Evidencia científica de la rehabilitación en la espondilitis anquilosante / Scientific evidence on rehabilitation in ankylosing spondylitis

Objetivo. Revisar la evidencia que justifica el tratamiento rehabilitador de la espondilitis anquilosante (EA) mediante ejercicio y educación, y analizar el contenido más adecuado. Estrategia de búsqueda. Revisión sistemática de estudios controlados, revisiones sistemáticas, metaanálisis y guías de práctica clínica de las bases de datos MEDLINE, SCOPUS, Web of Knowledge, Cochrane Library y PEDro desde enero de 2008 a diciembre de 2013. Selección de estudios. Se seleccionaron 14 artículos. Resultados. Todos los estudios, así como las publicaciones de revisión, que investigan la eficacia del ejercicio terapéutico, exponen beneficios en los diferentes parámetros funcionales que definen la enfermedad. Se prefieren los ejercicios grupales supervisados, ya sean dentro o fuera del agua y, en su defecto o de manera complementaria, en el domicilio. Deben tenerse presentes las motivaciones, deseos, expectativas y fatiga del paciente. Los programas de rehabilitación han demostrado ser costo-eficaces. Conclusión. La rehabilitación se muestra eficaz para el tratamiento de la EA (AU)

Objective. To review the evidence on the rehabilitation treatment of ankylosing spondylitis (AS) through exercise and education and to analyze the most appropriate content. Search strategy. We carried out a systematic review of controlled trials, systematic reviews, meta-analyses and clinical practice guidelines in MEDLINE, SCOPUS, Web of Knowledge, Cochrane Library, and PEDro published from January 2008 to December 2013. Study selection. 14 articles were selected. Results. All studies, as well as review articles, that investigated the efficacy of therapeutic exercise demonstrated benefits in the various functional parameters of the disease. Supervised group exercises are preferred, whether in or out of water, or even at home as a supplement or alternative. Factors that should be considered are patients’ motivations, desires, expectations, and fatigue. Rehabilitation programs have been demonstrated to be cost-effective. Conclusion. Rehabilitation is effective in the treatment of AS (AU)

[Spondyloarthropathies--clinical evaluation and physical therapy]. / Fizikalna terapija i klinicka evalucija uspjesnosti lijecenja bolesnika sa spondiloartropatijama.

Spondyloarthropathy is a group of chronic autoimmune disorders including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, arthritis associated with inflammatory bowel disease, acute anterior uveitis and undifferentiated spondyloarthropathies. The spondyloarthropathies share common clinical, radiological, and genetic features that are clearly distinct from other inflammatory rheumatic diseases. The major goal in the management of patients with rheumatic disorders is to control or cure the disease and to preserve and control function and health status. To measure treatments' efficacy standardized assessment of organ morphology, function, and of health status are required. The instruments for measuring health status or quality of life cover a variety of dimensions of health, including physical, social, and emotional functioning. Measurements used to evaluate the efficacy of treatments in ankylosing spondylitis include spinal and chest movement, duration and severity of morning stiffness, and quality of sleep. Health status indices such as the HAQ or AIMS are not readily applicable to spondyloarthropaties. It is reason to use some others: 1. Functional status measure S-HAQ for patients with spondylitis by adding five items to the HAQ, to cover the activities identified as most problematic; 2. Functional index for the assessment of ankylosing spondylitis (Dougados Functional Index - DFI) - it is valid and reliable and shows sufficient responsiveness; S-HAQ appears at least as sensitive to change as the Dougados Index; 3. The Leeds Disability Questionnaire assesses disability in ankylosing spondylitis, inquiring about four areas of function: mobility, bending down, reaching up and neck movements, and postures; 4. The Bath Ankylosing Spondylitis Functional Index (BASFI) 10 item self-administered questionnaire to assess function and activities of daily living in patients with ankylosing spondylitis. Physical therapy is one of the most important way to restore function and health status in patients with spondyloarthropathies, esspecially individual kinesitherapy. We use and many other procedures combine them with kinesitherapy (ultrasound, cryotherapy, electrotherapy, laser ...).