THU0596 Is Group-Based Exercise Better than Home-Based Exercise in Patients with Ankylosing Spondylitis Stabilized with Tumor Necrosis Factor-Alpha Inhibitor Therapy? A Randomized Controller Study
Authors: J. Sollini, T. Nava, A. Parlatoni, V. Moretti, P. Scendoni
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease. A specific exercise program, in addition to pharmacological therapy, is more and more considered a significant integrated approach in AS treatment. <h3>Objectives</h3> To compare, in patients with AS stabilized with tumor necrosis factor (TNF)-alpha inhibitor therapy, the effectiveness on pain, spine mobility, physical function, and disability of group-based exercise program and home-base exercise program. <h3>Methods</h3> Thirty patients (26 males, 4 females) with AS were randomly divided into two groups: Ambulatory Group (AG) and Home Group (HG). AG (<i>n</i> =15) patients received instruction for a group-exercise program 3 days a week and 45 minutes a day under the supervision of the same physiotherapist for 6 weeks. HG (<i>n</i> =15) patients practiced the exercises, illustrated by a physiotherapist during a dedicated and guided session, individually at home, 3 days a week for 6 weeks. Patients were evaluated according to BASFI, BASDAI, HAQ, BASMI before treatment (T0), at the end of the treatment (T1), 1 month (T2) and 6 months (T3) since the end of the treatment. ANOVA statistical analysis (p=0.05) was performed. <h3>Results</h3> In all outcomes (BASFI, BASDAI, HAQ e BASMI) a significant overall improvement was observed (p&lt;0.0001), return at baseline value was observed partially at T2 and completely at T3. There were significant improvement in the "tragus to wall distance" (TWD) test (p&lt;0.05) in AG at T1. The "lumbar side flexion" (LSF) was improved (p&lt;0.05) in AG at T1 and T2. TWD and LSF improvement showed a positive result also in the BASMI total score (p&lt;0.0001), that was significantly better at the end of T1 in AG than in HG. <h3>Conclusions</h3> A significant improvement in all outcome measurements was observed in T1 due to exercise program compliance in all patients. In both groups a slight worsening of outcome results at T1 was observed, due to discontinuation of exercise program. At T3, all benefits obtained were almost lost with a consequent return to basal values (T0). TWD improvement reveals that ambulatory exercise program is more effective due to exercise supervision and adherence to program. AG patients obtained a better extension and better flexion of lumbar rachis. Patients in AG group obtained overall a significant better BASMI score at the end of the assisted treatment. <h3>References</h3> Sweeney S, Taylor G, Calin A (2002) The effect of a home based exercise intervention package on outcome in ankylosing spondylitis: a randomized controlled trial. J Rheumatol 29(4):763–6 Lim HJ, Moon YI, Lee MS (2005) Effects of home-based daily exercise therapy on joint mobility, daily activity, pain, and depression in patients with ankylosing spondylitis. Rheumatol Int 25(3):225–9 Karapolat H et al (2007) Comparison of group based exercise versus home-based exercise in patients with ankylosing spondylitis: effects on Bath Ankylosing Spondylitis Indices, quality of life and depression. Clin Rheumatol 27(6):695–7 Durmus D, Alayli G, Cil E, Canturk F (2009) Effects of a home-based exercise program on quality of life, fatigue, and depression in patients with ankylosing spondylitis. Rheumatol Int 29(6):673-7 <h3>Disclosure of Interest</h3> None declared