Abstract

Objective Evidence regarding the impact of multimodal treatment on disease activity and functional performance in ankylosing spondylitis (AS) remains scarce. This study aims to evaluate changes in these outcomes after multimodal rehabilitation, using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Functional Index (BASFI).

Methods Mixed-effects linear regression was performed on prospectively collected registry data to explore associations between timepoints and BASDAI/BASFI. Predicted linear margins from fixed effects were calculated for each timepoint. Data were derived from AS patients who underwent multimodal rehabilitation and completed questionnaires at baseline (T0), post-intervention (T1), and at 3 (T2), 6 (T3), and 9 (T4) months follow-up.

Results Twohundred-fourtynine AS patients were included (52.14 ± 10.20 years; 42.57% female, BMI: 26.64 ± 4.27 kg/m2). Compared to baseline, BASFI/BASDAI improved significantly until 6 and 9 months, respectively. Predicted BASDAI scores at T0, T1, T2 and T3 were 2.99 (95%CI 2.77; 3.21), 2.31 (2.08; 2.53), 2.38 (2.15; 2.61) and 2.69 (2.46; 2.92). At T4 the score was higher than at T0 (3.04 (2.81; 3.28)). Compared to T0, BASDAI score at T1 reflected a clinically relevant change. Predicted BASFI scores at T0, T1, T2, T3 and T4 were 4.09 (3.88; 4.31), 2.71 (2.49; 2.94), 2.83 (2.60; 3.06), 3.24 (3.01; 3.46) and 3.59 (3.36; 3.82). Compared to T0, BASFI scores at T1, T2 and T3 reflected a clinically relevant change.

Conclusion Significant improvements in physical functioning and disease activity among AS patients following multimodal rehabilitation were found. Such interventions may serve as a valuable complement to pharmacological treatment.

What is really known on this topic

What this study adds

To our knowledge this is the first study to evaluate changes in BASFI and BASDAI in context of multimodal spa therapy.

Significant improvements in both BASFI and BASDAI up to 9 months after treatment.

How this might affect research, practice, or policy

The findings may complement the lack of knowledge in context of disease activity and physical performance after multimodal treatment interventions.

The study might also emphasize the determination of adequate treatment intervals.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive any funding

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics Committee of the County of Salzburg (Amt der Salzburger Landesregierung, Ethikkommission fuer das Bundesland Salzburg, Postfach 527, 5010 Salzburg gave ethical approval for this work.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors

AbbreviationsASASAssessment of Spondyloarthritis international SocietyBASDAIBath Ankylosing Spondylitis Disease Activity IndexBASFIBath Ankylosing Spondylitis Functional IndexBMIbody mass indexCIconfidence intervalEULAREuropean League Against RheumatismJAKJanus kinaseNSAIDnonsteroidal anti-inflammatory drugPROpatient-reported outcomeQoLquality of lifeRCTrandomized controlled trialRMDrheumatic musculoskeletal disorderSpAspondyloarthropathyTNFiTNF-α inhibitor