Exercise Adherence in Patients With Ankylosing Spondylitis: Difference between revisions
(intro) |
(qol) |
||
| Line 1: | Line 1: | ||
== Introduction == | == Introduction == | ||
Ankylosing spondylitis (also called Bechterew's disease or Marie-Strumpell disease) is a seronegative spondyloarthritis of the spine and pelvis. It is a chronic inflammatory rheumatic disease with unknown aetiology. AS causes inflammatory back pain, which can lead to structural and functional impairments and a decrease in quality of life. AS is also called "Bamboo Spine" due to bony formation at the level of the joint capsule and cartilage. Hence, affected joints progressively become stiff and sensitive. The treatment for AS mainly consists of drug therapy (usually nonsteroidal anti-inflammatory drugs), and regular performance of an exercise regimen designed by physiotherapists to improve or maintain mobility and posture <ref>Barlow, J.H., Macey, S.J., Struthers, G., 1992. Psychosocial factors and self-help in ankylosing spondylitis patients. Clin Rheumatol 11, 220–225. <nowiki>https://doi.org/10.1007/BF02207961</nowiki></ref>. Exercise therapy has been consistently supported by current evidence to be a beneficial treatment for patients with AS <ref>Millner, J.R., Barron, J.S., Beinke, K.M., Butterworth, R.H., Chasle, B.E., Dutton, L.J., Lewington, M.A., Lim, E.GS., Morley, T.B., O’Reilly, J.E., Pickering, K.A., Winzenberg, T., Zochling, J., 2016. Exercise for ankylosing spondylitis: An evidence-based consensus statement. Seminars in Arthritis and Rheumatism 45, 411–427. <nowiki>https://doi.org/10.1016/j.semarthrit.2015.08.003</nowiki></ref>. According to the NHS UK, there is no known cure for AS at the moment <ref>NHS UK, 2019. Ankylosing spondylitis - Treatment. nhs.uk. URL <nowiki>https://www.nhs.uk/conditions/ankylosing-spondylitis/treatment/</nowiki> (accessed 5.24.20).</ref>. As a result, exercise treatment has to be maintained for the remainder of the patient's life and long term exercise adherence is crucial. | Ankylosing spondylitis (also called Bechterew's disease or Marie-Strumpell disease) is a seronegative spondyloarthritis of the spine and pelvis. It is a chronic inflammatory rheumatic disease with unknown aetiology. AS causes inflammatory back pain, which can lead to structural and functional impairments and a decrease in quality of life. AS is also called "Bamboo Spine" due to bony formation at the level of the joint capsule and cartilage. Hence, affected joints progressively become stiff and sensitive. The treatment for AS mainly consists of drug therapy (usually nonsteroidal anti-inflammatory drugs), and regular performance of an exercise regimen designed by physiotherapists to improve or maintain mobility and posture <ref>Barlow, J.H., Macey, S.J., Struthers, G., 1992. Psychosocial factors and self-help in ankylosing spondylitis patients. Clin Rheumatol 11, 220–225. <nowiki>https://doi.org/10.1007/BF02207961</nowiki></ref>. Exercise therapy has been consistently supported by current evidence to be a beneficial treatment for patients with AS <ref>Millner, J.R., Barron, J.S., Beinke, K.M., Butterworth, R.H., Chasle, B.E., Dutton, L.J., Lewington, M.A., Lim, E.GS., Morley, T.B., O’Reilly, J.E., Pickering, K.A., Winzenberg, T., Zochling, J., 2016. Exercise for ankylosing spondylitis: An evidence-based consensus statement. Seminars in Arthritis and Rheumatism 45, 411–427. <nowiki>https://doi.org/10.1016/j.semarthrit.2015.08.003</nowiki></ref> and it is recommended by the NHS guideline as a vital component in managing patients with AS. According to the NHS UK, there is no known cure for AS at the moment <ref>NHS UK, 2019. Ankylosing spondylitis - Treatment. nhs.uk. URL <nowiki>https://www.nhs.uk/conditions/ankylosing-spondylitis/treatment/</nowiki> (accessed 5.24.20).</ref>. As a result, exercise treatment has to be maintained for the remainder of the patient's life and long term exercise adherence is crucial. | ||
=== Quality of life in patients with AS === | == Quality of life in patients with AS == | ||
Exercise and quality of life are closely linked together. Studies have shown that exercise therapy is able to improve the quality of life in patients with long term illness <ref>Hacker, E., 2009. Exercise and Quality of Life: Strengthening the Connections. Clin J Oncol Nurs 13, 31–39. <nowiki>https://doi.org/10.1188/09.CJON.31-39</nowiki></ref>. Therefore, the quality of life in patients with AS should be explored. | |||
A recent US-based survey (AS Life Impact survey) on the quality of life in patients with AS was published <ref>Rosenbaum, J.T., Pisenti, L., Park, Y., Howard, R.A., 2019. Insight into the Quality of Life of Patients with Ankylosing Spondylitis: Real-World Data from a US-Based Life Impact Survey. Rheumatol Ther 6, 353–367. <nowiki>https://doi.org/10.1007/s40744-019-0160-8</nowiki></ref>. | |||
* The overall mean score for the Evaluation of Ankylosing Spondylitis Quality of Life (EASi-QoL) questionnaire is 28.9 (medium impact). | |||
* Female patients are more likely to report a high impact of AS than male in all the domains (physical, emotional, social and discomfort domains) of the questionnaire. (p< 0.05) | |||
** Various aspects of daily living being affected include: | |||
*** Lifting a child or heavy object (P<0.0001) | |||
*** Standing for 30 mins (P=0.0128) | |||
*** Feeling tired or lacking in energy (P=0.0004) | |||
*** Interference with sleep (P=0.0081) | |||
*** Worried about the future (P<0.0001) | |||
*** Lacked drive or motivation (P=0.0364) | |||
*** The ability to concentrate (P=0.0057) | |||
*** Prevented them from being physically active (P=0.0092) | |||
*** Travel by car or public transport (P=0.0019) | |||
*** Interference with work (P=0.0268) | |||
== Exercise Adherence in patients with AS == | == Exercise Adherence in patients with AS == | ||
| Line 23: | Line 39: | ||
== Facilitators to exercise adherence == | == Facilitators to exercise adherence == | ||
=== Group therapy === | |||
== Clinical bottom line == | == Clinical bottom line == | ||
<references /> | <references /> | ||
Revision as of 20:02, 24 May 2020
Introduction[edit | edit source]
Ankylosing spondylitis (also called Bechterew's disease or Marie-Strumpell disease) is a seronegative spondyloarthritis of the spine and pelvis. It is a chronic inflammatory rheumatic disease with unknown aetiology. AS causes inflammatory back pain, which can lead to structural and functional impairments and a decrease in quality of life. AS is also called "Bamboo Spine" due to bony formation at the level of the joint capsule and cartilage. Hence, affected joints progressively become stiff and sensitive. The treatment for AS mainly consists of drug therapy (usually nonsteroidal anti-inflammatory drugs), and regular performance of an exercise regimen designed by physiotherapists to improve or maintain mobility and posture [1]. Exercise therapy has been consistently supported by current evidence to be a beneficial treatment for patients with AS [2] and it is recommended by the NHS guideline as a vital component in managing patients with AS. According to the NHS UK, there is no known cure for AS at the moment [3]. As a result, exercise treatment has to be maintained for the remainder of the patient's life and long term exercise adherence is crucial.
Quality of life in patients with AS[edit | edit source]
Exercise and quality of life are closely linked together. Studies have shown that exercise therapy is able to improve the quality of life in patients with long term illness [4]. Therefore, the quality of life in patients with AS should be explored.
A recent US-based survey (AS Life Impact survey) on the quality of life in patients with AS was published [5].
- The overall mean score for the Evaluation of Ankylosing Spondylitis Quality of Life (EASi-QoL) questionnaire is 28.9 (medium impact).
- Female patients are more likely to report a high impact of AS than male in all the domains (physical, emotional, social and discomfort domains) of the questionnaire. (p< 0.05)
- Various aspects of daily living being affected include:
- Lifting a child or heavy object (P<0.0001)
- Standing for 30 mins (P=0.0128)
- Feeling tired or lacking in energy (P=0.0004)
- Interference with sleep (P=0.0081)
- Worried about the future (P<0.0001)
- Lacked drive or motivation (P=0.0364)
- The ability to concentrate (P=0.0057)
- Prevented them from being physically active (P=0.0092)
- Travel by car or public transport (P=0.0019)
- Interference with work (P=0.0268)
- Various aspects of daily living being affected include:
Exercise Adherence in patients with AS[edit | edit source]
Factors Affecting Adherence[edit | edit source]
Strategies to Increase Adherence[edit | edit source]
- Supervised exercise[edit | edit source]
- Home Exercise Program (HEP)[edit | edit source]
- Patient education: Exercise following an educational program[edit | edit source]
- Medical Treatment[edit | edit source]
Measurement of Adherence[edit | edit source]
Barriers to exercise adherence[edit | edit source]
Facilitators to exercise adherence[edit | edit source]
Group therapy[edit | edit source]
Clinical bottom line[edit | edit source]
- ↑ Barlow, J.H., Macey, S.J., Struthers, G., 1992. Psychosocial factors and self-help in ankylosing spondylitis patients. Clin Rheumatol 11, 220–225. https://doi.org/10.1007/BF02207961
- ↑ Millner, J.R., Barron, J.S., Beinke, K.M., Butterworth, R.H., Chasle, B.E., Dutton, L.J., Lewington, M.A., Lim, E.GS., Morley, T.B., O’Reilly, J.E., Pickering, K.A., Winzenberg, T., Zochling, J., 2016. Exercise for ankylosing spondylitis: An evidence-based consensus statement. Seminars in Arthritis and Rheumatism 45, 411–427. https://doi.org/10.1016/j.semarthrit.2015.08.003
- ↑ NHS UK, 2019. Ankylosing spondylitis - Treatment. nhs.uk. URL https://www.nhs.uk/conditions/ankylosing-spondylitis/treatment/ (accessed 5.24.20).
- ↑ Hacker, E., 2009. Exercise and Quality of Life: Strengthening the Connections. Clin J Oncol Nurs 13, 31–39. https://doi.org/10.1188/09.CJON.31-39
- ↑ Rosenbaum, J.T., Pisenti, L., Park, Y., Howard, R.A., 2019. Insight into the Quality of Life of Patients with Ankylosing Spondylitis: Real-World Data from a US-Based Life Impact Survey. Rheumatol Ther 6, 353–367. https://doi.org/10.1007/s40744-019-0160-8
