New Insights in Physical Therapy and Rehabilitation in Axial Spondyloarthritis: A Review

Abstract

Axial spondyloarthritis (axSpA) is a chronic and inflammatory rheumatic disease characterized by pain, structural and functional impairments, and reduced mobility and potential deformity of the axial skeleton. Treatment of axSpA includes pharmacological and non-pharmacological therapy. However, in the biologic era, unmet needs still remain for patients intolerant to or non-responders to biologic drugs and despite the development of new treatments, physical therapy and rehabilitation are of crucial importance in the management of axSpA patients. The aim of this manuscript is to review the current evidence on the assessment, physical therapy, and rehabilitation in axSpA patients.

Effects of non-manipulative osteopathic management in addition to physical therapy and rehabilitation on clinical outcomes of ankylosing spondylitis patients: A preliminary randomized clinical trial

“…Physical activity is advised for persons with inflammatory and musculoskeletal diseases (Rausch Osthoff et al, 2018) and musculoskeletal rehabilitation programs involving aerobic, strengthening exercises, stretching, and physical therapy have demonstrated beneficial improvement on functional and clinical outcomes in patients with AS (Elyan and Khan, 2008;Ince et al, 2006;Perrotta et al, 2019). Moreover, authors demonstrated that group physical therapy showed better outcomes compared to home exercises for thoracolumbar mobility, fitness, and on global health (Hidding Table 2 Pre-intervention and post-intervention descriptive data (mean and standard deviation) by groups; Anova analysis and post-hoc tests (p-values 5.2 2.4 3.9 2.4 5.2 1.9 4.9 1.7 0.497 0.003 0.035 1.000 0.794 0.005 1.000 Fig.…”

To move or not to move: the paradoxical effect of physical exercise in axial spondyloarthritis

“…Indeed, physical therapy interventions for axSpA have shown to be an important part of the disease management, with a tendency to be more effective when done as a supervised outpatient group. 51–55 The cornerstone of physical therapy in axSpA is regular exercise 9 shown to reduce disease activity, pain and stiffness and improve physical functioning, chest expansion, spinal mobility and cardiorespiratory performance in axSpA patients. It also has the potential to reduce depressive symptoms.…”

“…Physical therapy and exercise are considered to be one of the cornerstones of the management of disease, especially for patients with severe radiographic involvement. 9 Although rehabilitation and exercise programmes reduce disease activity and improve spinal function and quality of life, the concept of mechanical stress as a contributor to disease development and progression represents a conceptual challenge for this approach. Despite the observed benefits, specific or excessive exercise could potentially and paradoxically increase the extent of microdamage at entheseal sites, and, thus, worsen the disease outcomes.…”

Recent advances in managing axial spondyloarthritis

“…ASAS-EULAR recommend that patients should be educated about axSpA and encouraged to exercise on a regular basis and stop smoking; physical therapy should be considered 6 . The inclusion of aerobic components, cardiorespiratory exercises, and educational programs in traditional programs of exercises may lead to improved clinical outcomes, although the most effective exercise protocol remains unclear 12 . Promising effects of cardiorespiratory and strength exercises on emotional distress, fatigue, and ability to do a full day’s activities were shown in a small pilot Scandinavian study in patients with axSpA 13 .…”