Background Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease. A specific exercise program, in addition to pharmacological therapy, is more and more considered a significant integrated approach in AS treatment.
Objectives To compare, in patients with AS stabilized with tumor necrosis factor (TNF)-alpha inhibitor therapy, the effectiveness on pain, spine mobility, physical function, and disability of group-based exercise program and home-base exercise program.
Methods Thirty patients (26 males, 4 females) with AS were randomly divided into two groups: Ambulatory Group (AG) and Home Group (HG). AG (n =15) patients received instruction for a group-exercise program 3 days a week and 45 minutes a day under the supervision of the same physiotherapist for 6 weeks. HG (n =15) patients practiced the exercises, illustrated by a physiotherapist during a dedicated and guided session, individually at home, 3 days a week for 6 weeks. Patients were evaluated according to BASFI, BASDAI, HAQ, BASMI before treatment (T0), at the end of the treatment (T1), 1 month (T2) and 6 months (T3) since the end of the treatment. ANOVA statistical analysis (p=0.05) was performed.
Results In all outcomes (BASFI, BASDAI, HAQ e BASMI) a significant overall improvement was observed (p<0.0001), return at baseline value was observed partially at T2 and completely at T3. There were significant improvement in the “tragus to wall distance” (TWD) test (p<0.05) in AG at T1. The “lumbar side flexion” (LSF) was improved (p<0.05) in AG at T1 and T2. TWD and LSF improvement showed a positive result also in the BASMI total score (p<0.0001), that was significantly better at the end of T1 in AG than in HG.
Conclusions A significant improvement in all outcome measurements was observed in T1 due to exercise program compliance in all patients. In both groups a slight worsening of outcome results at T1 was observed, due to discontinuation of exercise program. At T3, all benefits obtained were almost lost with a consequent return to basal values (T0). TWD improvement reveals that ambulatory exercise program is more effective due to exercise supervision and adherence to program. AG patients obtained a better extension and better flexion of lumbar rachis. Patients in AG group obtained overall a significant better BASMI score at the end of the assisted treatment.
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Disclosure of Interest None declared
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