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

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Abstract

Objectives:

The aim of this meta-analysis is to investigate the comparative efficacy between supervised- and home-based programs in patients with ankylosing spondylitis (AS).

Method:

A systematic search in PubMed, Web of Science, EMBASE, and the Cochrane Library was electronically performed by 2 independent investigators in order to capture all potential studies comparing supervised- with home-based in patients with AS from inception to April 2018. After extracted essential information, apprised risk of bias, statistical analysis was performed with Review Manager (RevMan) software (version 5.3.0). The protocol was registered at PROSPERO platform with an identifier of CRD42018097046.

Results:

A total of 7 studies comprising 271 patients were included finally. Meta-analyses showed that, compared to home-based program, supervised-based program was associated with reduced bath ankylosing spondylitis metrology index (BASMI) scores (mean difference [MD], -0.45; 95% confidence interval [CI], -0.73, -0.17), bath ankylosing spondylitis disease activity index (BASDAI) scores (MD, -0.48; 95% CI, -0.88, -0.08), and bath ankylosing spondylitis functional index (BASFI) scores (MD, -0.78; 95% CI, -1.19, -0.37). However, depression scores (standard mean difference, -0.22; 95% CI, -0.58, 0.14) between the 2 groups showed no significant defference.

Conclusions:

Both supervised- and home-based programs can benefit to reduce BASMI, BASDAI, and BASFI scores in AS patients. However, short-term, supervised exercise program may be more effective than home-based exercises at decreasing disease activity with AS.

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Most cited references 32

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2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis

Jo Adams, Nina Brodin, Hanne Dagfinrud … (2018)

Regular physical activity (PA) is increasingly promoted for people with rheumatic and musculoskeletal diseases as well as the general population. We evaluated if the public health recommendations for PA are applicable for people with inflammatory arthritis (iA; Rheumatoid Arthritis and Spondyloarthritis) and osteoarthritis (hip/knee OA) in order to develop evidence-based recommendations for advice and guidance on PA in clinical practice. The EULAR standardised operating procedures for the development of recommendations were followed. A task force (TF) (including rheumatologists, other medical specialists and physicians, health professionals, patient-representatives, methodologists) from 16 countries met twice. In the first TF meeting, 13 research questions to support a systematic literature review (SLR) were identified and defined. In the second meeting, the SLR evidence was presented and discussed before the recommendations, research agenda and education agenda were formulated. The TF developed and agreed on four overarching principles and 10 recommendations for PA in people with iA and OA. The mean level of agreement between the TF members ranged between 9.8 and 8.8. Given the evidence for its effectiveness, feasibility and safety, PA is advocated as integral part of standard care throughout the course of these diseases. Finally, the TF agreed on related research and education agendas. Evidence and expert opinion inform these recommendations to provide guidance in the development, conduct and evaluation of PA-interventions and promotion in people with iA and OA. It is advised that these recommendations should be implemented considering individual needs and national health systems.

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Effectiveness of Exercise Programs in Ankylosing Spondylitis: A Meta-Analysis of Randomized Controlled Trials

Virginie Pécourneau, Adeline Ruyssen-Witrand, Arnaud Constantin … (2018)

To assess the effectiveness of exercise programs on disease activity and function in ankylosing spondylitis (AS) by a systematic review and meta-analysis of randomized controlled trials (RCTs).

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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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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: February 2020

Publication date (Electronic): 21 February 2020

Volume: 99

Issue: 8

Electronic Location Identifier: e19229

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

[c ]Department of Nursing, Chongqing University Cancer Hospital

[d ]Department of Gastroenterology, Chongqing University Cancer Hospital, Chongqing

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

Author notes

[∗ ]Correspondence: Lifen Jin, Department of Nursing, the First People's Hospital of Yunnan Province & the Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan 650032, China (e-mail: 13411359922@ 123456qq.com ); Xu Tian, Department of Gastroenterology, Chongqing University Cancer Hospital, 181 Hanyu Road, Shapingba District, Chongqing 400030, China (e-mail: yxtx880919@ 123456hotmail.com ); Weiqing Chen, Department of Gastroenterology, Chongqing University Cancer Hospital, 181 Hanyu Road, Shapingba District, Chongqing 400030, China (e-mail: CQCH_ChenWQ@ 123456163.com ).

Article

Publisher ID: MD-D-19-07601 Accession ID: 19229

DOI: 10.1097/MD.0000000000019229

PMC ID: 7034711

PubMed ID: 32080122

SO-VID: 58babd94-09cc-4800-be2a-5338cf633f3b

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

History

Date received : 4 October 2019

Date revision received : 22 December 2019

Date accepted : 21 January 2020

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Keywords: ankylosing spondylitis,home-based exercise,meta-analysis,supervised-based exercise,systematic review

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Keywords: ankylosing spondylitis, home-based exercise, meta-analysis, supervised-based exercise, systematic review

The comparative efficacy of supervised- versus home-based exercise programs in patients with ankylosing spondylitis : A meta-analysis

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Most cited references 32

2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis

Effectiveness of Exercise Programs in Ankylosing Spondylitis: A Meta-Analysis of Randomized Controlled Trials

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

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