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Physiotherapy (PS) is essential for axial spondyloarthritis (axSpA) and low back pain (LBP) management. Painful symptoms may arise from spine inflammation in axSpA,1 in non-specific (NS)LBP specific causes are lacking.2 Regardless of the disease background, mental health (MH) may influence outcomes. Anxiety and depression might support disability and transition to chronicity in NSLBP3 and worsening of disease activity (DA) or quality of life (QoL) in axSpA.4 Considering the beneficial effect of physical activity on MH disorders including depression,5 6 we examined the effect of PS on disease and MH outcomes in axSpA and NSLBP.
The 48 weeks (w) lasted study with once a week supervised group (SG)PS comprised three questionnaire (Q) surveys at baseline, w16 and w48. Briefly, the 1 hour SGPS lesson guided by physiotherapist was focused on core strengthening, core stabilisation muscles activation, spine traction and balance followed by cardiorespiratory fitness and relaxation. Each Q-survey comprised assessment of MH, QoL (5D-EQ), pain intensity (PI, numeric rating scale (NRS)), DA (ankylosing spondylitis (AS) DA score, ASDAS), function (AS Bath functional index, BASFI) and questions for work and sport habits. The self-reported MH questionnaires contained 21 questions reflecting anxiety (Beck anxiety inventory, BAI) and somatic, cognitive and affective signs of depression (Beck depression inventory, BDI-II).
The study followed Declaration of Helsinki, and was approved by the local Ethical Committee and participants provided informed consent. The stable disease and therapy (axSpA), clinical diagnosis of acute NSLBP episode in last 3 months, age (18–60), medical history information were inclusion criteria. Exclusion criteria covered osteoporosis, fibromyalgia, fractures, disk bulging, autoimmune disorders, cancer, chronic infections, pregnancy, current surgery or psychiatric therapy including antidepressants.
Fifty-five individuals attended and 43 of them completed w48. The survival in the study was similar in both groups (table 1). A number of individuals dropped out due to Pregnancy (2), surgery (2), personal reasons (2), changes in axSpA pharmacotherapy (1), infection (1) and absence in three consecutive lessons (4).
Demographic parameters and variation of the pain intensity, quality of life, working habits, disease activity, function and psychological outcomes in axSpA and NSLBP
At baseline, all variables were almost comparable between axSpA and NSLBP, but the intergroup differences in PI and BDI-II scores significantly changed at w16 and w48 (table 1). In NSLBP, the PI score significantly decreased at w16 (p=0.040) and sustained at w48 (p=0.042). The change (∆) of PI significantly differed between axSpA and NSLBP in period I (baseline to w16): 0.59; SD: 2.12 and −1.11; SD: 1.99, respectively, p=0.009 and in period II (baseline to w48):0.88; SD: 2.27 and −1.33; SD: 2.27, respectively, p=0.009 (data not shown).
The ∆BDI-II did not differ between axSpA and NSLBP in period I (−0.48±2.56 and −0.73; SD: 2.56, respectively), and period II (−0.50; SD: 2.66 and −1.00; SD: 2.66, respectively), p=ns, data not shown. Of three dimensions the BDI-II at baseline, the somatic scores were significantly higher in axSpA (2.47; SD: 2.54) and NSLBP (1.92; SD: 2.38) compared to the affective and cognitive tasks (axSpA: 1.00; SD: 1.26 and 0.70; SD: 1.71 and NSLBP: 0.48; SD: 0.91 and 0.56; SD: 1.21, respectively), all p<0.01. The scores for the affective and somatic dimensions of the BDI-II at w48 were significantly decreased in NSLBP (0.06±0.24 and 0.82±1.24, respectively) but not in axSpA (0.81; SD: 1.17 and 2.67; SD: 1.87, respectively), with both p<0.01 (data not shown).
Of all participants reaching w48, ∆BDI-II decreased significantly in females compared to males during period I (−2.06; SD: 2.89 to 0.19; SD: 1.92; p=0.008) and II (−2.19; SD: 2.99 to 0.19; SD1.92; p=0.004; data not shown).
In axSpA, the BASFI worsened during period I and II and the ASDAS-CRP between w16 and w48; all p<0.05 (table 1).
We conclude, regular SGPS may improve MH and disease outcomes in NSLBP but not axSpA during 1-year follow-up. In axSpA on stable therapy, once a week SGPS only might not be sufficient for maintaining disease activity and function.
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Ethics approval
The study was approved by the Prague Faculty of Physical Education and Sport at Charles University in Prague, Czech Republic (Number: 193/2017). Participants gave informed consent to participate in the study before taking part.
Acknowledgments
All authors would like to thank Mr Dr Petr Fučík for statistical analysis and consultation. Mrs Alena Swienteková, Mrs Barbora Smetanová and Mr Václav Dráb for technical support.
Footnotes
Contributors MH: design of the study, contribution to the acquisition of the patients with axSpA data, analyses and interpretation of the data and contribution to the acquisition of the patients with NSLBP data, interpretation of the data, responsibility for the correct inclusion and exclusion patients from the study, selection of questionnaires for axSpA and patients with NSLBP, preparation of questionnaires for use and interpretation of the data, analyses of the data, communication with statistics, drafting a paper, revising a paper and final approval of the paper. AL: design of the study, contribution to the acquisition of the patients with NSLBP data, interpretation of the data, leader of the exercise lessons as physiotherapists' schedule and design of the exercise lessons, selection of type of exercises, provision of questionnaires for axSpA and NSLBP at the beginning and during follow-up, revising of the paper and final approval of the paper. KD: contribution to the acquisition of the patients with NSLBP data, back-up for AL during exercise lessons, consultation about the composition of the exercise lesson including type of selected exercises, revising a paper and final approval of the paper. DD: selection of psychological questionnaires and interpretation of the data, revising a paper and final approval of the paper. KP: contribution to the acquisition of the patients with axSpA data, interpretation of the data, consultation about design of the study, consultation about the analysed data and results of the study, revising of the paper and final approval of the paper.
Funding This study was supported by Development of science at Charles University in Prague: COOPERATIO, by the Ministry of Health, Czech Republic: Project for the conceptual development of research organisation 00023728 Institute of Rheumatology and by the Czech Health Research Council: NU21-09-00297.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.