2-week physical therapy program shows benefits for axSpA patients

Findings demonstrate for 1st time that exercise can improve spinal mobility

Patricia Inacio PhD avatar

by Patricia Inacio PhD |

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A person is seen doing stretching exercises on a yoga mat.

A two-week tailored physical therapy program — comprising physiotherapy, occupational therapy, and cognitive behavioral therapy — led to significant improvements in spinal mobility and function among people with axial spondyloarthritis (axSpA), a new study shows.

Improvements were assessed using an electronic device, called Epionics SPINE (ES), which objectively evaluates spinal mobility.

According to the research team, the use of this tool for the first time provided clinical evidence that an exercise-based program can significantly improve spinal mobility.

“This is relevant for clinical studies where more objective parameters are needed to document the success of an intervention,” researchers wrote.

The study, “Impact of daily physical therapy over 2 weeks on spinal mobility including objective electronic measurements and function in patients with axial spondyloarthritis,” was published in the journal Therapeutic Advances in Musculoskeletal Disease.

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Occupational and cognitive work part of physical therapy program

axSpA is a type of chronic arthritis that mainly affects the joints in the spine, pelvis, and chest. It comprises both nonradiographic axSpA (nr-axSpA), in which no damage is visible on an X-ray, and radiographic axSpA (r-axSpA), also known as ankylosing spondylitis, where such damage is visible.

Due to chronic inflammation, people with axSpA have physical limitations, which represent a challenge in activities of daily living.

Physical activity has been shown to ease disease activity and improve spinal mobility and function, and ultimately quality of life, among axSpA patients.

While self-reported measures are commonly used to assess physical function among patients, they may not accurately reflect the individual’s true physical performance level. This has been increasing the use of performance-based tests, the investigators noted.

Now, researchers in Germany sought to assess the effects of a standardized two-week physical therapy program — known as multimodal rheumatologic complex treatment, or MRCT — on several functional and mobility parameters of axSpA patients.

The MRCT included supervised individual and group sessions of physiotherapy, occupational therapy, and cognitive behavioral therapy, which is a type of talk therapy. In addition, the program included 45 minutes of daily gymnastics and 30 minutes of water exercises, as well as muscle strength work. Thermotherapy, which involves the application of heat or cold, and electrotherapy, or treatment using electrical energy, also were part of the program.

Further, the participants also were encouraged to perform daily supervised and individual exercises as part of the physical therapy program to increase cardiovascular fitness and muscle strength.

In total, 80 axSpA patients, nearly three-quarters of them men, underwent MRCT. The participants, who had a mean age of 46.6, were followed at Ruhr-University Bochum.

Among the group, 53 participants had ankylosing spondylitis and 27 had nr-axSpA. Measurements were made before the MRCT program, or at baseline, and right after it ended. All 80 participants completed the physical therapy program.

Disease activity, measured by the Bath AS Disease Activity Index (BASDAI) and the AS Disease Activity Score, was high. Global functioning was moderately impaired, and limitations in physical function and in spinal mobility were noted.

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ES electronic device found effective for assessing mobility

After the physical therapy program, disease activity was lessened — as shown by a significant decrease of the mean BASDAI scores from 5.4 to 4.3. Physical function also was markedly improved, with Bath Ankylosing Spondylitis functional index scores decreasing from a mean of 5.6 to 4.8. Both these scales have scores that range from 0 to 10.

Significant spinal mobility benefits also were seen with the Bath Ankylosing Spondylitis Metrology Index and ES. The Ankylosing Spondylitis Performance-based Improvement, a tool measuring time, pain, and exertion to perform daily activities, and the Short Physical Performance Battery of functional mobility further showed “a very clear improvement” from start to end of the program, the researchers noted.

Regarding axSpA subtypes, the team found that participants with ankylosing spondylitis, but not those with nr-axSpA, experienced significant improvements in ES measures of spinal mobility. Before MRCT, disease activity and physical function were significantly worse in ankylosing spondylitis patients.

Importantly, the effect of this extensive physical activity was confirmed by using the ES as an objective tool to assess spinal mobility. The ES demonstrated for the first time that … spinal mobility can significantly improve related to an exercise intervention.

The use of medications had no impact on any parameter.

Overall, “our study also confirms the positive effect of the 2-week exercise program MRCT on spinal mobility and function,” the researchers wrote.

“Importantly, the effect of this extensive physical activity was confirmed by using the ES as an objective tool to assess spinal mobility. The ES demonstrated for the first time that … spinal mobility can significantly improve related to an exercise intervention,” the team added.

Noted study limitations included the lack of a control group. Such controls, the scientists said, could be patients not performing any exercise or those who only performed physical activity as usual.

“However, patients with axSpA are in general less active and have a decreased spinal mobility compared with healthy controls,” the team noted.

Importantly, the team did note that “patients who do not exceed their daily recommended level of [physical activity] are unlikely to experience a significant improvement in mobility and overall function within 2 weeks.”