved to have external validity and a good performance compared to existing criteria This double-blind , r and omized controlled study was conducted with the aim to investigate the effect of magnetic field therapy applied to the hip region on clinical and functional status in ankylosing spondylitis ( AS ) patients . Patients with AS ( n = 66 ) who were diagnosed according to modified New York criteria were enrolled in this study . Patients were r and omly divided in two groups . Participants were r and omly assigned to receive magnetic field therapy ( 2 Hz ) ( n = 35 ) , or placebo magnetic field therapy ( n = 31 ) each hip region for 20 min . Patients in each group were given heat pack and short-wave treatments applied to bilateral hip regions . Both groups had articular range of motion and stretching exercises and strengthening exercises for surrounding muscles for the hip region as well as breathing and postural exercises by the same physical therapist . These treatment protocol s were continued for a total of 15 sessions ( 1 session per day ) , and patients were examined by the same physician at months 1 , 3 and 6 . Visual analogue scale ( VAS ) pain , VAS fatigue , Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , Bath Ankylosing Spondylitis Functional Index ( BASFI ) , Bath Ankylosing Spondylitis Metrologic Index ( BASMI ) , DFI , Harris hip assessment index and Ankylosing Spondylitis Quality of Life scale ( ASQOL ) were obtained at the beginning of therapy and at month 1 , month 3 and month 6 for each patient . There were no significant differences between groups in the VAS pain , VAS fatigue , morning stiffness , BASDAI , BASFI , BASMI , DFI , Harris hip assessment index and ASQoL at baseline , month 1 , month 3 or month 6 ( p > 0.05 ) . Further r and omized , double-blind controlled studies are needed in order to establish the evidence level for the efficacy of modalities with known analgesic and anti-inflammatory action such as magnetotherapy , particularly in rheumatic disorders associated with chronic pain Arthritis is a common chronic disease causing pain and progressive disability to millions of people . The purpose of the study was to examine the effectiveness of group patient education for people with one form of arthritis , ankylosing spondylitis ( AS ) , in terms of change in : arthritis self-efficacy ; psychological well-being ; physical well-being ; and home exercise activities . The Self-Management Course-Ankylosing Spondylitis ( SMC-AS ) demonstrated positive effects on arthritis self-efficacy and psychological well-being at 6-month follow-up . Analysis of change over time in the intervention group showed improvements in depression , self-efficacy and severity at 3 weeks , with trends towards continued improvement evident at 6 months . In contrast , the positive effects on range and frequency of home exercise activities at 3 weeks were not maintained at 6 months . In conclusion , the effectiveness of short , intensive patient education courses was demonstrated . However , the need for strategies to sustain improvements in exercise behaviour need to be explored BACKGROUND Exergames are a well-known type of game based on a virtual avatar 's body movements . This hightech approach promotes an active lifestyle . OBJECTIVES The aim of this r and omized controlled trial was to evaluate the effects of exergames on pain , disease activity , functional capacity and quality of life in patients with ankylosing spondylitis ( AS ) . MATERIAL AND METHODS The study involved 60 patients , who were r and omized into either the exergame group ( EG ) or the control group ( CG ) . The EG patients engaged in exergaming , and CG patients did not engage in any exercises . The exergaming sessions were performed five times a week for eight weeks ( 40 sessions in total ) . The patients were assessed before and after the eight-week program on a visual analog scale ( VAS ) , the Bath Ankylosing Spondylitis Functional Index ( BASFI ) , the Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) and the Ankylosing Spondylitis Quality of Life ( ASQOL ) question naire . RESULTS A statistically significant improvement was observed in VAS , BASFI , BASDAI and ASQoL scores in the EG group after completion of the exercise program ( p < 0.05 ) . CONCLUSIONS This study is a first step in investigating the possibilities of using an exergame platform to help patients with spondyloarthropathies to adopt a more physically active lifestyle . The results of this study suggest that exergames increase physical activity and decrease the pain scores in AS patients and also could , therefore , be feasible and safe
There is not sufficient evidence yet available to base recommendations for or against the use of physiotherapy interventions for ankylosing spondylitis
BACKGROUND Ankylosing spondylitis ( AS ) is a chronic rheumatic disease .
Due to the consequences of the disease , physiotherapy is regarded to be an important part of the treatment .
OBJECTIVES The objective is to summarise the available scientific evidence on the effectiveness of physiotherapy interventions in the management of AS .