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Abstract
Background Involvement of musculoskeletal system (inflammatation, atrophy and permanent damage to the muscle) in idiopathic inflammatory myopathies (IIM) leads to impaired function and reduced muscle strength, endurance, aerobic capacity and decreased quality of life. Data on efficacy of non-pharmacologic care in IIM is very limited due to variety in studied interventions/outcomes.
Objectives To address the limitations of existing studies, and evaluate the effect of a controlled, long-term (24-week intervention, 24-week follow-up), intensive (1h physiotherapy twice weekly, and home-exercise for 1h 5x weekly), tailored physiotherapy program to improve muscle strength, endurance and deep stabilizer system, and quality of life/disability in cohorts with a substantial number of IIM patients.
Methods All patients fulfilled the Bohan and Peter 1975 diagnostic criteria for dermatomyositis (DM) or polymyositis (PM), had skeletal muscle involvement, and were consecutively recruited from 2014 to 2016 at the Institute of Rheumatology in Prague. Both groups received educational materials and instructions for home exercise at baseline, however, only intervention group underwent the intensive physiotherapy programme. At months 0,3,6,12 all patients were assessed by a physician [physical examination, Myositis intention to treat index (MITAX), Myositis disease activity assessment visual analogue scale (MYOACT), and Myositis damage index (MDI)], and a physiotherapist blinded to intervention [standardized tests evaluating the level of muscle strength [Manual muscle test-8 (MMT-8)], and endurance [Functional index-2 (FI-2)], patients filled out patient reported outcomes (PRO)/questionnaires [HAQ, SF-36, Beck's depression inventory-II (BDI-II), PROs assessing nutrition and fatigue], body composition was analyzed using densitometry (iDXA Lunar) and bioelectric impedance (BIA2000-M), and patients provided blood for routine laboratory analysis and biobanking. Normality of data was tested and inter-group analysis performed with 2-way ANOVA and intra-group analysis by Friedmann's test with Dunn's post hoc test.
Results 27 IIM patients (22 female/5 male, 10 DM/12 PM/5 IMNM (immune mediated necrotizing myopathy), median of age 58.0 and disease duration 7.0 years) were recruited into the intervention group (IG) and 27 patients into the control group (CG) (24 female/3 male, 13 DM/12 PM/2 IMNM, median of age 56.5 and disease duration 4.7 years). Compared to observed statistically significant deterioration in CG over the period of months 0–6, we found statistically significant improvement in FI-2, MMT8, HAQ, BDI-II (Table 1). Only numerical improvement in IG compared to numerical deterioration in CG, which has not reached statistical significance, was observed in SF-36 and fatigue PROs.
Conclusions Our intensive 24-week physiotherapy programme led to a significant improvement in muscle strength, endurance, function and depression, which was clinically meaningful in a substantial proportion of patients.
Acknowledgements Supported by AZV-16–33574A.
Disclosure of Interest None declared