Continuation of group physical therapy is necessary in ankylosing spondylitis: results of a randomized controlled trial

Abstract

Purpose: Group physical therapy in patients with ankylosing spondylitis was studied to determine whether beneficial effects persisted after cessation of the intervention.

Methods: After a 9-month period of supervised group physical therapy, 68 patients were randomized for another 9 months to unsupervised daily exercises at home (discontinuation group) or continuation of weekly sessions of supervised group physical therapy (continuation group). Endpoints were spinal mobility (thoraco-lumbar flexion and extension, chest expansion, cervical rotation), fitness (maximum work capacity), functioning (Sickness Impact Profile (SIP), Health Assessment Questionnaire for the Spondylarthropathies [HAQ-S], Functional Index [FI]), and patient's global health assessment on a visual analogue scale.

Results: Time for exercises at home was significantly higher in the continuation than in the discontinuation group (mean duration 1.9 versus 1.2 hr per week, P < 0.05). The continuation group improved in global health (mean improvement 1.6; 32%) and in SIP score. Scores for thoraco-lumbar mobility and HAQ-S did not change very much, whereas chest expansion, cervical rotation, fitness, and FI deteriorated. The average attendance for group therapy sessions was 62%. The discontinuation group improved only marginally (0.2; 4%) in global health, whereas all other endpoints decreased. Only for global health and HAQ-S were the differences statistically significant in favor of the continuation group.

Conclusions: Global health and functioning are sustained or even improved further if group physical therapy is continued. Spinal mobility decreased slightly in both groups.