[Translation of the 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis and linguistic validation in German-speaking countries with healthcare professionals]

Impact of daily physical therapy over 2 weeks on spinal mobility including objective electronic measurements and function in patients with axial spondyloarthritis

Background

Patients with axial spondyloarthritis (axSpA) are often compromised by impaired function and mobility. The standardized 2-week inpatient program 'multimodal rheumatologic complex treatment' (MRCT) was designed for patients with axSpA. The Epionics SPINE (ES) is an objective tool validated to assess mobility.

Objective

To investigate the impact of MRCT on physical function and mobility including range of motion (RoM) and kinematics (RoK).

Design

Single-center interventional, observational trial.

Methods

Patients with axSpA presenting with high disease activity and impaired physical function were consecutively recruited to undergo MRCT. Assessments performed before (V1) and after (V2) the intervention included Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis functional index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), the ankylosing spondylitis physical performance index (ASPI), the Short Physical Performance Battery (SPPB), and ES measurements.

Results

At baseline, the 80 patients included had: BASDAI 5.5 ± 1.5, BASFI 5.6 ± 2.0, BASMI 4.2 ± 1.8, SPPB 13.8 ± 1.8, and ASPI 37.3 ± 18.1 s. Clinically relevant improvements between V1 versus V2 were noted for BASFI, BASMI, and all other assessments (p < 0.001), and also for ES measures of RoK (all p < 0.003) and RoM (all p < 0.04), while a positive trend was seen for flexion and extension (RoM). There was no significant effect of changes in medication (all p > 0.05).

Conclusion

The 2-weeks MRCT was associated with definite improvements of function and mobility. Importantly, the effect of this extensive physical activity was confirmed by using the ES as an objective tool to assess spinal mobility. The ES demonstrated for the first time that the RoK of spinal mobility can significantly improve related to an exercise intervention.

Trial registration

Ethical Committee: Ruhr-Universität (reference-number: 19-6735-BR).

Patients' awareness towards physical activity in the treatment of axial spondyloarthritis

INTRODUCTION

The course of axial spondyloarthritis (axSpA) is often characterized by impairments in physical function and mobility. Regular physical activity (PA) is a cornerstone of axSpA management. Recent European League Against Rheumatism (EULAR) recommendations for PA have stressed the importance of their implementation.

OBJECTIVE

Cohort study to investigate the awareness on and individual implementation of axSpA patients towards PA.

METHODS

Patients with axSpA and impaired physical function (Bath AS Functional Index [BASFI] score≥2.0) were recruited consecutively. All patients underwent a clinical examination including assessments of disease activity, physical function, mobility and global functioning. Patients also had to fill out structured questionnaires on knowledge, awareness and individual attitudes to PA.

RESULTS

Out of a total of 100 patients enrolled, 96 were included. Most respondents (n=82, 85.4%) were aware that PA has significant health benefits for patients with axSpA. Even though less than half of the patients (n=44, 42.7%) were aware that actual EULAR recommendations do exist, 45 patients (46.9%) did already fulfill these in terms of frequency/week. The majority of patients (n=61, 67.7%) had been informed about the benefits of PA by their physician, and physiotherapy had often been prescribed (n=61, 63.3%). Many patients (n=51, 53.1%) reported to perform individual exercise programs, and some (n=22, 22.9) supervised PA.

CONCLUSION

Even though the majority of axSpA patients are not aware of the recent EULAR recommendations for PA, many understand and agree that PA is beneficial for their health status. Health care providers should concentrate on the patients who are not active and do not know about the benefits of PA.

Assessments zur Erhebung des Fitnesszustandes in Therapiegruppen für Personen mit axialer Spondyloarthritis – eine Machbarkeitsstudie

Hintergrund Die Schweizerische Vereinigung Morbus Bechterew hat die Empfehlungen für körperliche Aktivität der europäischen Rheumaliga in einem Gruppentherapie-Konzept für Personen mit axialer Spondyloarthritis (axSpA) umgesetzt. Dieses Konzept beinhaltet neben der Anleitung zum Training in allen 4 Fitnessdimensionen (Ausdauer, Kraft, Beweglichkeit, Neuromotorik) auch Bewegungsberatung und regelmäßige Fitness-Assessments für die Planung und Dokumentation des individuellen Therapiefortschritts sowie für die Qualitätsevaluation der Therapiegruppen.

Ziel Evaluation der Durchführbarkeit der Fitness-Assessments, indem Physiotherapeut*innen (PT) und Gruppenteilnehmende mit axSpA (TNaxSpA) Akzeptanz, Praktikabilität und Integration beurteilen.

Methode Machbarkeitsstudie in 4 Pilottherapiegruppen. PT führten die Assessmentbatterie, bestehend aus a) Chester Step Test (CST) für die aerobe Fitness, b) modifizierter Rumpfkrafttest für die Rumpfkraft, c) Bath Ankylosing Spondylitis Metrology Index (BASMI) für die Beweglichkeit der Wirbelsäule und d) Single Leg Stance Test (SLST) für das Gleichgewicht, mit den TNaxSpA durch. Anschließend bewerteten die PT und TNaxSpA mittels Fragebögen die Akzeptanz, Durchführbarkeit und Integration. Die Durchführbarkeit der Bewertungen wurde anhand von 3 Stufen (I–III) definiert: Bei einer positiven Bewertung von > 80 % (Stufe I) wurde eine bestimmte Bewertung als geeignet angesehen, bei einer positiven Bewertung von 50–80 % (Stufe II) waren Anpassungen erforderlich, bei einer positiven Bewertung von < 50 % (Stufe III) wurde eine bestimmte Bewertung als nicht geeignet für die Gruppenübungstherapie angesehen und es musste eine neue Auswahl getroffen werden.

Ergebnisse Der BASMI wurde von TNaxSpA und PT mit Stufe I bewertet, es waren keine Anpassungen erforderlich. Der CST, SLST und modifizierte Rumpfkrafttest wurden von TNaxSpA mit Stufe I und von PT mit Stufe II bewertet, notwendige Anpassungen wurden entsprechend definiert.

Schlussfolgerung Aus Sicht der Patient*innen wurde die Durchführbarkeit der Tests in Bezug auf Akzeptanz, Durchführbarkeit und Integration positiv bewertet. Aus Sicht der PT waren einige Personen mit axSpA einsetzbar. Auf diese Weise kann der individuelle Fitnesszustand evaluiert und die Interventionen angepasst werden, sodass die Qualität der Gruppenübungstherapie kontinuierlich evaluiert und gegebenenfalls verbessert werden kann.

[Axial spondyloarthritis : Update on management based on the interdisciplinary S3 guidelines on axial spondyloarthritis including early forms and ankylosing spondylitis]

This review article presents the innovations in the update of the S3 guidelines on axial spondylarthritis. The total of eight new recommendations address the areas of the consideration of differential diagnoses, coordination of comorbidity management, including a vaccination strategy, treatment targets, safety of nonsteroidal anti-inflammatory drugs (NSAID), treatment response to biological disease-modifying antirheumatic drugs (bDMARD) and discontinuation strategies when remission has been achieved. In this article the authors deal particularly with the areas of early diagnosis and referral as well as exercise therapy and drug treatment.