Abstract
This study aimed to evaluate the safety and effectiveness of non-pharmacological interventions supervised by a physiotherapist in patients with Ankylosing Spondylitis, PROSPERO Protocol number CRD42020209453. Five databases (PubMed, PEDro, Scopus, Web of Science Core, and EMBASE) and reference lists with relevant articles were searched. Randomised controlled trials (RCTs) on the effectiveness of non-pharmacological interventions supervised by a physiotherapist were compared with usual care or home-based exercise programmes. Two investigators independently screened eligible studies. A total of 12 RCTs satisfied eligible criteria. The risk of bias ranged between medium and high. The meta-analysis results indicated that between supervised physiotherapy and usual care, the former was significantly associated with improvement in disease activity (standardised mean difference = −0.37, 95% CI, −0.64; −0.11; p < 0.001, I2 = 71.25%, n = 629), and functional capacity (standardised mean difference = −0.36, 95% CI, −0.61; −0.12, p < 0.05; n = 629). No statistically significant differences emerged when interventions were compared with home-based exercise programmes. Supervised physiotherapy is more effective than usual care in improving disease activity, functional capacity, and pain in patients with ankylosing spondylitis. No significant improvements emerged when supervised physiotherapy and home-based exercise programmes were compared. Further investigation and RCTs with larger samples are needed.
Highlights
Ankylosing spondylitis (AS) is a painful and progressive chronic inflammation of the axial skeleton that mainly affects the spine and sacroiliac joints [1]
This paper aimed to evaluate the beneficial effects of non-pharmacological interventions supervised by a physiotherapist in reducing AS symptoms
Our work demonstrated an overall positive impact of supervised physiotherapy on disease activity and functional limitation compared to usual care
Summary
Ankylosing spondylitis (AS) is a painful and progressive chronic inflammation of the axial skeleton that mainly affects the spine and sacroiliac joints [1]. Because of the fusion of some small bones, the spine can become less flexible and result in a hunchedforward posture [2]. Chronic pain, functional disabilities, and resource consumption are associated with ankylosing spondylitis. The human leukocyte antigen HLA-B27 has been suggested as a key element in the pathogenesis of AS [8]. AS prevalence in people with positive (HLA)-B27 is approximately 5–6% [9]. Genetic studies have demonstrated that HLA-B27 contributes to ~20.1% of AS heritability [10]. The main clinical manifestations of AS are back pain and progressive spinal rigidity, as well as inflammation of the hips, shoulders, peripheral joints, and fingers/toes. Inflammatory skin conditions, inflammatory bowel disease, enthesitis, and anterior uveitis can be present [15]
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