The comparative efficacy of group- versus home-based exercise programs in patients with ankylosing spondylitis

Author(s): Hui Liang , RN, BScN, MSN ^a ^, ^b , Xu Tian , RN, BScN, MSN ^c , Xiao-Ling Liu , RN, BScN ^c , Shu-Ya Wang , RN, BScN ^b ^, ^d , Yi Dai , RN, BScN, MSN ^a ^, ^b , Li Kang , RN, BScN ^a ^, ^b , Li-Sai Chen , RN, BScN, MSN ^a ^, ^b , Li-Fen Jin , RN, BScN ^a ^, ^b ^, ^∗

Publication date (Electronic): 20 July 2018

Journal: Medicine

Publisher: Wolters Kluwer Health

Keywords: ankylosing spondylitis, group-based exercise, home-based exercises, meta-analysis

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Abstract

Background:

Ankylosing spondylitis (AS) is an important factor to not only cause employment obstacle, but also result in serious social economic load. Several randomized controlled trials investigated the efficacy of group- versus home-based exercise programs in patients with AS. This systematic review will collect and summarize the available evidence to realize the effectiveness of group- and home-based programs in patients with AS.

Methods:

A search in PubMed, Web of Science, EMBASE, and the Cochrane Library will be electronically performed by 2 independent investigators to capture all potential studies comparing group- and home-based in patients with AS. The time limit of search will be from their inception to April 2018. Two independent investigators provide their agreement in presencial meeting for a final selection, and at a later stage, the articles will be reviewed in full-text by the all authors. Quantitative analysis will be performed with Review Manager (RevMan) software (version 5.3.0).

Results:

This meta-analysis will provide a high-quality synthesis of current evidence of group- versus home-based exercise programs in patients with AS.

Conclusion:

The conclusion of our meta-analysis will provide the evidence which program is an effective intervention for patient with AS.

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Most cited references 15

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Fatigue in patients with ankylosing spondylitis: A comparison with the general population and associations with clinical and self-reported measures.

Nina Vøllestad, Jon H Loge, T K Kvien … (2005)

To investigate 1) levels of fatigue in patients with ankylosing spondylitis (AS) compared with the general population; 2) the relationships between fatigue and demographic, self-reported, and clinical measures; and 3) the performance of both a generic and a disease-specific measure of fatigue. Patients with AS (n = 152) were compared with people from the general population (n = 2,323). Fatigue was assessed by the Short Form 36 (SF-36) vitality scale and the fatigue item of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Other measures of self-reported health included BASDAI for disease activity, Bath Ankylosing Spondylitis Functional Index for functional abilities, and the SF-36 for mental health. Clinical measures comprised Bath Ankylosing Spondylitis Metrology Index for joint mobility and erythrocyte sedimentation rate and C-reactive protein as inflammatory markers. The explanatory power of demographic, self-reported, and clinical measures was examined in a block regression model. The mean +/- SD SF-36 vitality score was 43 +/- 24 in the patients and 60 +/- 21 in the general population (P < 0.001). The SF-36 vitality and the BASDAI fatigue scores were consistently associated with measures of mental health and disease activity. Clinical measures did not show explanatory power. A cutoff at 70 mm on the BASDAI fatigue item implied specificity of 0.77 and sensitivity of 0.82. Self-reported measures of disease activity and mental health contributed significantly to explain fatigue, whereas clinical measures of inflammation and joint mobility did not. The BASDAI fatigue item reached acceptable sensitivity and specificity with a cutoff at 70 mm when using the low vitality scores of SF-36 as an external indicator.

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Exercise therapy for spondyloarthritis: a systematic review.

Tom O'Dwyer, Finbar O’Shea, Fiona Wilson (2014)

To evaluate the effects of therapeutic exercise on pain, stiffness, quality of life, physical function, disease activity, health-related fitness and cardiovascular risk factors in adults with spondyloarthritis (SpA). Electronic databases (Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE/PubMed, PEDro, AMED, CINAHL) were systematically searched from inception to October 2013 using medical subject headings and keywords. This was supplemented by searching conference abstracts and a hand search of reference lists of included studies. Randomised and quasi-randomised studies of adults with SpA in which at least one of the comparison groups received an exercise intervention were included. Outcomes of interest were pain, stiffness, quality of life, physical function and disease activity. Secondary outcomes were health-related fitness and cardiovascular risk factors. Two reviewers independently screened studies for inclusion. Methodological quality was assessed by two reviewers using the Cochrane risk of bias tool and the PEDro scale. Twenty-four studies, involving 1,498 participants, were included. Meta-analyses were not undertaken due to clinical heterogeneity, and this review focuses on qualitative synthesis. Moderate evidence supports exercise interventions in improving physical function, disease activity and chest expansion compared to controls; there is low-level evidence of improved pain, stiffness, spinal mobility and cardiorespiratory function. Supervised group exercise yields better outcomes than unsupervised home exercise. The addition of aerobic components to flexibility programmes improves cardiorespiratory outcomes, but not cardiovascular risk factors. The most effective exercise protocol remains unclear. Current evidence suggests that therapeutic exercises are beneficial for adults with ankylosing spondylitis; effects on other SpA subtypes are unknown.

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Health status of patients with ankylosing spondylitis: a comparison with the general population.

H Dagfinrud, T K Kvien, Frank Loge … (2004)

To examine the subjective health in patients with ankylosing spondylitis (AS) compared with the general population, and to explore the associations between health status and age, sex of the patients, and educational level in AS. Health status was assessed with a generic instrument (SF-36) in 314 patients with AS and in 2323 people from the general population. Subgroup analyses were performed according to age, sex, and educational level. Standard difference scores (s-scores) were calculated to ensure the clinical meaningfulness of the norm based comparisons. Both men and women with AS reported significantly impaired health on all scales of the SF-36. Women reported significantly worse health on physical health domains. However, when calculating differences from the general population, numerically larger s-scores were found for men (except for physical role and vitality). The relative impact of AS seems to diminish with increasing age. In AS, better health was significantly associated with higher education across all scales. Deviations from the general population on the non-physical health aspects were especially pronounced in patients with low education. All key dimensions of health are affected by AS. The physical aspects seem to be most severely affected, but in the less educated group of patients, the disease impact on the mental health aspects was also considerable. Evaluation and management planning should take the complexity of AS into consideration. The focus on physical function should be maintained, and additional attention should be paid to the mental and social consequences of AS.

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Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: July 2018

Publication date (Electronic): 20 July 2018

Volume: 97

Issue: 29

Electronic Location Identifier: e11540

Affiliations

[a ]Department of Nursing, the First People's Hospital of Yunnan Province

[b ]The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China

[c ]Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing

[d ]Department of Rheumatology and Immunology, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China.

Author notes

[∗ ]Correspondence: Li-Fen Jin, Department of Nursing, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China, The Affiliated Hospital of Kunming University of Science and Technology, 157 Jinbi Road, Kunming 650032, Yunnan, China (e-mail: 13411359922@ 123456qq.com ).

Article

Publisher ID: MD-D-18-04156 Accession ID: 11540

DOI: 10.1097/MD.0000000000011540

PMC ID: 6086499

PubMed ID: 30024543

SO-VID: 1453cab9-01a2-4a4a-bc60-d5481a31f3fb

License:

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

History

Date received : 20 June 2018

Date accepted : 25 June 2018

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Keywords: ankylosing spondylitis,group-based exercise,home-based exercises,meta-analysis

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Keywords: ankylosing spondylitis, group-based exercise, home-based exercises, meta-analysis

The comparative efficacy of group- versus home-based exercise programs in patients with ankylosing spondylitis : Protocol for a meta-analysis

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Most cited references 15

Fatigue in patients with ankylosing spondylitis: A comparison with the general population and associations with clinical and self-reported measures.

Exercise therapy for spondyloarthritis: a systematic review.

Health status of patients with ankylosing spondylitis: a comparison with the general population.

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