Do physical therapy modalities have additional benefit over exercise therapy in the management of Ankylosing Spondylitis? A randomized controlled trial

Ülkü Dönmez; Cihat Öztürk; Ece Çınar; Hayriye Koçanaoğlulları; Sercan Gücenmez; Simin Hepgüler

doi:10.19161/etd.1037447

TR EN

Ankilozan spondilit tedavisinde fizik tedavi yöntemlerinin egzersize ek olarak olumlu etkileri var mıdır? Randomize kontrollü çalışma

Öz

Amaç: Bu çalışmanın amacı; AS hastalarında global postural reedukasyon (GPR) programı ve radar (mikrodalga) egzersizleri ve radar tedavisinin ağrı, hastalık aktivitesi ve fonksiyonel durum üzerine olan etkisinin araştırılmasıdır. Gereç ve yöntem: 77 AS tanılı hasta çalışmaya dâhil edilmiştir. 1.gruba (n:25) 3 hafta boyunca haftada 5 gün, GPR egzersizleri verilmiştir. 2.gruptaki hastalara (n:26) aynı egzersiz programına ek olarak egzersiz öncesi lomber paraspinal kaslar üzerine 20 dakika radar tedavisi uygulandı. 3.grup ise kontrol grubu hastalardı. Tüm hastalar tedavi öncesi, tedavi sonrası 3.hafta, 3.ay ve 6.ayda değerlendirildi. Bulgular: Grup içi değerlendirmede; egzersiz grubunda tedavi öncesine göre tedavi sonrası 6.ayda tüm değerlendirme parametrelerinde istatistiksel anlamlı iyileşme olduğu gözlendi (p<0,05). İkinci grupta ise tedavi öncesine göre tedavi sonrası 6.ayda gündüz ağrısı dışında tüm parametrelerde olumlu yönde gelişme olduğu saptandı (p<0,05). Kontrol grubunda da tedavi öncesine göre tedavi sonrası 6.ayda BASMI, BASDAI ve Beck depresyon skorlarında anlamlı iyileşme saptandı (p<0,05). Gruplar arası karşılaştırmada; tedavi sonrası 6.ayda tüm parametrelerde istatistiksel anlamlı fark saptandı (p<0,05).Birinci ve ikinci gruplar yani egzersiz programı alan gruplarda, kontrol grubuna kıyasla BASMI, BASFI, BASDAI ve Beck depresyon envanterindeki iyileşme anlamlı olarak daha iyi saptanmıştır (p<0,05). Sonuç: AS hastalarında verilen GPR yönteminin hastalık aktivitesi, yaşam kalitesi, ağrı ve depresyon üzerine olumlu etkisi olduğu görüldü. Ancak bu çalışmada egzersiz öncesi ısıtıcı etkisinden yaralanılmak üzere verilen radar tedavisinin bu gelişmelere ek katkı sağlamadığı gözlendi.

Anahtar Kelimeler

Do physical therapy modalities have additional benefit over exercise therapy in the management of Ankylosing Spondylitis? A randomized controlled trial

Abstract

Aim: The aim of this study was to evaluate the effectiveness of microwave therapy and global postural reeducation (GPR) exercises on disease activity, pain, quality of life and functional status in patients with ankylosing spondylitis (AS). Materials and Methods: 77 patients diagnosed with AS were included in the study. First group (n: 25) was treated with global postural reeducation exercises 5 days a week, for 3 weeks. Patients in the second group (n: 26), in addition to GPR, were treated with microwave therapy before each exercise session to warm lumbar paraspinal muscles. Third group (n: 26) consisted of controls. Subjects were evaluated at baseline, on the third week, third and six months. Results: In the first group, improvement in all parameters was found to be significant (p<0.05). Second group exhibited statistical improvement in all outcome measures (p<0.05) except daytime pain (p >0.05). In the control group, improvements in BASMI, BASDAI and Beck depression scores were statistically significant (p<0.05). Intergroup comparisons showed a statistically significant difference among groups in all outcome measures at the sixth month follow-up (p<0.05). First and second groups which received GPR demonstrated greater improvement in BASMI, BASFI, BASDAI and Beck depression inventory scores compared with the control group (p<0.05). Conclusion: Our results show that GPR has beneficial effects on disease activity, quality of life, pain and depression in patients with AS. We could not detect any additional benefits of microwave therapy applied before exercise.

Keywords

Destekleyen Kurum

Yoktur

Kaynakça

Khan MA. Ankylosing spondylitis: clinical features. In: Hochberg M, Silman A, Smolen J, Weinblatt M, Weisman M, eds. Rheumatology. 3rd ed. London, UK: Mosby: A Division of Harcourt Health Sciences Ltd; 2003:1161-81.
Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis suppl 2009; 68 Suppl 2: 1-44.
Ozgocmen S, Akgul O, Altay Z, Altindag O, Baysal O, Calis M, et al. Expert opinion and key recommendations for the physical therapy and rehabilitation of patients with ankylosing spondylitis. Int J Rheum Dis 2012; 15: 229-38.
Souchard PE, Meli O, Sgamma D, Pillastrini P. Rieducazione posturale globale. EMC - Medicina Riabilitativa 2009; 16: 1-10.
Bonetti F, Curti S, Mattioli S, Mugnai R, Vanti C, Violante FS, et al. Effectiveness of a 'Global Postural Reeducation' program for persistent low back pain: a non-randomized controlled trial. BMC Musculoskelet Disord 2010; 11: 285.
Amorim CS, Gracitelli ME, Marques AP, Alves VL. Effectiveness of global postural reeducation compared to segmental exercises on function, pain, and quality of life of patients with scapular dyskinesis associated with neck pain: a preliminary clinical trial. J Manipulative Physiol Ther 2014; 37: 441-7.
Fernandez-de-Las-Penas 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; 84: 407-19.
Sozay S. Seronegatif Spondiloartropatili Hastalara Fiziksel Tip ve Rehabilitasyon Yaklaşımlari. Turkiye Klinikleri J Immunol Rheumatol 2004; 4: 72-6.

van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984; 27: 361-8.
Rudwaleit M, van der Heijde D, Landewe R, Akkoc N, Brandt J, Chou CT, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011; 70: 25-31.
Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, Garrett SL, Calin A. Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index. J Rheumatol 1994; 21: 1694-8.
Akkoc Y, Karatepe AG, Akar S, Kirazli Y, Akkoc N. A Turkish version of the Bath Ankylosing Spondylitis Disease Activity Index: reliability and validity. Rheumatol Int 2005; 25: 280-4.
Calin A, Garrett S, Whitelock H, Kennedy LG, O'Hea J, Mallorie P, et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 1994; 21: 2281-5.
Duruoz MT, Doward L, Turan Y, Cerrahoglu L, Yurtkuran M, Calis M, et al. Translation and validation of the Turkish version of the Ankylosing Spondylitis Quality of Life (ASQOL) questionnaire. Rheumatol Int 2013; 33: 2717-22.
Calin A, Marder A, Becks E, Burns T. Genetic differences between B27 positive patients with ankylosing spondylitis and B27 positive healthy controls. Arthritis Rheum 1983; 26: 1460-4.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561-71.
Dagfinrud H, Kvien TK, Hagen KB. Physiotherapy interventions for ankylosing spondylitis. Cochrane Database Syst Rev 2008; CD002822.
van Tubergen A, Landewe R, van der Heijde D, Hidding A, Wolter N, Asscher M et al. Combined spa-exercise therapy is effective in patients with ankylosing spondylitis: a randomized controlled trial. Arthritis Rheum 2001; 45: 430-8.
Hidding A, van der Linden S, Boers M, Gielen X, de Witte L, Kester A, et al. Is group physical therapy superior to individualized therapy in ankylosing spondylitis? A randomized controlled trial. Arthritis Care Res 1993; 6: 117-25.
Viitanen JV, Lehtinen K, Suni J, Kautiainen H. Fifteen months' follow-up of intensive inpatient physiotherapy and exercise in ankylosing spondylitis. Clin Rheumatol 1995; 14: 413-9.
Kraag G, Stokes B, Groh J, Helewa A, Goldsmith CH. The effects of comprehensive home physiotherapy and supervision on patients with ankylosing spondylitis-an 8-month followup. J Rheumatol 1994; 21: 261-3.
Zochling J, van der Heijde D, Dougados M, Braun J. Current evidence for the management of ankylosing spondylitis: a systematic literature review for the ASAS/EULAR management recommendations in ankylosing spondylitis. Ann Rheum Dis 2006; 65: 423-32.
Moldover JR, Bartels MN, Braddom RL. Cardiac Rehabilitation. Physical medicine and rehabilitation. Philadelphia: W.B. Saunders Company. 2000:665-86.
Jennings F, Oliveira HA, de Souza MC, Cruz Vda G, Natour J. Effects of Aerobic Training in Patients with Ankylosing Spondylitis. J Rheumatol 2015; 42: 2347-53.
Rosu OM, Ancuta C. McKenzie training in patients with early stages of ankylosing spondylitis: results of a 24-week controlled study. Eur J Phys Rehabil Med 2014; 51: 261-8.
Helliwell PS, Abbott CA, Chamberlain MA. A Randomised Trial of Three Different Physiotherapy Regimes in Ankylosing Spondylitis. Physiotherapy 1996; 82: 85-90.
Analay Y, Ozcan E, Karan A, Diracoglu D, Aydin R. The effectiveness of intensive group exercise on patients with ankylosing spondylitis. Clin Rehabil 2003; 17: 631-6.
Santos H, Brophy S, Calin A. Exercise in ankylosing spondylitis: how much is optimum? J Rheumatol 1998; 25: 2156-60.
Sweeney S, Taylor G, Calin A. The effect of a home based exercise intervention package on outcome in ankylosing spondylitis: a randomized controlled trial. J Rheumatol 2002; 29: 763-6.
Liang H, Zhang H, Ji H, Wang C. Effects of home-based exercise intervention on health-related quality of life for patients with ankylosing spondylitis: a meta-analysis. Clin Rheumatol 2015; 34: 1737-44.
Silva EM, Andrade SC, Vilar MJ. Evaluation of the effects of Global Postural Reeducation in patients with ankylosing spondylitis. Rheumatol Int 2012; 32: 2155-63.
Vanti C, Generali A, Ferrari S, Nava T, Tosarelli D, Pillastrini P. General postural rehabilitation in musculoskeletal diseases: scientific evidence and clinical indications. Reumatismo 2007; 59:192-201.
Durmus D, Alayli G, Uzun O, Tander B, Canturk F, Bek Y, et al. Effects of two exercise interventions on pulmonary functions in the patients with ankylosing spondylitis. Joint Bone Spine 2009; 76: 150-5.
Gyurcsik ZN, Andras A, Bodnar N, Szekanecz Z, Szanto S. Improvement in pain intensity, spine stiffness, and mobility during a controlled individualized physiotherapy program in ankylosing spondylitis. Rheumatol Int 2012; 32: 3931-6.
Fernández-de-las-Peñas C, Alonso-Blanco C, Alguacil-Diego IM, Miangolarra-Page JC. One-Year Follow-up of Two Exercise Interventions for the Management of Patients with Ankylosing Spondylitis: A Randomized Controlled Trial. Am J Phys Med Rehab 2006; 85: 559-67.
Pavy S, Brophy S, Calin A. Establishment of the minimum clinically important difference for the bath ankylosing spondylitis indices: a prospective study. J Rheumatol 2005; 32: 80-5.
Bodur H, Ataman S, Rezvani A, Bugdayci DS, Cevik R, Birtane M, et al. Quality of life and related variables in patients with ankylosing spondylitis. Qual Life Res 2011; 20: 543-9.
Aytekin E, Caglar NS, Ozgonenel L, Tutun S, Demiryontar DY, Demir SE. Home-based exercise therapy in patients with ankylosing spondylitis: effects on pain, mobility, disease activity, quality of life, and respiratory functions. Clin Rheumatol 2012; 31: 91-7.
Yigit S, Sahin Z, Demir SE, Aytac DH. Home-based exercise therapy in ankylosing spondylitis: short-term prospective study in patients receiving tumor necrosis factor alpha inhibitors. Rheumatol Int 2013; 33: 71-7.
Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain 2004; 8: 283-91.
Ciprian L, Lo Nigro A, Rizzo M, Gava A, Ramonda R, Punzi L, et al. The effects of combined spa therapy and rehabilitation on patients with ankylosing spondylitis being treated with TNF inhibitors. Rheumatol Int 2013; 33: 241-5.
Altan L, Bingol U, Aslan M, Yurtkuran M. The effect of balneotherapy on patients with ankylosing spondylitis. Scand J Rheumatol 2006; 35: 283-9.
Tishler M, Brostovski Y, Yaron M. Effect of spa therapy in Tiberias on patients with ankylosing spondylitis. Clin Rheumatol 1995; 14: 21-5.
ENGİNAR, AU; UĞURLU, H. Effectiveness of Physical Therapy In Ankylosing Spondylitis: A Randomized Controlled Study. Mustafa Kemal Üniversitesi Tıp Dergisi, 2021 11.42: 44-50.
Sari H, Cakmak B, Can G. Efficacy of Physical Therapy Agents on Quality of Life and Emotional Status in Ankylosing Spondylitis. Turk J Phys Med Rehab 2003; 49: 8-12.

Ayrıntılar

Birincil Dil

İngilizce

Konular

Sağlık Kurumları Yönetimi

Bölüm

Araştırma Makalesi

Yazarlar

Ülkü Dönmez
0000-0002-0007-1517
Türkiye

Cihat Öztürk
0000-0002-7311-3829
Türkiye

Ece Çınar ^*
0000-0002-9710-1582
Türkiye

Hayriye Koçanaoğlulları
0000-0002-5545-1023
Türkiye

Sercan Gücenmez
0000-0001-7785-4061
Türkiye

Simin Hepgüler
0000-0001-9419-1618
Türkiye

Yayımlanma Tarihi

22 Aralık 2021

Gönderilme Tarihi

2 Mart 2021

Kabul Tarihi

4 Mayıs 2021

Yayımlandığı Sayı

Yıl 2021 Cilt: 60 Sayı: 4

DOI

https://doi.org/10.19161/etd.1037447

IZ

https://izlik.org/JA87TJ86PG

Kaynak Göster

RIS / Bibtex

Vancouver

1.Ülkü Dönmez, Cihat Öztürk, Ece Çınar, Hayriye Koçanaoğlulları, Sercan Gücenmez, Simin Hepgüler. Do physical therapy modalities have additional benefit over exercise therapy in the management of Ankylosing Spondylitis? A randomized controlled trial. ETD. 01 Aralık 2021;60(4):365-74. doi:10.19161/etd.1037447