Physiotherapy interventions for ankylosing spondylitis

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Abstract
Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease. Due to the consequences of the disease, physiotherapy is considered to be an important part of the overall management of AS. The objective of this review was to summarise the available scientific evidence on the effectiveness of physiotherapy interventions in the management of AS. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, CINAHL and PEDro up to February 2004 for all relevant publications, without any language restrictions. The reference lists of relevant articles were checked and the authors of included articles were contacted. We included randomised and quasi‐randomised studies with patients classified by the AS New York criteria and where at least one of the comparison groups received some kind of physiotherapy. The main outcomes of interest were pain, stiffness, spinal mobility, physical function and patient global assessment. Two reviewers independently selected trials for inclusion, extracted data and assessed trial quality. Investigators were contacted to obtain missing information. Six trials with a total of 561 participants were included in this updated review as compared to three trials and 241 patients in the previous version. Two trials compared individualised home exercise programs with no intervention and reported low quality evidence for effects in spinal mobility (relative percentage differences (RPD) 37%) and physical function, in favour of the home exercise program. Three trials compared supervised group physiotherapy with an individualised home‐exercise program and reported moderate quality evidence for small differences in spinal mobility (RPD 18%) and patient global assessment in favour of supervised group exercises. Finally, in one study a three week inpatient spa‐exercise therapy followed by 37 weeks of weekly outpatient group physiotherapy (without spa) was compared with weekly outpatient group physiotherapy alone; there was moderate quality evidence for effects in pain (RPD 18%), physical function (RPD 24%) and patient global assessment (RPD 29%), in favour of the combined spa‐exercise therapy. The results of this review suggest that a home exercise program is better than no intervention, supervised group physiotherapy is better than home exercises, and that combined inpatient spa‐exercise therapy followed by supervised outpatient weekly group physiotherapy is better than weekly group physiotherapy alone. The tendency toward positive effects of physiotherapy in the management of AS calls for further research in this field. New trials should also address other physiotherapy interventions commonly used in clinical practice.