Mihai B, van der Linden S, de Bie R, Stucki G
Department of Internal Medicine and Rheumatology Ion Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
Eura Medicophys. 2005 Jun;41(2):149-53.
The aim of this study was to assess both the opinion of an international group of experts about the place and importance of physiotherapy in the management of ankylosing spondylitis (AS) as well as the awareness of the responders about scientific evidence on efficacy and cost-effectiveness of physiotherapy in AS.
An e-mail questionnaire ''Experts' Beliefs on Physiotherapy for Patients with Ankylosing Spondylitis'' has been sent to all 71 international ASsessment of Ankylosing Spondylitis (ASAS) members. Completion of the twenty-eight-item questionnaire was done through the ASAS website (www.ASAS-group.org).
The number of responders was 53 (response rate 73%). Altogether 94% of the responders regard themselves as experts in the field of clinical care for AS patients. There is almost unanimous (86-92%) consensus on the efficacy of physiotherapy (widely defined, i.e. as physical therapy-including exercises, application of physical modalities and spa-therapy) for patients with axial and peripheral joint manifestations of AS. Physiotherapy is considered to be indicated for both early AS (less than 2 years after diagnosis) (88%) and AS of longer duration (2 to 10 years) (94%), implying that this non-pharmaceutical intervention should be made available for or should be prescribed to AS patients. Also daily exercises at home are considered indicated for both early (less than 2 years after diagnosis) AS (90%) and AS of longer duration of disease (90%). High-level evidence (Cochrane reviews or publications of one or more randomized controlled clinical trials) favoring efficacy of physiotherapy was considered available by 33% of the participants, whereas 43% replied ''no'' and 24% did not know. Finally, excluding the costs of the intervention, 39% of the participants reported that Spa-therapy might reduce health care costs as usage of NSAIDs, physician visits and ability to work or sick leave, whereas 26% said ''no'' and 35% did not know.
The international ASAS experts hold a favorable opinion on the efficacy of physiotherapy in AS, including group exercises and spa therapy, almost irrespective of disease duration and type of articular involvement (axial/peripheral). Awareness of published evidence on physiotherapy in AS is unsatisfactory.
本研究旨在评估一个国际专家小组对于物理治疗在强直性脊柱炎（AS）管理中的地位和重要性的看法，以及受访者对物理治疗在AS中疗效和成本效益的科学证据的认知情况。
一份名为“强直性脊柱炎患者物理治疗专家信念”的电子邮件问卷已发送给所有71名国际强直性脊柱炎评估（ASAS）成员。通过ASAS网站（www.ASAS-group.org）完成这份包含28个条目的问卷。
回复者有53人（回复率73%）。总计94%的回复者认为自己是AS患者临床护理领域的专家。对于物理治疗（广义定义，即包括运动疗法、物理治疗手段的应用和温泉疗法）对AS轴向和外周关节表现患者的疗效，几乎达成了一致意见（86%-92%）。物理治疗被认为适用于早期AS（诊断后不到2年）（88%）和病程较长（2至10年）的AS（94%），这意味着这种非药物干预应为AS患者提供或应开给他们。同样，家庭日常锻炼也被认为适用于早期（诊断后不到2年）AS（90%）和病程较长的疾病（90%）。33%的参与者认为有支持物理治疗疗效的高级别证据（Cochrane综述或一项或多项随机对照临床试验的出版物），而43%回答“没有”，24%表示不知道。最后，排除干预成本，39%的参与者报告温泉疗法可能会降低医疗保健成本，如非甾体抗炎药的使用、看医生的次数以及工作能力或病假情况，而26%表示“不会”，35%表示不知道。
国际ASAS专家对物理治疗在AS中的疗效持赞成意见，包括集体运动和温泉疗法，几乎与病程和关节受累类型（轴向/外周）无关。对已发表的AS物理治疗证据的认知情况并不理想。
