Relationship between spinal mobility measures and quality of life in patients with ankylosing spondylitis.

The aim of this study was to assess spinal mobility status and Quality of life (QoL) of patients with ankylosing spondylitis (AS) and determine the relationship between spinal mobility and measures of clinical condition including QoL. A total of 74 patients with AS were included in this study. Disease specific instruments Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) were applied, and mobility testing: occiput-wall distance and chest expansion. QoL was assessed by the Short Form-36 (SF-36). The mean age was 48.5 years; there were significant correlations between BASMI score and age (P < 0.001), disease duration (P < 0.001), symptoms duration (P < 0.001) and BASFI (P < 0.001). BASMI was negatively correlated with SF-36 physical function subscale (P < 0.001) and general health subscale (P = 0.029). In multivariate regression analysis, BASFI score (P < 0.001) was independently associated factor with physical function domain of SF-36. This study showed that in AS spinal mobility measures are associated with physical function, general health, emotional role and mental health domains of QoL.

Assessment of functional disability and quality of life in patients with ankylosing spondylitis.

INTRODUCTION: Ankylosing spondylitis is a chronic progressive autoimmune inflammatory disorder involving mainly the axial skeleton and larger peripheral joints that progressively limits spinal mobility and may lead to irreversible structural changes and consequently to impaired physical function and reduced quality of life. OBJECTIVE: The aim of this study was to assess functional disability and quality of life of patients with ankylosing spondylitis and determine the correlation between functional disability and quality of life. METHODS: The study enrolled 74 patients with ankylosing spondylitis (16 females and 58 males). The demographic data of the patients were collected. Functional disability was assessed with the Bath Ankylosing Functional Index (BASFI). Quality of life was assessed by the Short-Form 36 (SF-36) and the European Quality of Life Questionnaire (EuroQoL/EQ-5D). RESULTS: In our study, the mean age was 48.5 +/-10.3 years. BASFI was negatively correlated with the SF-36 physical function subscale (p < 0.001), physical role (p = 0.002), bodily pain (p = 0.003), general health (p < 0.001), vitality (p = 0.012) and mental health (p = 0.010) subscale. There was a significantly inverse correlation between the BASFI score and the rating scale of EQ-5D (p = 0.001). In the regression model, the BASFI score (p = 0.000) showed an independent association with the physical function domain of SF-36. CONCLUSION: In conclusion, the BASFI index was associated with physical function, physical role, bodily pain, general health, vitality and mental health domains of SF-36 and also with the rating scale of EQ-5D.

[Assessment of health-related quality of life of patients with chronic arthritis].

The assessment of the quality of life as a subjective measure of therapeutic intervention outcome appears to be increasingly adopted by different fields of medicine. In contrast to conventional indicators of condition, which are recognized as objective outcomes, the health-related quality of life (HRQoL) focuses on the patient himself. HRQoL has been determined as the perception of the individual of his or her situation in the current culture and value system; it includes wishes, expectations and emotional responses of the individual related to his or her health. Chronic arthritis leads to irreversible structural changes in joints and consequently to impaired physical function and reduced HRQoL. Today there are validated disease specific ("target") questionnaires to assess HRQoL in patients with rheumatoid arthritis and ankylosing spondylitis, but not yet in patients with psoriatic arthritis. A disease specific questionnaire makes easier approach to patients suffering from a specific rheumatic condition; it enables the comparison of HRQoL among patients suffering from the different types of chronic arthritis. The most frequently used questionnaire in the assessment of the HRQoL of patients suffering from chronic arthritis is the generic MOS 36-Item Short-Form Health Survey (SF-36) which is considered as the "gold standard". It is a generic questionnaire for the assessment of HRQoL in patients with chronic arthritis. To our knowledge, there are only a few studies focused on the HRQoL of patients suffering from chronic arthritis in Serbia and Montenegro.

[Dysphagia rehabilitation].

Dysphagia and aspiration are important problems among the elderly population, particularly in neurological patients and patients with cancers of the oropharingeal area or laryngs. Early detection and rehabilitation are crucial because adequate management can reduce morbidity and complications like aspiration pneumonia, dehidratation and malnutrition. We overviewed rehabilitation procedures including nutritional management, postures, maneuvers, exercises and stimulation techniques and their efficacy in treatment of patients with dysphagias.

[Influence of physical treatment on disease activity and health status of patients with chronic arthritis].

INTRODUCTION: This is an open uncontrolled study about effects of physical treatment on disease activity parameters of patients with rheumatoid arthritis and psoriatic arthritis. OBJECTIVE: The aim of the study was to establish if there was any improvement of disease activity parameters after four weeks of physical and spa treatment. METHOD: We compared morning stiffness, tender and swollen joint count, body pain level and Disease Activity Score 28 (DAS-28) in patients with rheumatoid and psoriatic arthritis, and assessed the effect of physical and spa treatment on those parameters. The research encompassed 109 patients: 69 with rheumatoid arthritis (RA group) and 40 with psoriatic arthritis (PA group). They were from Norway, staying for four weeks in June-September 2003. The groups served as their own controls--"one group pre-test post test" study. Disease activity measurement was made twice: at the beginning and at the end of treatment. The therapeutic set consisted of mud applications, kinesitherapy, mineral water pool and electrotherapy. RESULTS: At the beginning there was no significant difference in observed disease activity parameters between patients with rheumatoid and psoriatic arthritis (p > 0.05). After four weeks of physical and spa treatment disease activity was significantly reduced in all observed parameters in both groups: morning stiffness (p < 0.001 RA + PA), tender joint count (p < 0.01 RA + PA), swollen joint count (p < 0.01 RA; p < 0.05 PA), body pain (p < 0.01 RA + PA) and DAS-28 score (p < 0.01 RA+PA). CONCLUSION: Physical and spa treatment, together with climatic factors in Igalo, lead to a significant reduction of disease activity parameters of patients suffering from rheumatoid arthritis and psoriatic arthritis.

[Beneficial effects of spa treatment on functional status and quality of life of patients with rheumatoid arthritis].

INTRODUCTION: Rheumatoid arthritis (RA) is a chronic constantly deteriorating disease of unpredictable clinical course, with exacerbations, remissions and damaged joints. It leads to the loss of self-sufficiency, independence in performing many daily activities, decrease of working ability and invalidity. Beside physical factors, which are regarded as most responsible for the poorer quality of life of RA patients, psychological changes are also significant, such as the feeling of helplessness, hopelessness and depression. The goal of the treatment of patients with RA is to decrease illness symptoms, slow down the development of illness progression, improvement of physical functioning and provision of expert help to the RA patients to adapt to life. OBJECTIVE: The aim of the study was to assess the influence of spa therapy on the functional condition and life quality of RA patients. METHODS: The study involved 69 patients with RA (51 female and 18 male, on average aged 55.2 +/- 11.4 years, with illness duration 12.5 +/- 7.5 years), and were a part of a cohort from Norway, suffering of inflammatory rheumatism. All the patients came for four-week rehabilitation at the Institute for Physical Medicine, Rehabilitation and Rheumatology "Dr. Simo Milosevic" in Igalo, Montenegro. The RA patients underwent treatment with mud compresses, mud, mineral and pearl baths, as well as with underwater shower massage (balneotherapy) kinesitherapy and certain forms of electrotherapy with analgesic effects. The evaluation was done on admission and after completed physical therapy when we assessed RA patients' functional condition and quality of life. The functional condition was determined using the Modified Health Assessment Questionnaire (MHAQ), and the quality of life using the Medical Outcomes Study Short Form 36-item Questionnaire (SF-36), which encompassed eight life domains. RESULTS: After completion of 28-dayspa therapy, RA patients showed a significant improvement in functional condition. Their quality of life was significantly improved in all dimensions of SF-36 Questionnaire (p < 0.01), and the functional status (MHAQ score) was also significantly better (p < 0.01). CONCLUSION: Balneotherapy, together with climatic factors in Igalo, leads to a significant improvement of functional status and quality of life in patients suffering from RA.

[The impact of physical therapy on the quality of life of patients with rheumatoid and psoriatic arthritis].

INTRODUCTION: This open, uncontrolled study examined the effects of physical therapy and rehabilitation on the quality of life in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). MATERIAL AND METHODS: The study included a total of 109 patients (69 with RA and 40 with PsA). Patients came from Norway for a four-week rehabilitation period at the Institute of Physical Medicine, Rehabilitation & Rheumatology--Igalo from June till October, 2003. This was a self-controlled, pretest/posttest study. All patients had six days of physical therapy per week, during a four-week stay, which made a total of 24 therapy days. Basic therapy included mud packs/baths, kinesitherapy, hydrokinesitherapy and electrotherapy with analgesic effects. Quality of Life measurements were conducted two times (on admission and discharge) using questionnaire EuroQoL (EQ-5D). The research also included evaluation of ACR improvement. RESULTS: Pain/disability scale and the well being scale showed that quality of life in patients with PsA was significantly lower in comparison with RA patients. However, after 4 weeks, quality of life was much better in most dimensions of the EuroQoL questionnaire. Patients showed no improvement in self-care activities (in both group.) and daily activities (in group with PsA). Significant improvement was measured also in ACR improvement criteria (around 30%). CONCLUSIONS: Physical therapy at the Igalo Institute and good climate conditions have significantly improved the Health-Related-Quality-of-Life in both groups of patients. ACR index showed great