Demontis Alessandra, Trainito Sabina, Del Felice Alessandra, Masiero Stefano
Rehabilitation Unit, Department of Rheumatology and Physical Medicine, University of Milan, Piazza Ferrari, 1, Milan, Italy.
Rehabilitation Unit, Department of Neuroscience-DSN, University of Padua, Via Giustiniani 3, 35128, Padua, Italy.
Rheumatol Int. 2016 Mar;36(3):333-9. doi: 10.1007/s00296-015-3399-6. Epub 2015 Dec 7.
Balance impairment is a frequent and undertreated manifestation in ankylosing spondylitis, leading to increased risk of falls and lower quality of life. Our aim was to assess supervised training and home-based rehabilitation efficacy on balance improvement in ankylosing spondylitis subjects on biologic agents. This was a single-blinded, quasi-randomized parallel study in a single outpatient Rehabilitation Clinic of a tertiary referral center. Subjects with ankylosing spondylitis on biologic agents were assigned either to supervised training and home-based rehabilitation program (rehabilitation group) plus educational-behavioral therapy, or to educational-behavioral therapy alone (educational groups). The same therapist provided therapy. Outcome measures were assessed at baseline (T0), end of treatment (T1) and at 7-month follow-up (T2). Rheumatologic outcomes were Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Functional Index and Bath Ankylosing Spondylitis Disease Activity Index. Balance parameters (anterior-posterior oscillation, latero-lateral oscillation, sway area, sway density and sway path) were evaluated by stabilometry in a condition of open and closed eyes. Forty-six subjects (36 M, 10 F) were enrolled. Demographic data and clinical status at baseline were comparable between the two groups (22 rehabilitation group, 20 educational group). Primary outcome was sway density that improved both at T1 (SDy: open eyes p = 0.003, closed eyes p = 0.004) and at T2 (SDx: open eyes p = 0.0015, closed eyes p = 0.032). A trend toward improvement in the rehabilitation group rather than in the educational group emerged for balance parameters, especially those measured with closed eyes (0.004 < p < 0.048 at T1 and 0.004 < p < 0.036 at T2). Supervised training and home exercise lead to balance improvement in people with ankylosing spondylitis. Eyes-closed trials show a more marked trend toward improvement, and this may suggest a positive effect of rehabilitation on proprioception.
平衡功能障碍是强直性脊柱炎中常见且治疗不足的表现，会导致跌倒风险增加和生活质量下降。我们的目的是评估在使用生物制剂的强直性脊柱炎患者中，监督训练和家庭康复对改善平衡功能的疗效。这是一项在三级转诊中心的单一门诊康复诊所进行的单盲、准随机平行研究。使用生物制剂的强直性脊柱炎患者被分配到监督训练和家庭康复计划（康复组）加教育行为疗法，或仅接受教育行为疗法（教育组）。由同一位治疗师提供治疗。在基线（T0）、治疗结束时（T1）和7个月随访时（T2）评估结果指标。风湿病学结果指标为巴斯强直性脊柱炎测量指数、巴斯强直性脊柱炎功能指数和巴斯强直性脊柱炎疾病活动指数。通过睁眼和闭眼状态下的稳定测量法评估平衡参数（前后摆动、左右摆动、摆动面积、摆动密度和摆动路径）。共招募了46名受试者（36名男性，10名女性）。两组在基线时的人口统计学数据和临床状况具有可比性（康复组22名，教育组20名）。主要结果指标是摆动密度，在T1（SDy：睁眼p = 0.003，闭眼p = 0.004）和T2（SDx：睁眼p = 0.0015，闭眼p = 0.032）时均有所改善。康复组在平衡参数方面呈现出比教育组更明显的改善趋势，尤其是在闭眼状态下测量的参数（T1时0.004 < p < 0.048，T2时0.004 < p < 0.036）。监督训练和家庭锻炼可改善强直性脊柱炎患者的平衡功能。闭眼试验显示出更明显的改善趋势，这可能表明康复对本体感觉有积极影响。
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