Twelve-month follow-up of rehabilitation treatment forthe management of patients with ankylosing spondylitisin anti-TNF treatment. A randomized controlled trial

Introduction. Management ankylosing spondylitis (AS) requires a combined pharmacological and non-pharmacological therapy. The aim of this study was to assess the long term effects on pain, spine mobility, physical function outcome of the rehabilitation program. Materials and methods. Thirty-eight outpatients (8 women and 30 men, mean age 47.5±10.6 years) with clinically stabilized AS, in treatment with a standard dose of TNF drugs for at least 9 months, were consecutively enrolled into the study and randomly recruited to rehabilitation (n=18; Rehabilitation Group, RG) or no rehabilitation treatment (n=20; Control Group, CG). Rehabilitation treatment included 2 educational meetings and 12 exercise sessions (60 min. session, 2 times/week), including exercises for spine/hip joint flexibility, stretching, chest and breathing expansion. The patients were taught the programmed exercises and encouraged to perform them at home at least three times per week. Outcome assessment after rehabilitation treatment and 12-months follow-up included: spinal pain intensity by the Visuo-Analogue Scale, Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Disease Activity Index, chest expansion, active range of motion of cervical and lumbar spine measured by a pocket goniometer (IncliMed®). Results. The 2 groups were comparable in demographic characteristics and no significative differences were found in clinical evaluations at baseline. Intragroup comparison after the rehabilitation treatment (after 2 moths from the start) showed that the RG significantly improved (p ≤ 0.050) in pain, functional and spine mobility, compared to CG, and the results were maintained to check at 12-month follow-up. Conclusion. Our results show that the combination of an intensive group exercise and an educational-behavioural program can provide promising results in the long-term functional and mobility outcomes for the management of patients with clinically stabilized SA in treatment with TNF.