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The effectiveness of aquatic physical therapy intervention on disease activity and function of ankylosing spondylitis patients: a meta-analysis
Psychology, Health & Medicine
Abstract
This study aimed (i) to complement existing research by focusingon aquatic physical therapy was potentially beneficial to patients with AS; (ii)tosystematically analyze all evidence available in the literature about effectiveness of the aquatic physical therapy intervention on pain and disease activity in AS patients.
A systematic search was performed in major electronic databasesto identify studies reporting aquatic physical therapy intervention on pain and disease activity of AS patients. Three independent investigators screened the identified articles, extracted the data, and assessed the methodological quality of the included studies. Qualitative descriptions were conducted, and quantitative analysis was performed with RevMan software (version 5.3).The results were expressed in terms of mean difference(MD) and the corresponding 95% confidence interval.A total of five studies comprising 1,393 participants were included in the study. Meta-analyses showed that aquatic physical therapy interventions significantly reduced the pain scores(SMD=−0.44, 95 % CI:−0.84,−0.04, p=0.03) and BASDAI scores (MD=−0.40, 95% CI:−0.73,−0.06, p=0.02) because of follow up time among these studies; therefore, a subgroup analysis should be conducted for comparison. Aquatic physical therapy can statistically significantly reduce pain and disease activity in patients with AS compared with controls.
... A BASDAI score >4 is internationally accepted to indicate active disease. Tool (IV): The Numeric Pain Rating Scale (NPRS) (35)(36)(37) . The Numeric Pain Rating Scale is a segmented numeric version of the visual analog scale in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of pain. ...
... All tools of the study were developed by the researcher to collect the data after extensive review of literature (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) . And used to collect data except tool (II): Bath Ankylosing Spondylitis Functional Index (BASFI) was developed by (30,31) , tool (III): Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (32)(33)(34) and tool (IV): The Numeric Pain Rating Scale (NPRS) (35)(36)(37) . ...
... All tools of the study were developed by the researcher to collect the data after extensive review of literature (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) . And used to collect data except tool (II): Bath Ankylosing Spondylitis Functional Index (BASFI) was developed by (30,31) , tool (III): Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (32)(33)(34) and tool (IV): The Numeric Pain Rating Scale (NPRS) (35)(36)(37) . ...
... In this respect, our findings are congruent with the results obtained by Bestaş et al. (2022), who mentioned the positive effects of aquatic exercises on the improvement of pain and function of patients with AS [35]. In a meta-analysis, Zhao et al. reported the significant effects of aquatic exercises on the pain reduction in patients with AS, claiming that more clinical trials should be performed in this area [38]. In addition, the [37]. ...
... Regardless of the type of exercise 14:183 given in the aquatic environment, the warmth of the water, comfortable and painless exercises, and hydrostatic pressure in water have been able to reduce time to walk a distance of 40-MWT and improve the functional capacity of patients by decreasing the pain, strengthening the muscles and increasing the range of motion of the joints, which confirms the results of studies performed in this area. In a meta-analysis, Zhao et al. [38] evaluated the effect of aqua-based physical therapy on the activity and function of patients with AS, reporting that aquatic exercises can significantly reduce pain and improve performance. In a prospective controlled study, Bestaş et al. [35] performed a comparative assessment of aqua-based and land-based exercises to determine their effects on the function of patients with AS. ...
Background
Aqua Pilates and Aqua Stretch exercises are different and new methods for the rehabilitation of musculoskeletal disorders. This study aimed to compare the effectiveness of Aqua Stretch and Aqua Pilates interventions in the treatment of pain, function, and posture of the spine in ankylosing spondylitis (AS) patients.
Methods
Forty patients participated in this study who were randomly allocated into Aqua Stretch, aqua Pilates, and control. The experimental groups received four 60-min training sessions each week for six weeks. However, the control group had only its routine drug treatment (NSAIDs & Anti TNF). Pain with Visual Analog Scale (VAS), function with Bath Ankylosing Spondylitis Functional Index (BASFI) and 40-m walking test (MWT), quality of life with ankylosing spondylitis quality of life (ASQoL), and posture of the spine with the Spinal Mouse were evaluated. Evaluations were performed before and after the interventions. Repeated measure ANOVA was employed to determine the main and interaction effects.
Results
Aqua Stretch and Aqua Pilates had a significant effect on pain (Aqua-Pilates: P = 0.0001; Aqua-Stretch: P = 0.0001), BASFI (Aqua-Pilates: P = 0.01; Aqua-Stretch: P = 0.02), 40-MWT (Aqua-Pilates: P = 0.006; Aqua-Stretch: P = 0.0001) and ASQoL (Aqua-Pilates: P = 0.01; Aqua-Stretch: P = 0.001), spinal range of motion (ROM) (Aqua-Pilates: P = 0.0001; Aqua-Stretch: P = 0.0001) at a similar ratio. However, the control group did not present any improvement in these factors (P > 0.05). Moreover, the minimal clinically important difference (MCID) revealed that the Aqua Stretch group performed better than the Aqua Pilates group in terms of VAS, ASQOL, and 40-MWT factors.
Conclusions
Aqua Stretch and Aqua Pilates had statistically the same effect on improving pain, function, quality of life, and spinal ROM, while MCID results revealed that the Aqua Stretch group performed better than the Aqua Pilates in terms of VAS-ASQOL-40-MWT.
Trial registration It is notable that local ethics committee approval was obtained (IR.KUMS.REC.1399.1137), and the study was registered in Iranian Registry of Clinical Trials (IRCT; IRCT20190426043377N3; registered on 22/05/2021, https://fa.irct.ir/user/trial/56058/view) and patient recruitments were started on 06/07/2021.
... Epidemiological evidence has implicated that a range of modifiable lifestyle factors play a contributory role in the development of AS. [5][6][7][8][9][10] However, inconsistent results in the literature regarding the impact of various lifestyle factors on AS were observed, which can be explained by differences in study methodology and the inability to obtain sufficient information on AS events through long-term follow-up. Generally, previous studies focused on the association between individual lifestyle factors and AS without investigating the role of other modifiable factors comprehensively, and ignoring the fact that each specific healthy lifestyle factor was capable of coexisting with the others which may result in a synergistic effect on people's health. ...
Background: Whether the lifestyle is associated with the risk of ankylosing spondylitis (AS) in the presence of different genetic risk levels remains unknown. We aimed to evaluate modifiable lifestyle-genetic susceptibility interaction with the risk of AS.
Methods: This study included 382,035 individuals free of AS at baseline in the UK Biobank. A lifestyle score based on a combination of body mass index, smoking status, alcohol consumption, diet, sleep duration and physical activity, and a polygenic risk score (PRS) using 24 ASassociated genetic loci were constructed for each participant, and were further classified into three lifestyle and genetic risk categories, respectively. Cox proportional hazards regression models were applied to evaluate the associations of lifestyle, PRS with AS risk. Moreover, we estimated the percentage of total association between healthy lifestyle score and AS mediated by systemic inflammation markers.
Findings: During a median follow-up of 13.6 years, 694 patients with AS were diagnosed in the UK Biobank cohort. With unfavorable lifestyle as the reference group, intermediate lifestyle (hazard ratio [HR]: 0.65, 95% confidence interval [CI]: 0.53-0.80) and favorable lifestyle (HR: 0.59, 95% CI: 0.46-0.74) were associated with a decreased risk of AS. For the combined effect of lifestyle and PRS, participants with unfavorable lifestyle and high genetic risk had the highest risk of AS (HR: 1.95, 95% CI: 1.32-2.89) compared to those with favorable lifestyle and low genetic risk. However, no evidence of addictive and multiplicative interaction were observed. Furthermore, mediation analyses revealed that the inverse association between healthy lifestyle score and AS risk was in part mediated by systemic inflammation which ranged from 0.54% for neutrophil-to-HDL-c ratio to 13.79% for C-reactive protein.
Interpretation: Our study suggested that adherence to a favorable lifestyle significantly reduced the risk of AS by attenuating the systemic inflammatory response, which was independent of genetic susceptibility to AS.
... Aquatic physical therapy-also known as hydrotherapy or aquatic exercise [8]-has been widely used for the purpose of rehabilitation and treatment of many diseases [9], such as rheumatic disease, fibromyalgia, stroke, Parkinson disease, and so on [10][11][12]. Aquatic physical therapy is defined as exercise in lukewarm water, assistance and resistance of warm water to relieve pain, muscle relaxation and making more effective exercise, which is a safe and effective medium treatment way for achieving exercise-related goals [13,14]. In general, this therapy involves a variety of exercise modalities including aerobic, stretching, resistance, flexibility and stability training [15]. ...
To determine and evaluate the benefits of aquatic physical therapy as a rehabilitation strategy for women with breast cancer on health outcomes. Electronic databases including PubMed, Web of Science, Embase, Cochrane Library and China National Knowledge Infrastructure (CNKI), Weipu (VIP) and Wanfang database were systematically searched until June 2021. Randomized controlled trials were included if they evaluated the effects of aquatic physical therapy in breast cancer patients. The quality of the trials included was assessed by the two independent researchers according to the Cochrane Collaboration Handbook recommendations. Outcome measures were fatigue, waist circumference and quality of life (QoL). The study was registered under PROSPERO (CRD42021157323). Totally, five studies comprising 356 participants were included in the study. Meta-analyses showed that aquatic physical therapy interventions significantly reduced the fatigue score (MD = -2.14, 95%CI: -2.82, -1.45, p<0.01) compared with usual care; In addition, we also observed that, compared with land-based exercise, aquatic physical therapy greatly improved the QoL (MD = 2.85, 95%CI: 0.62, 5.09, p = 0.01). However, aquatic physical therapy cannot improve physical index (waist circumference) compared to usual care (MD = -3.49, 95%CI: -11.56,4.58, p = 0.4). Consequently, aquatic physical therapy had a positive effect on the fatigue and QoL. The results of this meta-analysis can provide a reliable evidence for evaluating the interventional effectiveness of aquatic physical therapy.
... However, there is insufficient literature evidence to support a strong recommendation of aquatic exercises for early arthritis [7]. Most of the available reviews (published or in progress) focused on the treatment of a sole rheumatic disease [15][16][17][18][19] or the target condition was not a rheumatic disease. Thus, studies that included individuals with rheumatoid arthritis and/or spondyloarthritis probably could not be included in these mentioned reviews. ...
Spondyloarthritis and rheumatoid arthritis are classified as inflammatory arthritis and represent a significant source of pain and disability. Non-pharmacological intervention with physical exercise is among the therapeutic approaches most used by health professionals. This study aimed to investigate the effectiveness of aquatic exercise in the treatment of inflammatory arthritis. The review was registered on the PROSPERO (CRD42020189602). The databases (PubMed, PEDro, Web of Science, and SciELO) were searched for studies involving adults with inflammatory arthritis and subjected to rehabilitation with aquatic exercise compared to any other control group, from the year 2010 to March 2022. Pain, disease activity, and physical function were regarded as primary outcomes. Two reviewers completed the eligibility screening and data extraction, and disagreements were resolved by a third reviewer. The methodological quality was assessed using the PEDro scale. A total of 5254 studies were identified, and nine articles were included, totalling 604 participants. Regarding pain, two studies showed that aquatic exercise was superior to home exercise. One study showed that disease activity was significantly improved in the aquatic group compared to the land-based exercise and the control groups (no exercise). Two studies reported that therapy containing aquatic exercise was able to improve physical function. Overall, the studies included in this review indicate that aquatic exercise is effective in treating pain, disease activity, and physical function in individuals with inflammatory arthritis. However, further studies carrying stronger evidence should be conducted to determine whether the treatment with aquatic exercise is superior to other types of therapies.
... [21,37] Spa therapy and exercise in addition to anti-inflammatory medications and formal physical therapy was associated with significant improvement in function in a randomized control study, and aquatic physical therapy has been shown in meta-analyses to significantly reduce pain and disease activity. [46,74] Although the methods have evolved, physical therapy is a mainstay of treatment and prescribed to patients with AS. A summary of therapeutic options for AS can be found in Table 1. ...
Background
Ankylosing spondylitis (AS) is a chronic, progressive, inflammatory disease of the spine and SI joints. Diagnostic criteria and treatments have continued to evolve, necessitating a historical compendium of AS and its management. This paper aims to review the historical context underlying the discovery of AS, as well as the major diagnostic and therapeutic discoveries in the last two centuries.
Methods
A scoping review of the literature pertaining to AS was performed via the Pubmed, Scopus, and Web of Science databases. Future directions of AS treatments were assessed by querying the clinicaltrials.gov website.
Results
The history of AS can be traced as far back as ancient Egypt (as evidenced by the discovery of its presence in ancient Egyptian mummies) to the late 20 th century, when the inherited nature of AS was linked to a genetic factor, HLA-B27. Each discovery made throughout the years led to further investigations into the pathophysiology, diagnosis, and treatment of AS. The criteria to differentiate AS from rheumatoid arthritis were first reported in 1893. Since then, diagnostic criteria for AS have undergone a series of changes before the present-day diagnostic criteria for AS were ultimately determined in 2009 by the Assessment of Spondyloarthritis International Society.
Conclusion
As the pathophysiology of AS is better understood, healthcare providers are able to diagnose and treat the condition more effectively. In particular, earlier diagnosis and multiple treatment options have facilitated efficient and more effective treatment.
... Hydrotherapy is needed in terms of clinical trial. It is very important to highlight the positive aspects on pain management among patients with arthritis pain [9][10]. ...
Introduction: Hydrotherapy is a warm water therapy used in relieving pain such as muscle pain, back pain and inflammation associated with the arthritis pain. In arthritic condition hydrotherapy helps to improving blood circulation. It is commonly used for treating muscle injuries and stroke and brain injuries. Objectives: To determine the effectiveness of mechanical hydrotherapy on pain management among patients with arthritis pain. Materials and Methods: In this study a quantitative research approach with an experimental pre-test post-test research design was used for the present study. Purposive sampling was the sampling method used to collect data from arthritis patients on the basis of standardized numerical pain rating scale (NPRS). The sample size was 70, for experimental group 35 samples and control group was 35 samples. For experimental group the mechanical hydrotherapy was given along with prescribed medicines and for control group only prescribed medicine was monitored. Results: The majority of participants were male 41 (58.57%) and female 29 (41.43%) as compared to male. In experimental group male were 22 (62.85%) and female were 13 (37.15%) and in control group male were19 (54.28%) and female were 16 (45.72%). Before intervention on day-1 pre assessment pain mean value was 7.51 and standard deviation was 1.46 in experimental group and In control group mean value was 7.91 and standard deviation was 1.12. On day-7 post assessment pain the outcome of an experimental group after mechanical hydrotherapy with reducing pain, mean value was1.80 and standard deviation was 1.07 and in control group mean value was 7.97 and 1.27. Statistically significant improvement seen in the level of pain regarding effectiveness of mechanical hydrotherapy on pain management among patients with arthritis pain. Conclusion: Hence it is statistically clear that, the mechanical hydrotherapy to arthritis patients is helpful in managing the pain effectively.
... Identically, a change in the BASDAI was observed after one year, with a decrease in the education group, and the percentage of patients reaching the PASS for BASDAI was also higher in the education group. This difference of BASDAI change and PASS based on the BASDAI status between groups could have been explained by the increase of exercise, as both physical activity in general [25][26][27] and axSpA-specific home-based exercises [28] have been associated with an BASDAI improvement. This might be the explanation of a change in the BASDAI but not in the ASDAS, which does not include the item 'fatigue' (potentially improved by increased physical activity). ...
Objective
To evaluate the impact of a nurse-led program of self-management and self-assessment of disease activity in axial spondyloarthritis.
Methods
Prospective, randomized, controlled, open, 12-month trial (NCT02374749). Participants were consecutive axial spondyloarthritis patients (according to the rheumatologist) and nurses having participated in a 1-day training meeting. The program included self-management: educational video and specific video of graduated, home-based exercises for patients; and self-assessment: video presenting the rationale of tight monitoring of disease activity with composite scores (Ankylosing Spondylitis Disease activity Score, ASDAS/Bath Ankyslosing Spondylitis Disease Activity Index, BASDAI). The nurse trained patients to collect, calculate and report (monthly) ASDAS/BASDAI. Treatment allocation was by random allocation to this program or a comorbidities assessment (not presented here and considered here as the control group).
Results
A total of 502 patients (250 and 252 in the active and control groups, respectively) were enrolled (age: 46.7 (12.2) years, male gender: 62.7%, disease duration: 13.7 (11.0) years). After the one-year follow-up period, the adherence to the self-assessment program was considered good (i.e. 79% reported scores >6 times). Despite a lack of statistical significance in the primary outcome (e.g. coping) there was a statistically significant difference in favor of this program for the following variables: change in BASDAI, number and duration of the home exercises in the active group, and physical activity (international physical activity score, IPAQ).
Conclusion
This study suggests a short-term benefit of a nurse-led program on self-management and self-assessment for disease activity in a young axial spondyloarthritis population in terms of disease activity, exercises and physical activity.
The 2018 European Alliance of Associations for Rheumatology provided recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. It confirmed its safety and feasibility in this patient population, alongside describing possible health benefits. The aim of this narrative review is to synthesise the literature investigating the effects of physical activity and exercise interventions on patient-centred outcomes in a range of inflammatory rheumatic diseases since 2018 to help guide clinical practice.
Databases (Cochrane Database of Systematic Reviews, Cochrane central register of controlled trials database, MEDLINE via Pubmed, Embase and CINAHL) were searched for studies from 01/01/2018 to 31/08/2021 for systematic reviews, meta-analyses and randomised controlled trials exploring physical activity interventions in a population of adults with rheumatological diseases. Data on study population, interventions, outcomes and quality was collected before synthesis of the findings and categorisation into three disease groups: rheumatoid arthritis (RA), axial spondyloarthritis (AxSpA), and connective tissue disease (CTD).
Eighty-six reports were included. Interventions included swimming, aquatic exercises, global posture retraining and land based aerobic exercises with significant heterogeneity also seen in dosing and frequency. Improved quality of life, cardiovascular fitness and physical function, alongside reductions in disease activity and fatigue, were reported as having either a positive or possible positive effect in all disease groups. Outcomes such as pain and mood-related outcomes (such as anxiety and depression) showed the most variation across the disease groups.
Physical activity interventions have numerous benefits on patient reported outcomes in patients with rheumatological disease from positive impacts on disease activity, physical function and cardiovascular fitness to improvements in multifactorial outcomes like fatigue and quality of life. It should be an integral part of a holistic management approach.
Background:
There has been a dearth of research into the benefits of water-based workouts for ankylosing spondylitis (AS) patients.
Objective:
This study aimed to compare the effect of Aqua Stretch and Aqua Pilates in improving quality of life (QOL), function, and pain in AS patients.
Methods:
This study was conducted on 40 patients, who were randomly assigned to the Aqua Pilates, Aqua Stretch, and control groups. The experimental groups attended interventions for six-week. QOL, pain intensity, function, and fatigue were measured before and after treatments.
Results:
Except for the chest expanding, all variables in the Aqua Stretch group changed significantly after six weeks (p< 0.05). QOL (p= 0.002), 6MWT (p= 0.016), and Schober flexion (p= 0.011) showed changes, while BASDAI (p= 0.0001), VAS (p= 0.0001), fatigue (p= 0.0001), and Schober extension (p= 0.028) showed significant decreases. Except for chest expansion and Schober extension, which did not alter significantly after six-week of Aqua Pilates (p> 0.05), all other variables did. There was an increasing trend in 6MWT and Schober flexion (p= 0.021) and a decreasing trend in BASDAI (p= 0.002), VAS (p= 0.0001) and fatigue (p= 0.002). Except for QOL (p= 0.016), no statistically significant differences were found between the groups.
Conclusion:
All variables had a significant change after six-week Aqua Stretch, except for the chest expanding. Chest expanding and Schober extension were the variables which had no significant change after six-week Aqua Pilates. With the exception of QOL, no statistically significant differences were found between the groups. Aqua Stretch had the greatest effect on the VAS, as measured by the minimum clinically relevant differences (MCID). Moreover, in Aqua Stretch alone, there was a notable impact on fatigue, QOL, and the BASDAI.
Purpose
In order to study whether far-infrared fabrics can be used as a garment for breast cancer patients, or as an adjuvant rehabilitation underwear for breast cancer patients after postoperative radiotherapy and chemotherapy, to eliminate tissue edema. To explore the effect of different far-infrared fabrics on the proliferation and invasion of breast cancer cells as a basic in vitro study.
Design/methodology/approach
Six kinds of fabrics of the same specification with different far-infrared nanoparticles were selected. MCF7 and Bcap37 breast cancer cells were used to study the effect of far-infrared fabrics on cell proliferation and invasion. Six kinds of far-infrared fabrics were used to culture breast cancer cells and explore their effects on breast cancer cell growth and the difference between different far-infrared fabrics.
Findings
It is found that the far-infrared emissivity of six kinds of fabrics are different, among which tea carbon fabric is the highest, followed by volcanic fabric, graphene fabric and biomass graphene fabric are the lowest. The results show that the far-infrared fabrics can significantly inhibit the proliferation and invasion of breast cancer cells, the higher the far-infrared emissivity is, and the longer the time of far-infrared radiation, the more significant the inhibition effect is.
Originality/value
Far-infrared fabrics can inhibit proliferation and invasion of breast cancer cells in vitro . Therefore, far-infrared fabrics can be used for adjuvant rehabilitation of breast cancer patients. This conclusion provides a basis for the application of far-infrared functional fabrics in the medical field. This conclusion provides a basis for the application of far-infrared functional fabrics in medical field.
Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.
[Purpose] The purpose of this study was to compare the effects of land exercise and aquatic exercise on chronic stroke patients. [Subjects and Methods] The subjects were randomly divided into a land exercise group (12 males and 10 females; average age: 56.09 ± 7.22 years) and an aquatic exercise group (15 males and 7 females; average age: 51.55 ± 8.27 years). Subjects from both groups received general conventional treatment during the experimental period. In addition, all subjects engaged in extra treatment sessions. This extra treatment consisted of trunk stability strengthening exercises and balance training exercises in the land exercise group, whereas in the aquatic exercise group subjects participated in balance board exercises and walking exercises using buoyancy equipment in the hospital swimming pool. [Results] The joint position sense test and performance oriented mobility assessment showed significant improvements in both groups. However, the joint position sense test and performance oriented mobility assessment showed there was more improvement in the aquatic exercise group than in the land exercise group. [Conclusion] The results suggest that aquatic exercise is more effective than land exercise at improving the joint position sense and clinical functions of stroke patients.
Introduction: The World Health Organization (WHO) is in the process of updating the "Guidelines for safe recreational water environments, volume 2: swimming pools and similar environments (2006). The update plans to contain a chapter on the health benefits of immersion and therapeutic aquatic exercise in pools and spas.
Methods: In order to write a narrative review, searches in PubMed, Embase, Cinahl, Sportdiscus, PEDro and Cochrane central were conducted in May-October 2012.
The group of 8 experts focused on persons with a medical diagnosis as described in the ICD-10 and their resultants effects (as described in the ICF)., but has been restricted to diseases, which have been presented in aquatic research literature sufficiently.
Keywords about the interventions included “Hydrotherapy Or Water exercise Or Aquatic exercise Or Aquatic therapy Or Water rehabilitation Or Aquatic physical therapy Or Aquatic rehabilitation Or Aquatics”, as well as the appropriate keywords for the pathologies.
References were restricted to Level 1-3 evidence papers as defined by the Oxford Centre of Evidence Based Medicine.
Results: In summary, across musculoskeletal disorders (low back and neck pain, osteoarthritis, joint replacement, fibromyalgia, rheumatoid arthritis and ankylosing spondylitis), both active and passive interventions have low to high clinical effects on outcome parameters at the various ICF levels and on quality of life. Adverse effects have not been reported.
The evidence across neurological diseases (stroke, Parkinson disease, multiple sclerosis) is limited in comparison to musculoskeletal ones and mainly focuses on balance, gait, functional independence and quality of life. Moderate to high clinical effects have been found for these parameters. Effects on fatigue are conflicting. No adverse effects have been reported.
Discussion: This narrative review didn’t allow a comparison with other interventions and only focuses on the health benefits of aquatic interventions themselves. Description of intervention and the applied doses were often insufficient, therefore the exact parameters of the intervention tactics still have to be established. Many studies were underpowered and would need follow-up studies that are more rigorous in order to establish the health benefits with higher effects sizes and statistical significance.
Conclusion: The average - level 2 - evidence of therapeutic aquatic exercise and balneotherapy in neuro-musculoskeletal diseases have moderate to high beneficial effects on variables at the levels if function (primarily pain) and activity of the ICF, as well as on quality of life. These benefits seem to comparable across the diseases.
Objective
To summarize evidence on the effects of aquatic therapy on mobility in individuals with neurological diseases.
Data sources
MEDLINE, EMBASE, PsycInfo, CENTRAL, CINAHL, SPORTDiscus, PEDro, PsycBITE and OT Seeker were searched from inception to 15 September 2014. Hand-searching of reference lists was performed in the selected studies.
Review methods
The search included randomized controlled trials and quasi-experimental studies that investigated the use of aquatic therapy and its effect on mobility of adults with neurological diseases. One reviewer screened titles and abstracts of retrieved studies from the search strategy. Two reviewers independently examined the full texts and conducted the study selection, data extraction and quality assessment. A narrative synthesis of data was applied to summarize information from included studies. The Downs and Black Scale was used to assess methodological quality.
Results
A total of 116 articles were obtained for full text eligibility. Twenty studies met the specified inclusion criteria: four Randomized Controlled Trials (RCTs), four non-randomized studies and 12 before-and-after tests. Two RCTs (30 patients with stroke in the aquatic therapy groups), three non-randomized studies and three before-and-after studies showed “fair” evidence that aquatic therapy increases dynamic balance in participants with some neurological disorders. One RCT (seven patients with stroke in the aquatic therapy group) and two before-and-after tests (20 patients with multiple sclerosis) demonstrated “fair” evidence on improvement of gait speed after aquatic therapy.
Conclusion
Our synthesis showed “fair” evidence supporting the use of aquatic therapy to improve dynamic balance and gait speed in adults with certain neurological conditions.
Whole body vibration (WBV) is a contemporary treatment modality that holds promise as an exercise training method in health–compromised individuals. A growing number of studies on individuals with Parkinson Disease are examining whether WBV improves balance and functional mobility. However, interpreting WBV studies is challenging since there is variability in the manner in which WBV intervention is conducted. The primary goal of this systematic review was to investigate the effect of WBV on improving mobility and balance as measured by a
battery of clinical tests, in patients with Parkinson disease. Studies based on WBV parameters were characterized and a systematic search of peer-reviewed literature in five major databases was conducted. Randomized-controlled trials investigating the effects of WBV in patients with a Parkinson diagnosis and no cognitive impairment were included. A total of six publications met the inclusion criteria. Overall, studies demonstrated mixed results in favor of WBV for improving balance or mobility. The majority of studies seem to suggest a favorable benefit following WBV for mobility and balance, but not when compared to other active
intervention or placebo. There was variability in the manner in which WBV intervention was applied. Variations among the six studies included: duration of intervention and rest, follow-up period, type of control groups, frequency of vibration, number of treatment sessions and sex distribution of subjects. Future research
is needed to investigate the effects of different types of equipment and treatment dosage in individuals with Parkinson disease.
Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease that affects mainly the axial skeleton and causes significant pain and disability. Aquatic (water-based) exercise may have a beneficial effect in various musculoskeletal conditions. The aim of this study was to compare the effectiveness of aquatic exercise interventions with land-based exercises (home-based exercise) in the treatment of AS. Patients with AS were randomly assigned to receive either home-based exercise or aquatic exercise treatment protocol. Home-based exercise program was demonstrated by a physiotherapist on one occasion and then, exercise manual booklet was given to all patients in this group. Aquatic exercise program consisted of 20 sessions, 5× per week for 4 weeks in a swimming pool at 32–33 °C. All the patients in both groups were assessed for pain, spinal mobility, disease activity, disability, and quality of life. Evaluations were performed before treatment (week 0) and after treatment (week 4 and week 12). The baseline and mean values of the percentage changes calculated for both groups were compared using independent sample t test. Paired t test was used for comparison of pre- and posttreatment values within groups. A total of 69 patients with AS were included in this study. We observed significant improvements for all parameters [pain score (VAS) visual analog scale, lumbar flexion/extension, modified Schober test, chest expansion, bath AS functional index, bath AS metrology index, bath AS disease activity index, and short form-36 (SF-36)] in both groups after treatment at week 4 and week 12 (p
To investigate the relationships between inflammation, nocturnal back pain and fatigue in ankylosing spondylitis (AS) and the impact of 12 weeks' etanercept treatment versus sulfasalazine or placebo.
Data were combined from four clinical trials for patients with AS who received at least one dose of etanercept, sulfasalazine or placebo and had at least one postbaseline assessment value. Linear regression was performed (controlling for site, protocol and demographics), to explore the relationship between inflammation (C-reactive protein [CRP]), nocturnal back pain (visual analog scale [VAS] 0-100 mm) and fatigue (VAS 0-100 mm Bath AS Disease Activity Index fatigue item).
Out of 1283 patients (etanercept, n = 867; sulfasalazine, n = 187; placebo, n = 229), improvement in nocturnal back pain was a significant predictor of improvement in fatigue. Significant correlations were found between nocturnal back pain and fatigue, but not CRP levels. Etanercept provided significantly greater pain/fatigue improvement than sulfasalazine or placebo. Improvements in nocturnal back pain and fatigue had weak relationships with improvement in inflammation (CRP level).
AS patients treated with etanercept demonstrated superior improvement in nocturnal back pain and fatigue versus sulfasalazine or placebo. Decrease in nocturnal back pain can improve fatigue. Assessing treatment response using CRP levels alone may be misleading without also examining patient-reported outcomes such as back pain and fatigue.
Background
Physiotherapists as primary health care practitioners are well placed in promoting physically active lifestyles, but their role and practice towards its promotion among patients in Nigeria has not been fully investigated. This study was therefore aimed at determining the knowledge, attitude and practice of Nigerian physiotherapists towards promotion of non-treatment physical activity among patients.
Methods
Three hundred and eight practicing physiotherapists from various public and private hospitals in 14 states of Nigeria completed an adopted 20-item questionnaire, which collected information on physical activity promotion in physiotherapy practice.
Result
Respondents with good knowledge and attitude towards physical activity promotion in patient management were 196(63.6%) and 292(94.8%) respectively. Only 111 (36%) of the respondents counselled more than 10 patients in the past one month on the benefits of adopting a more physically active lifestyle. Chi-square analysis showed a significant association between low practice of physical activity promotion in patient management with inadequate consultation time (ℵ2 = 3.36, p = 0.043), years of working experience of physiotherapists (ℵ2 = 11.37, p =0.023) and relative physical activity levels of physiotherapists (ℵ2 = 11.82, p = 0.037). The need for Physical activity recommendation guideline was supported by 287 (97%) respondents.
Conclusion
Nigerian physiotherapists have good knowledge and attitude towards promotion of physically active lifestyle in their patients but do not counsel many of them, due to insufficient consultation time. Integrating brief counselling into usual treatment sessions is perceived as the most feasible form of physical activity promotion in patient management.
The main objective of the study was to examine the self reported health status in patients with ankylosing spondylitis (AS) compared with the general population and the secondary objective (in the AS group) was to study the association between health status, demographic parameters, and specific disease instruments in AS.
A cross sectional study of 100 AS patients recruited between 2006 and 2009 at the Department of Rheumatology. Health status was assessed by using the SF-36 health questionnaire in patients with AS. Demographic characteristics and disease-specific instruments were also examined by the questionnaire. A sample of 112 healthy individuals was also surveyed using the SF-36 health questionnaire.
This study showed a great impairment in the quality of life of patients with AS involving all scales. All male patients with AS reported significantly impaired health-related quality of life on all items of the SF-36 compared with the general population whereas female patients reported poorer health on three items only, namely physical functioning, general health and bodily pain. Mental health was mostly affected than physical role. The physical role was significantly higher in patients with high education level than in patients with low education level (p=0.01). Physical functioning was better in employed patients. All scales of SF-36 were correlated with BASFI, BASDAI and BAS-G. Only physical functioning and general health were correlated with BASMI.
Impairment in the quality of life can be significant when suffering from AS, affecting mental health more than physical health. Among disease parameters, functional impairment, disease activity, mobility limitation, and spinal pain were the most associated factors resulting to the deterioration of quality of life.
Epidemiologic studies on spondyloarttritides (SpA) encompass mode descriptions on disease appearance within the population, levels of disease frequency: incidence and prevalence, comorbidity, mortality, geographical distribution and clinical features, as well as risk factors for disease appearance. Ethnical, genetic, environmental performers are linked with appearance and expression of the disease. Clear distinction among SpA subgroups, especially in their early phases might not always be possible due to clinical picture overlapping, thus within the initial phase of the disease, the diagnosis of certain SpA diseases might be underestimated. SpA prevalence with various different populations varies between 0.21% up to 1.9% worldwide, and it varies between 1% up to 2% within Europe. With Eskimo population on Alaska and population of Siberia, prevalence rates appear to be from 2% up to 3.4%. SpA are rare with African and Japanese populations. Differences between ethnical groups might be explained by different criteria for selection of a target population, but with differences in HLA-B27 frequency as well. HLA-B27 subtypes distribution plays significant impact on AS prevalence with different race/ethnical groups. Challenges that aggravate the exact evaluation of the SpA diseases with the population, include comprise heterogeneity of population, lack of application feasibility of valid criteria (like testing on HLA-B27 antigen, pelvis radiography and MR), but also transition issue of certain SpA symptoms (eg. peripheral arthritis, enthesitis). Spondyloarthtritis (SpA) present a serious health, social and economical problem everywhere in the world. Uniform data for all populations are significant for making a proper picture on this disease group arduousness, and for epidemiological studies such data, because of their mutual overlapping, should be united within one single group.
Aging compromises the ability of the central nervous system to maintain body balance and reduces the capacity for adaptive reactions. To prevent falls, the reception conditions for sensory information need to be improved.
To evaluate the impact of a structured aquatic and a non-aquatic exercise program for lower-limb muscle endurance on the static and dynamic balance of elderly people.
This was a prospective randomized clinical study in which the variables were assessed before and after the training program. Thirty-six elderly people were evaluated using four tests: the Berg Balance Scale, Dynamic Gait Index, gait speed and tandem gait. The participants were randomized into three groups: aquatic exercise group, non-aquatic exercise group and control group. The exercise groups underwent a program for lower-limb muscle endurance that consisted of 40-minute sessions twice a week for six weeks. The participants were reevaluated after six weeks. The data were analyzed statistically using the univariate ANOVA test for comparisons between the groups before and after the intervention.
The program for lower-limb muscle endurance significantly increased balance (p<0.05) in the evaluation tests after the training program.
The muscle endurance program provided a significant improvement in static and dynamic balance among community-dwelling elderly people. It was also possible to infer that this improvement occurred regardless of the environment, i.e. aquatic or non-aquatic. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under the number ACTRN 12609000780257.
The field of spondyloarthritis (SpA) has experienced major progress in the last decade, especially with regard to new treatments, earlier diagnosis, imaging technology and a better definition of outcome parameters for clinical trials. In the present work, the Assessment in SpondyloArthritis international Society (ASAS) provides a comprehensive handbook on the most relevant aspects for the assessments of spondyloarthritis, covering classification criteria, MRI and x rays for sacroiliac joints and the spine, a complete set of all measurements relevant for clinical trials and international recommendations for the management of SpA. The handbook focuses at this time on axial SpA, with ankylosing spondylitis (AS) being the prototype disease, for which recent progress has been faster than in peripheral SpA. The target audience includes rheumatologists, trial methodologists and any doctor and/or medical student interested in SpA. The focus of this handbook is on practicality, with many examples of MRI and x ray images, which will help to standardise not only patient care but also the design of clinical studies.
To examine the subjective health in patients with ankylosing spondylitis (AS) compared with the general population, and to explore the associations between health status and age, sex of the patients, and educational level in AS.
Health status was assessed with a generic instrument (SF-36) in 314 patients with AS and in 2323 people from the general population. Subgroup analyses were performed according to age, sex, and educational level. Standard difference scores (s-scores) were calculated to ensure the clinical meaningfulness of the norm based comparisons.
Both men and women with AS reported significantly impaired health on all scales of the SF-36. Women reported significantly worse health on physical health domains. However, when calculating differences from the general population, numerically larger s-scores were found for men (except for physical role and vitality). The relative impact of AS seems to diminish with increasing age. In AS, better health was significantly associated with higher education across all scales. Deviations from the general population on the non-physical health aspects were especially pronounced in patients with low education.
All key dimensions of health are affected by AS. The physical aspects seem to be most severely affected, but in the less educated group of patients, the disease impact on the mental health aspects was also considerable. Evaluation and management planning should take the complexity of AS into consideration. The focus on physical function should be maintained, and additional attention should be paid to the mental and social consequences of AS.
Spa therapy is commonly used in the treatment of daily chronic diseases practice, but its benefits are still the subjects of discussion. This study investigates possible effects of a combined spa and physical therapy program on pain and hemodynamic responses in various chronic diseases.
The pain intensity and hemodynamic responses of 472 patients involved in a spa and physical therapy program were studied retrospectively. Assessment criteria were pain [Visual Analog Scale (VAS)] and hemodynamic responses (heart rate, blood pressure, respiratory rate). Assessments took place before, immediately after treatment, and after completion of the spa program (before discharge).
The patients with ankle arthrosis, fibromyalgia and cervical disc herniation reported the highest VAS score before treatment program (P < 0.05). After the therapy program, VAS scores were seen to decrease compared to before treatment (P < 0.05). The patients with osteoarthritis of the hip (1.3+/-1.2) and soft tissue rheumatism (1.3+/-1.2) had the lowest VAS score before discharge compared to patients with other pathologies (P < 0.05). No statistically significant differences were detected between both sexes in terms of pain improvement (P > 0.05). On discharge, all hemodynamic responses decreased significantly compared to before and immediately after initiation of the therapy program (P < 0.01).
To decrease pain and high blood pressure without hemodynamic risk, a combined of spa and physical therapy program may help to decrease pain and improve hemodynamic response in patients with irreversible pathologies.
Hydrotherapy is highly valued by people with rheumatoid arthritis yet few studies have compared the benefits of exercises in heated water against exercises on land. In particular, data on quality of life is rarely reported. This is especially important because patients treated with hydrotherapy often report an enhanced sense of well-being. We report a randomised controlled trial in which we compared the effects of hydrotherapy with exercises on land on overall response to treatment, physical function and quality of life in patients with rheumatoid arthritis.
One hundred and fifteen patients with RA were randomised to receive a weekly 30-minute session of hydrotherapy or similar exercises on land for 6 weeks. Our primary outcome was a self-rated global impression of change--a measure of treatment effect on a 7-point scale ranging from 1(very much worse) to 7 (very much better) assessed immediately on completion of treatment. Secondary outcomes including EuroQol health related quality of life, EuroQol health status valuation, HAQ, 10 metre walk time and pain scores were collected at baseline, after treatment and 3 months later. Binary outcomes were analysed by Fisher's exact test and continuous variables by Wilcoxon or Mann-Whitney tests.
Baseline characteristics of the two groups were comparable. Significantly more patients treated with hydrotherapy (40/46, 87%) were much better or very much better than the patients treated with land exercise (19/40, 47.5%), p < 0.001 Fisher's exact test. Eleven patients allocated land exercise failed to complete treatment compared with 4 patients allocated hydrotherapy (p = 0.09). Sensitivity analyses confirmed an advantage for hydrotherapy if we assumed non-completers would all not have responded (response rates 70% versus 38%; p < 0.001) or if we assumed that non-completers would have had the same response as completers (response rates 82% versus 55% p = 0.002). Ten metre walk time improved after treatment in both cases (median pre-treatment time for both groups combined 10.9 seconds, post-treatment 9.1 s, and 3 months later 9.6 s). There was however no difference between treatment groups. Similarly there were no significant differences between groups in terms of changes to HAQ, EQ-5D utility score, EQ VAS and pain VAS.
Patients with RA treated with hydrotherapy are more likely to report feeling much better or very much better than those treated with land exercises immediately on completion of the treatment programme. This perceived benefit was not reflected by differences between groups in 10-metre walk times, functional scores, quality of life measures and pain scores.
In this study, we compare the health-related quality of life (HRQoL) of patients with moderate-to-severe rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS), and study the effect of treatment with infliximab on the HRQoL of patients with these diseases. Short Form Health Survey-36 (SF-36) data from the placebo-controlled phases of 4 studies of infliximab in patients with inflammatory rheumatic diseases (n = 1990) were evaluated. Data came from the Anti-TNF Trial in Rheumatoid Arthritis with Concomitant Therapy (ATTRACT) (n = 428), the Safety Trial for Rheumatoid Arthritis with REMICADE Therapy (START) (n = 1083), the Ankylosing Spondylitis Study for the Evaluation of Recombinant Infliximab Therapy (ASSERT) (n = 279), and the Infliximab Multinational Psoriatic Arthritis Clinical Trial II (IMPACT II) (n = 200). SF-36 assessments were made at weeks 0, 10, 30, and 54 in ATTRACT, weeks 0, 6, and 22 in START, weeks 0, 12, and 24 in ASSERT, and weeks 0 and 14 in IMPACT II. All patient populations had significantly impaired physical aspects of HRQoL at baseline relative to the general population of the United States, and the magnitude of impairment was similar across the diseases. Mean baseline physical component summary scores were 29 in the RA cohort, 32 in the PsA cohort, and 29 in the AS cohort. In all 3 diseases, patients who received infliximab showed significant improvement in physical component summary scores compared with those who received placebo. The magnitude of the difference of improvement (effect size, 95%CI) between infliximab and placebo groups was similar in the AS (10.1, 9.2-11.0), PsA (8.6, 7.8-9.4), and RA (10.1, 9.2-11.0) cohorts. Patients with RA and those with PsA treated with infliximab also showed greater improvement in the mental component summary score than those in the placebo group with an effect size of 4.6 (4.2-5.1) in RA and 2.7 (2.4-3.1) in PsA. Patients in large randomized controlled studies of infliximab in RA, PsA, and AS had similar impairment in physical aspects of HRQoL at baseline and showed significantly greater improvement in HRQoL after treatment with infliximab.
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, randomized controlled trial, with assessments 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.
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 randomized 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 assessments. 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.
To assess the annual direct, indirect and total societal costs, quality of life (QoL) of AS in a Chinese population in Hong Kong and determine the cost determinants.
A retrospective, non-randomized, cross-sectional study was performed in a cohort of 145 patients with AS in Hong Kong. Participants completed questionnaires on sociodemographics, work status and out-of-pocket expenses. Health resources consumption was recorded by chart review. Functional impairment and disease activity were measured using the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), respectively. Patients' QoL was assessed using the Short Form-36 (SF-36).
The mean age of the patients was 40 yrs with mean disease duration of 10 yrs. The mean BASDAI score was 4.7 and BASFI score was 3.3. Annual total costs averaged USD 9120. Direct costs accounted for 38% of the total costs while indirect costs accounted for 62%. Costs of technical examinations represented the largest proportion of total cost. Patients with AS reported significantly impaired QoL. Functional impairment became the major cost driver of direct costs and total costs.
There is a substantial societal cost related to the treatment of AS in Hong Kong. Functional impairment is the most important cost driver. Treatments that reduce functional impairment may be effective to decrease the costs of AS and improve the patient's QoL, and ease the pressure on the healthcare system.
This first update of the ASAS/EULAR recommendations on the management of ankylosing spondylitis (AS) is based on the original paper, a systematic review of existing recommendations and the literature since 2005 and the discussion and agreement among 21 international experts, 2 patients and 2 physiotherapists in a meeting in February 2010. Each original bullet point was discussed in detail and reworded if necessary. Decisions on new recommendations were made - if necessary after voting. The strength of the recommendations (SOR) was scored on an 11-point numerical rating scale after the meeting by email. These recommendations apply to patients of all ages that fulfill the modified NY criteria for AS, independent of extra-articular manifestations, and they take into account all drug and non-drug interventions related to AS. Four overarching principles were introduced, implying that one bullet has been moved to this section. There are now 11 bullet points including 2 new ones, one related to extra-articular manifestations and one to changes in the disease course. With a mean score of 9.1 (range 8-10) the SOR was generally very good.
Ankylosing spondylitis (AS) is a disease that tends to affect younger individuals, many of whom are in the prime of their lives; therefore, incorporating the most up-to-date evidence into physiotherapy practice is critical. The purpose of this review is to update the most recent evidence related to physiotherapy intervention for AS and highlight the application of the findings to current physiotherapy research and clinical practice.
The results of this review add to the evidence supporting physiotherapy as an intervention for AS. The emphasis continues to be on exercise as the most studied physiotherapy modality, with very few studies examining other physiotherapy modalities. Results of the studies reviewed support the use of exercise, spa therapy, manual therapy and electrotherapeutic modalities. In addition, the results of this review help to understand who might benefit from certain interventions, as well as barriers to management.
A review of recently published articles has resulted in a number of studies that support the body of literature describing physiotherapy as an effective form of intervention for AS. In order to continue to build on the existing research, further examination into physiotherapy modalities, beyond exercise-based intervention, needs to be explored.
The aim of the study was to compare the effects of conventional exercise (CE), swimming and walking on the pulmonary functions, aerobic capacity, quality of life, Bath indexes and psychological symptoms in patients with ankylosing spondylitis (AS).
Forty-five patients were randomised into either swimming (group 1), walking (group 2), CE group (group 3). Patients in Group 1 performed CE and swimming, patients in Group 2 performed CE and walking and patients in Group 3 performed CE only. Exercise sessions were performed three times a week for a period of six weeks. Patients were assessed before and after the rehabilitation program, with respect to, pulmonary function test (forced vital capacity [FVC, mL], forced expiration volume in one second [FEV1, mL], FEV1/FVC (%) and vital capacity [VC, mL]), maximal oxygen uptake (pV.O2), 6-minute walking test (6MWT), Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Metrology Index, Nottingham Health Profile and Beck Depression Inventory.
There were significant increases in pVO2 and 6MWT after treatment in Groups 1 and 2 (P<0.05). FeV1, FVC and VC improved significantly with treatment in all three groups (P<0.05). A statistically significant improvement was observed in energy, emotional reaction and physical mobility sub-scores of NHP in three exercise groups after completion of the exercise program (P<0.05).
Swimming, walking and CE had beneficial effects on the quality of life and pulmonary functions. Aerobic exercises such as swimming and walking in addition to CE increased functional capacities of patients.
To determine the diagnostic utility of different spinal inflammatory lesions assessed by whole-body magnetic resonance imaging (MRI) in patients with ankylosing spondylitis (AS) or with recent-onset inflammatory back pain (IBP) compared with healthy controls.
We scanned 35 consecutive patients with AS fulfilling the modified New York criteria, 25 patients with IBP of <24 months' duration (both groups were age < or =45 years and had a Bath Ankylosing Spondylitis Disease Activity Index score > or =4), and 35 healthy age- and sex-matched volunteers using whole-body MRI STIR sequences of the spine. MRIs were independently assessed in random order by 3 readers blinded to patient identity. Inflammatory spinal lesions were recorded consistent with definitions proposed by the Canada/Denmark International MRI Working Group: vertebral corner inflammatory lesions (CIL) and noncorner inflammatory lesions in central sagittal slices and lateral inflammatory lesions (LIL) in lateral slices. Concordantly scored lesions for the 3 possible reader pairs were used in the analysis of sensitivity, specificity, likelihood ratios (LRs), and areas under the curve for the entire spine and by spinal segment.
Diagnostic utility was optimal when > or =2 CIL were recorded (for patients with AS, values for sensitivity, specificity, and positive LR were 69%, 94%, and 12, respectively, and for patients with IBP were 32%, 96%, and 8, respectively). LIL had high specificity (97%) but low sensitivity (31%). Nine controls had > or =1 CIL, but only 2 controls had >2 CIL.
Diagnostic utility of STIR MRI for AS is optimal when > or =2 CIL are present. A single CIL can be found in up to 26% of healthy individuals.
Aquatic therapy is justifiably a rapidly expanding, beneficial form of patient treatment. The goals established at the initial and subsequent evaluations usually are met as quickly and as sensibly as possible. Understanding the theory of water techniques is essential in implementing an aquatic therapy program. The success of the program, however, will always depend on the pleasure and benefits achieved by the patients. Remember, rheumatic patients most likely will need to modify their previous daily functioning. Patients need to be aware of the long-term ramifications of the disease process and understand how treatment and care may be altered during various stages of exacerbation and remission. Patient education is critical in ensuring individual responsibility for the changes that must be made when not supervised by a professional. Aquatic therapy is a step in molding a positive lifestyle change for the patient. The patient can be encouraged to be fitness oriented and, at the same time, exercise in a manner that is safe, effective, and biomechanically and physiologically sound. The environment, hopefully, also will be conductive to family and social interaction that ultimately encourages the compliance of long-term exercise programs.
The extent of heterogeneity in a meta-analysis partly determines the difficulty in drawing overall conclusions. This extent may be measured by estimating a between-study variance, but interpretation is then specific to a particular treatment effect metric. A test for the existence of heterogeneity exists, but depends on the number of studies in the meta-analysis. We develop measures of the impact of heterogeneity on a meta-analysis, from mathematical criteria, that are independent of the number of studies and the treatment effect metric. We derive and propose three suitable statistics: H is the square root of the chi2 heterogeneity statistic divided by its degrees of freedom; R is the ratio of the standard error of the underlying mean from a random effects meta-analysis to the standard error of a fixed effect meta-analytic estimate, and I2 is a transformation of (H) that describes the proportion of total variation in study estimates that is due to heterogeneity. We discuss interpretation, interval estimates and other properties of these measures and examine them in five example data sets showing different amounts of heterogeneity. We conclude that H and I2, which can usually be calculated for published meta-analyses, are particularly useful summaries of the impact of heterogeneity. One or both should be presented in published meta-analyses in preference to the test for heterogeneity.
Back pain associated with ankylosing spondylitis (AS) is referred to as inflammatory back pain (IBP). The value of the clinical history in differentiating IBP from mechanical low back pain (MLBP) has been investigated in only a few studies. In this exploratory study, we sought to evaluate the individual features of IBP and to compose and compare various combinations of features for use as classification and diagnostic criteria.
We assessed the clinical history of 213 patients (101 with AS and 112 with MLBP) younger than 50 years who had chronic back pain. Single clinical parameters and combinations of parameters were compared between the AS and MLBP patient groups.
Morning stiffness of >30 minutes' duration, age at onset of back pain, no improvement in back pain with rest, awakening because of back pain during the second half of the night only, alternating buttock pain, and time period of the onset of back pain were identified as independent contributors to IBP. Importantly, none of the single parameters sufficiently differentiated AS from MLBP. In contrast, several sets of combined parameters proved to be well balanced between sensitivity and specificity. Among these, a new candidate set of criteria for IBP, which consisted of morning stiffness of >30 minutes' duration, improvement in back pain with exercise but not with rest, awakening because of back pain during the second half of the night only, and alternating buttock pain, yielded a sensitivity of 70.3% and a specificity of 81.2% if at least 2 of these 4 parameters were fulfilled (positive likelihood ratio 3.7). If at least 3 of the 4 parameters were fulfilled, the positive likelihood ratio increased to 12.4.
A new set of criteria for IBP performed better than previous criteria in AS patients with established disease. A prospective study is needed to validate the diagnostic properties of the new candidate criteria set in patients with early disease.
To compare the effect of balneotherapy on physical activity and quality of life as well as the symptoms of pain and stiffness with exercise alone in ankylosing spondylitis (AS) patients.
A total of 60 patients who had a diagnosis of AS according to the modified New York criteria were included in the study. The patients were randomly assigned to two groups. In Group I (n = 30) the patients received balneotherapy in a therapeutic pool for 30 min once a day for 3 weeks. All patients received instructions on the exercise programme, which they were requested to repeat once a day for 30 min during the study. The patients in this group continued the same exercise programme after the end of the balneotherapy protocol to complete a course of 6 months. In Group II the patients were given the same exercise protocol but did not receive balneotherapy. Patients were evaluated before the start of the study and at 3 weeks and 24 weeks. Evaluation parameters were daily and night pain, morning stiffness, the patient's global evaluation and the physician's global evaluation (according to a scoring system of 1 to 5), the Bath Ankylosing Spondilitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Dougados Functional Index (DFI), tragus-wall distance, chest expansion, modified Shober test (MST), fingertip-fibula head distance, and Nottingham Health Profile (NHP).
Evaluations were completed in 54 patients in the two groups. Comparison of the groups showed significantly superior results for Group I for parameters of BASDAI, NHP total, pain, physical activity, tiredness and sleep score, patient's global evaluation and the physician's global evaluation at 3 weeks, but only for the parameters of patient's global evaluation and MST at 24 weeks.
Balneotherapy has a supplementary effect on improvement in disease activity and functional parameters in AS patients immediately after the treatment period. However, in the light of our medium-term evaluation results, we suggest that further research is needed to assess the role of balneotherapy applied for longer durations in AS patients.
The Patient Acceptable Symptomatic State (PASS) is the highest level of symptoms beyond which patients consider themselves well. It provides clinically meaningful information to interpret results from scales or questionnaires. Our goal was to determine the PASS in main outcome criteria when assessing patients with ankylosing spondylitis (AS) and to evaluate whether the PASS is stable over time.
We used data from a randomized controlled trial of 330 patients with AS. The PASS was estimated at weeks 2, 6, and 12 for the following patient-reported outcomes: global pain (measured on a visual analog scale [VAS]), nocturnal pain (VAS), patient's global assessment of disease activity (VAS), disease activity (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), and functional impairment (Bath Ankylosing Spondylitis Functional Index [BASFI]). We used an anchoring method based on patients answering yes or no to, "Is your current condition satisfactory, when you take your general functioning and your current pain into consideration?" The PASS was defined as the 75th percentile of the score for patients who considered their state satisfactory. All patients were considered together in the analysis.
The values (95% confidence interval) of PASS were 33.5 (29.2-38.6) for pain, 28.0 (23.1-34.1) for night pain, 35.7 (31.3-41.1) for patient's global disease assessment, 31.4 (26.9-37.0) for BASFI, and 34.5 (30.9-38.9) for BASDAI. The PASS estimates were stable over time for all criteria during followup.
This study provides cutoff values for the PASS for the main outcome measures in AS and shows that PASS values are stable over time.
We compared the short-term effects of Stanger bath therapy and conventional exercises on spinal mobility, functional capacity, disease activity, and quality of life with conventional exercise alone in ankylosing spondylitis (AS) patients. A total of 58 patients with a diagnosis of AS according to the modified New York criteria were included in this randomized prospective study. The patients were divided into two groups. Patients in group I (n = 30) received Stanger bath therapy and an exercise program. Group II (n = 28) patients were given the same exercise program but did not receive Stanger bath therapy. Patients were evaluated before (T0) and at the end of the treatments (T1). Evaluation parameters were the Bath AS Metrology Index (BASMI), Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), and AS Quality of Life (ASQoL). In both patient groups, a significant improvement was determined in all clinical outcomes between T0 and T1 except for BASMI in group II. Comparison of the groups showed significantly superior results in group I parameters of BASMI, BASFI, BASDAI, and ASQoL. Stanger bath therapy showed beneficial effects in spinal mobility, functional capacity, disease activity, and quality of life in AS patients immediately after the treatment period. We recommend Stanger bath therapy for AS patients in the short-term, but further research is imperative to assess whether improvement is sustained over a long-term follow-up.
Aquatic exercise training for fibromyalgia
- J Bonet
- H Marriott
- O Hassan
The preferred reporting items for systematic reviews and meta-analyses checklist
- J Picot
- D Hartwell
- P Harris
- D Mendes
- A J Clegg
- A Takeda
Cochrane handbook for systematic reviews of interventions. Version 5.1.0. Cochrane Database of Systematic Reviews
- T Higgins Jp
- S Green
Development and design of a multilevel program to improve the application of guidelines by physiotherapists
- P D R A B Oostendorp