Physiotherapy interventions for ankylosing spondylitis.
BACKGROUND
Ankylosing spondylitis (AS) is a chronic rheumatic disease. Due to the consequences of the disease, physiotherapy is regarded to be an important part of the treatment.


OBJECTIVE
The objective is to summarise the available scientific evidence on the effectiveness of physiotherapy interventions in the management of AS.


METHODS
We searched the Cochrane Musculoskeletal Group Trial register, Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and Pedro up to February 2000 for all relevant publications, limited to English and Scandinavian languages. The reference lists of relevant articles were checked and the authors of included articles were contacted.


METHODS
We included randomised and quasi randomised studies where the participants were patients with AS, classified by the New York criteria, and where at least one of the comparison groups received some kind of physiotherapy. The main outcomes of interest were spinal mobility, pain, stiffness, physical function and global assessment of change.


METHODS
Both reviewers independently selected trials for inclusion, extracted data and assessed trial quality. Investigators were contacted to obtain missing information.


RESULTS
Three trials were included with 241 participants, and all were assessed to have moderate to high risk of bias. Two trials compared the effect of supervised group physical therapy with an individualised home exercise program, and reported differences in favour of the supervised group. For pain and stiffness, the relative difference in change from baseline for the supervised group compared to the home exercise group was 50% after treatment. One trial compared an individual program of exercises and disease education with no intervention, and found differences in favour of the exercise group.


CONCLUSIONS
The tendency toward positive effects of physiotherapy, in the management of AS, call for further research in this field in order to reach sufficient evidence on which physiotherapy modalities and applications are to be recommended. New trials should address other physiotherapy interventions commonly used in practice. There is not sufficient evidence yet available to base recommendations for or against the use of physiotherapy interventions for ankylosing spondylitis.
Dagfinrud
H
H
University of Oslo, Section for Health Science, P.O.box 1153, Blindern, Oslo, Norway, 0316. h.s.dagfinrud@helsefag.uio.no
Hagen
K
K
D000553:Ambulatory Care; D006760:Hospitalization; D006801:Humans; D026741:Physical Therapy Modalities; D012648:Self Care; D013167:Spondylitis, Ankylosing / Q000534:rehabilitation*