SAT0369 Do Pyhsical Therapy Modalities Have Additional Benefit over Exercise Therapy in the Management of Ankylosing Spondylitis? A Randomized Controlled Trial

Background

Ankylosing spondylitis (AS)is a chronic inflammatory disease of the axial skeleton manifested by back pain and progressive stiffness of the spine.

Objectives

The purpose of this clinical trial was to evalute the effects of physical modality as microwave therapy and global postural reeducation program (1) in patients with anklyosing spondylitis (AS) on pain, functional and mobility outcomes.

Methods

Seventy-seven patients diagnosed with AS according to the modified criteria of New york and/or ASAS were allocated to three groups using a random numbers table. All patients received medical therapy which was not changed during the study.The first group was treated with global postural reeducation (GPR) method in which the shortened muscle chains are strecthed and strenghtened. The second group was treated with microwave therapy to heat lumbar paraspinal muscles in additon to GPR. The third group is control group which received only medical therapy The study lasted 3 months.During this period,patients received group sessions for three weeks. Each session was managed by an experienced physiotherapist and lasted for an hour.All patients were evaluted at the entry to the study,on the third week and third month visits by an assessor blinded to the intervention.The assesment parameters were: BASMI, BASDAI, BASFI, SF-36,VAS (for pain intensity) and beck depression questionaire.

Results

Between the groups there was no difference in demographic data. In the intragroup comparison (pre-post scores),the improvement in all outcome measures was statistically significant in GPR group (p<0.05) (except emotional role subscala of SF-36). In GPR plus microwave group showed stastitical improvement in all outcome measures at the third week (except VAS and emotional role subgroup of SF-36). Development in this group carried on to third month (except VAS). Intergroup comparison between the first and second groups which were based on GPR showed a greater improvement than the control group in BASMI, BASFI, BASDAI as well as beck depression and SF-36 scores. Intermalleolar distance and phsycial function subgroup of SF-36 showed a greater improvement in GPR group compared to GPR plus microwave group on third month visit (p<0.05). In the control group, the improvement in BASDAI, beck depression score, modified schober test and intermalleolar distance was stastistically significant at the third month follow-up (p<0.05).Although this outcomes also reached a significant level in control group,they did not show clinical improvement.

Conclusions

Our study shows that GPR method has a beneficial effect on spinal mobility, disease activity, quality of life and depression in patients with AS. It seems that using pysical modality such as microwave before exercise may not have additional benefit however this notion requires further research.

References

Fernández-de-Las-Peñas C, Alonso-Blanco C, Morales-Cabezas M, Miangolarra-Page JC. Two exercise interventions for the management of patients with ankylosing spondylitis: a randomized controlled trial. Am J Phys Med Rehabil. 2005 Jun;84(6):407-19.

Disclosure of Interest

None declared

DOI

10.1136/annrheumdis-2014-eular.4279