Mat Pilates Exercise Program in Patients With Axial Psoriatic Arthritis

Study Overview
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Brief Summary
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The aim of this study is to investigate the effectiveness of mat Pilates exercises on spinal mobility, spinal muscle endurance, disease activity, fatigue, emotional well-being, physical performance, and overall quality of life in Psoriatic Arthritis (PsA) patients with axial involvement.

Detailed Description
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Psoriasis is a chronic inflammatory skin disease commonly accompanied by joint involvement known as psoriatic arthritis (PsA) [1]. PsA is a subgroup of spondyloarthritis and is characterized by peripheral arthritis, dactylitis, enthesitis and spondylitis. Axial involvement, which occurs in approximately 40% of PsA patients may affect the entire spine, particularly the sacroiliac joint, leading to reduced cervical rotation, lateral flexion and anterior flexion of the spine [2,3]. Exercise interventions in PsA primarily aim to relieve pain, improve mobility and enhance functional capacity [4]. Mat Pilates exercises have been demonstrated as a safe and beneficial intervention in various rheumatic diseases, exhibiting significant improvements in functional status, fatigue, disease activity, pain, and overall quality of life [5-7]. Additionally, Pilates has been reported as effective in maintaining and enhancing spinal mobility [8,9]. However, despite these favorable outcomes, the efficacy of Pilates exercises in PsA remains unexplored. The aim of this study is to investigate the effectiveness of mat pilates exercises in psoriatic arthritis patients with axial involvement.

Official Title
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Investigating the Effects of Mat Pilates Exercises in Patients With Axial Psoriatic Arthritis

Conditions
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Psoriatic Arthritis

Intervention / Treatment
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* Other: Mat Pilates Exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Being classified as PsA according to CASPAR Classification Criteria Being between the ages of 18-65 Volunteering to participate in the study Exclusion Criteria: Any additional systemic disease other than PsA Any other condition that may prevent participation/continuation of the exercise program or completion of the assessments Regular exercise habits (following a structured exercise program at least 3 days a week) Being included in a physiotherapy and rehabilitation program within the last 6 months

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Exercise Group<br>Progressive mat Pilates exercises will be administered to by a physiotherapist in addition to the routine medical treatment. | Other: Mat Pilates Exercises<br>* The intervention will consist of mat Pilates exercises performed twice a week over a duration of 12 weeks, as an adjunct to the routine medical treatment for the patients, under the guidance of a qualified physiotherapist. Each exercise session will last for approximately 60 minutes. The treatment protocol will encompass targeted mobility exercises for the thoracic and lumbar regions, along with strengthening exercises focusing on core activation. The exercise program will be progressed in every four weeks.<br>|
| No Intervention: Control Group<br>Patients in control group will not receive any exercise intervention. They will continue to their routine medical treatment. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Physical Performance | The Ankylosing Spondylitis Performance Index (ASPI) will be used. The ASPI consists of three physical performance tasks: (a) bending forward to pick up six pencils from the floor; (b) putting on socks (average of three repetitions); and (c) getting up from the floor (average of three repetitions). Time to complete a task will be recorded in seconds for each test. | At baseline and 12 weeks later | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Functional Status | Bath Ankylosing Spondylitis Functional Index (BASFI) will be used. This self-reported scale evaluates the degree of functional limitation of patients in activities of daily living. It consists of 10 questions scored between 0-10 (0: easy, 10: impossible). The higher total scores indicate more functional limitation. | At baseline and 12 weeks later | 
| Change in Trunk Muscle Endurance | A static endurance test (lateral bridge test) will be employed to evaluate trunk muscle endurance. During this assessment, patients will be positioned in side-lying. Participants will be required to maintain this lateral bridge position for as long as possible, and the duration until the position cannot be maintained will be recorded in seconds. | At baseline and 12 weeks later | 
| Change in Spinal Mobility | Spinal mobility will be assessed by using the Bath Ankylosing Spondylitis Mobility Index including cervical rotation, modified Schober test (anterior flexion of the spine), maximal intermalleolar distance, lateral flexion of the spine, and tragus-wall distance. Higher scores indicate more limited spinal mobility. | At baseline and 12 weeks later | 
| Chance in Disease Activity | The Disease Activity Index for Psoriatic Arthritis (DAPSA) will be used for evaluating the disease activity. DAPSA is a composite score including the number of tender joints (over 68 joints), the number of swollen joints (over 68 joints), C-Reactive protein (CRP) level, the patient's self-reported health status, and evaluation of the patient's health status by the physician. DAPSA is calculated by summing all the values, and higher scores indicate higher disease activity. | At baseline and 12 weeks later | 
| Change in Fatigue | The Fatigue Severity Scale (FSS) will be used to evaluate the fatigue. It comprises 9 items that assess the severity of fatigue symptoms experienced by participants over the previous week. Each question is scored on a scale ranging from 1 (strongly disagree) to 7 (strongly agree), and the scores are then averaged to derive the total score. Higher scores indicate more fatigue. | At baseline and 12 weeks later | 
| Change in Emotional Status | The Hospital Anxiety and Depression Scale (HADS) will be used to evaluate emotional status. The HADS includes two sections: depression (7 questions) and anxiety (7 questions). Each question is scored between 0 and 3. Higher scores indicate higher anxiety or depression levels. | At baseline and 12 weeks later | 
| Change in Quality of Life | The Psoriatic Arthritis Quality of Life (PsAQoL) questionnaire will be used to assess the disease-related changes in quality of life. The PsAQoL includes 20 questions, each answered with either yes (1 point) or no (0 point). Higher scores indicate a reduced quality of life. | At baseline and 12 weeks later | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Pilates Exercise, Arthritis, Spine Mobility