Background Ankylosing spondylitis (AS) is characterized by progressive disability in affected patients. Especially, limited function of the thoracic spine is associated with a decrease in quality of life. Hence, physiotherapy is an essential component in the multimodal treatment concept of AS.
Objectives To explore the effects of manual mobilisation on the thoracic spine mobility, respiratory function and disease activity in patients with AS.
Methods Two randomly assigned groups, each consisting of 12 patients, were treated with physiotherapy during their stay in the hospital. One group was additionally treated with manual mobilisation of the thoracic spine for an average of 6 sessions, whereas the other group received conventional physiotherapy only. The primary outcome parameter was defined as change in the mobility of the thoracic spine represented by the Ott’s sign. The secondary outcome parameters were pain (VAS), respiratory function (difference in chest expansion and inspiratory vital capacity=IVC), disease activity (BASDAI), functional index (BASFI), and patient’s global score (BAS-G). Assessments were performed at baseline (admission to hospital), at discharge, and at one and three months after discharge. No new or change in medication was initialised.
Results Mobility of the thoracic spine (Ott’s sign) increased significantly within the group of manually mobilized patients compared to baseline at each of the follow-up visits (p_discharge=0.002, p_1 month=0.002, p_3 months=0.004). Of note, no significant change on thoracic spine mobility could be detected in the control group at each of the follow-ups. By comparing both groups, a significantly improved mobility of the manually mobilized patients at discharge (p=0.002) and one month later (p=0.009) was observed. There was no difference between the two groups at baseline and after 3 month. An impact on pain reduction (VAS) was not achieved in the control group. Merely, in the manually mobilized group pain reduction became obvious compared to baseline (p_discharge=0.006, p_1 month=0.005, p_3 months=0.013). Parameters of the respiratory function improved significantly during therapy with manual mobilisation. In comparison to baseline, chest expansion increased at all follow-up visits (p_discharge=0.001, p_1 month=0.026, p_3 months=0.013). IVC was positively influenced by the applied therapy at discharge (p=0.003) and after 3 months (p=0.008). In concern of the scores (BASDAI, BASFI, BAS-G), a significant decrease was detected, reflecting a general improvement in terms of disease activity and functional status. The observed effects on most of the outcome parameters lasted during the observational period of three months.
Conclusions The results show that physiotherapy especially manual mobilization of the thoracic spine promotes mobility, improves respiratory function and positively affects disease activity, functional, and global status. Therefore, manual mobilization of the thoracic spine as well tolerated method should be a major component in the concept of physiotherapy of patients with AS. Long-term efficacy cannot be considered, but the results of this study suggest repeated cycles, at least after three months.
Disclosure of Interest None Declared