Background The Assessment of SpondyloArthritis International Society (ASAS) and European League against Rheumatism (EULAR) working group state that optimal management of ankylosing spondylitis (AS) comprises a combination of pharmacological and non-pharmacological treatment, the latter including education, exercises and physiotherapy (Braun et al, 2011). However, even if several studies conclude with beneficial effects of physiotherapy and rehabilitation programs, more knowledge is needed to optimize the delivery of these interventions. Further, the results concerning the duration of the effect of rehabilitation are conflicting, and doubts remain about sustained improvement over long periods (Maseiro et al. 2011, Lubrano et al. 2006, Lubrano et al. 2007, Dagfinrud et al. 2008, Nghiem et al. 2008, Lubrano et al. 2011).
Objectives To evaluate the long term overall effects (mean effect over a one year period) of a multidisciplinary in-patient rehabilitation program for patients with ankylosing spondylitis (AS).
Methods In this observer blinded, randomised controlled trial, 46 patients received a three weeks in-patient rehabilitation program (rehabilitation group) and 49 patients received treatment as usual (control group). 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) (both scored 0-100, 0=low disease activity/good function). Secondary outcomes included well-being, spinal and hip mobility and health related quality of life measured by the Medical Outcome Study Short Form-36 (SF-36). Outcome assessments were made at four- and 12 months follow up, and 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 one year period -10.0, 95% CI: -3.7 to -16.3), in well-being (-7.3, 95% CI: -1.0 to -14.7), and in the SF-36 variables social functioning, role physical, role mental and bodily pain (mean differences ranging from 5.8 (pain) to 10.7 (role physical)). There were no differences between the groups in the BASFI-scores or in the other secondary outcomes.
Conclusions A three week in-patient rehabilitation program 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 AS.
Disclosure of Interest None Declared
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