Supervised training and home-based rehabilitation in patients with stabilized ankylosing spondylitis on TNF inhibitor treatment: a controlled clinical trial with a 12-month follow-up

Abstract

Objective: To assess the 12-month’s follow-up effects on pain, mobility, and physical function outcomes of a supervised training and home-based rehabilitation for ankylosing spondylitis patients stabilized with TNF-inhibitor therapy. Design: Controlled clinical trial (sequentially determined allocation) with 12-months’ follow-up. Setting: Patients’ homes. Subjects: A total of 69 subjects were allocated to either a rehabilitation programme (rehabilitation group, n = 22), an educational-behavioural programme (educational group, n = 24), and to neither programme (control group, n = 23). Interventions: Rehabilitation programme included supervised training and home exercises (stretching, strengthening, aerobic, chest, and spine/hip joint flexibility exercises); educational-behavioural programme included information on ankylosing spondylitis, pain and stress mechanisms, and control. Main measures: Spinal pain intensity, Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Disease Activity Index, chest expansion, and cervical and lumbar spine active range of motion measured by a pocket goniometer. Results: At baseline, the three groups exhibited comparable demographic characteristics and basal evaluations. Intra-group changes in the rehabilitation group from baseline to 12 months yielded statistically significant gains ( p < 0.05) for all outcomes. At 12-months follow-up, compared with the control and educational-behavioural, the rehabilitation group exhibited significant differences in chest expansion ( p = 0.001 and p < 0.001), Bath Ankylosing Spondylitis Disease Activity Index ( p = 0.012 and p = 0.050), and in some goniometric measurements as cervical rotation ( p = 0.007 and p = 0.014), toraco-lumbar rotation ( p = 0.009 and p = 0.050), and total cervical movements ( p = 0.009 and p = 0.001). Conclusion: In comparison with the educational-behavioural programme or no intervention, supervised training and home exercises improved long-term outcome in patients with ankylosing spondylitis.