Spondyloarthritis (SpA) refers to a group of rheumatic diseases that share common clinical, genetic and imaging features. They are divided into two: axial (axSpA) and peripheral. In addition to the pain caused by sacroiliitis and spondylitis, which are the main complaints, patients often experience joint stiffness, fatigue, mood disturbances and various degrees of functional limitations, and the quality of life of individuals can be significantly affected. Although there is consensus about the positive effects of exercise in AxSpA, no exercise regimen has been shown to be superior to another. Another exercise model whose effectiveness has been researched in recent years is "clinical pilates exercises". It is a version of the Pilates exercises created by Joseph Pilates, modified by physiotherapists to emphasize the most valuable components in the diagnosis and management of injuries and to increase their safety. Clinical Pilates exercises are an exercise model based on spinal stabilization principles. In addition, it has the principles of awareness, balance, breathing, concentration, centering, control, efficiency, flow, sensitivity, isolation and harmony. There are many studies investigating the effects of these exercises in the field of rehabilitation and highlighting improvements in different diseases, including ankylosing spondylitis, which is considered the prototype of axSpA. No study has been found examining exercise training applied via telerehabilitation to individuals with AxSpA and its effects. The aim of this study is to compare the effects of telerehabilitation and face-to-face clinical pilates-based exercise training on individuals with axial spondyloarthritis. Volunteers who meet the inclusion criteria will be randomly divided into 'telerehabilitation training group' and 'face-to-face training group' using the sealed envelope method. The individualized rehabilitation program will be applied to each group for 1 hour, 3 days a week, for 8 weeks. Disease-specific performance measurements and patient-reported scales that evaluate patients' disease activity, functionality, mood, quality of life, fear-avoidance, levels and perceptions of the disease will be applied to individuals three times in total: at the beginning, after the 8-week rehabilitation program and 6 months after the second evaluation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
50
Clinical Pilates-Based exercise training based on spinal stabilization aim at controlling the position of the trunk over the pelvis to provide optimal energy production and energy transfer to distal segments and involve the cocontraction of muscles, which may restore stability to the spine.
Hacettepe University, Faculty of Physical Therapy and Rehabilitation
Ankara, Turkey (Türkiye)
Evaluation of Functional Level
Bath Ankylosing Spondylitis Functional Index (BASFI): The index consists of 10 questions in total. For each item, the patient marks the VAS consisting of a 100 mm line. The score range is 0-100. The Turkish version study was conducted by Karatepe et al. made by. A high score indicates a bad result.
Time frame: 5 minutes, through study completion, an average of 8 weeks, change from baseline functional level at 8 weeks.
Evaluation of Disease Activity
Bath Ankylosing Spondylitis Disease Activity Index (BASDAI): The index consists of 6 items questioning 5 symptoms in total. The response of each item is evaluated with the Visual Analog Scale (VAS). A total score of ≥ 4 indicates active disease. Turkish version study Akkoç et al. made by.
Time frame: 3 minutes, through study completion, an average of 8 weeks, change from baseline disease activity at 8 weeks.
Evaluation of Spinal Mobility and Hip Function
Bath Ankylosing Spondylitis Metrology Index (BASMI): The index, which consists of five clinical measurements, namely cervical rotation, tragus-wall distance, lumbar lateral flexion, modified Schober's test, and intermalleolar distance, is accepted as the most valid method for evaluating the axial skeleton. The higher the BASMI score the more severe the patient's limitation of movement.
Time frame: 10 minutes, through study completion, an average of 8 weeks, change from baseline spinal mobility and hip function at 8 weeks.
Evaluation of Quality of Life
Ankylosing spondylitis quality of life questionnaire (ASQoL): ASQoL, which is one of the most commonly used disease-specific scales to measure the quality of life in axspa, consists of 18 items and total score ranges from 0-18. A high score indicates bad quality of life. The Turkish version study was conducted by Duruoz et al. made by.
Time frame: 1 minutes, through study completion, an average of 8 weeks, change from baseline quality of life at 8 weeks.
Evaluation of Biopsychosocial Status
BETY-Biopsychosocial Questionnaire (BETY-BQ): Each of the questions in this scale, which consists of 30 different cognitive belief statements, is scored between 0-4. The total score ranges from 0 to 120. A high score indicates a poor biopsychosocial level. It is a scale developed by Ünal et al.
Time frame: 10 minutes, through study completion, an average of 8 weeks, change from baseline biopsychosocial status at 8 weeks.
Evaluation of Depression and Anxiety Levels
Hospital Anxiety and Depression Scale (HADS):This scale consisting of 14 questions, odd-numbered questions question anxiety and even questions question depression. The options take values between 0-3, with a high score indicating a bad emotional state. The cut-off values of the scale were determined as 10 for the anxiety subscale and 7 for the depression subscale. The Turkish version study was done by Aydemir et al.
Time frame: 7 minutes, through study completion, an average of 8 weeks, change from baseline depression and anxiety levels at 8 weeks.
Evaluation of Kinesiophobia
Tampa Kinesophobia Scale (TCS): It is a 17-question scale that evaluates injury avoidance and fear of movement, and Kori et al. developed by. The Turkish version is from Tunca-Yılmaz et al. Made by. Its scoring is scored with "1 = Strongly disagree, 4 = Strongly agree". The score is calculated by reversing items 4, 8, 12, and 16. The total score is between 17 and 68. It is understood that the higher the score, the higher the kinesophobia. A total score of more than 37 is considered to be a high degree of kinesophobia.
Time frame: 5 minutes, through study completion, an average of 8 weeks, change from baseline kinesiophobia at 8 weeks
Evaluation of Illness Perception
Brief Illness Perception Scale (BIPQ): In this scale, which consists of 9 questions, each question evaluates a component of the perception of illness. The first eight questions take values between 0-10. A high score indicates an increased level of perception of the disease as worrisome. The total score ranges from 0 to 80. The ninth question is an open-ended question that questions the patient's opinion about the possible causes of the disease. Turkish validity and reliability study was done by Karataş et al.
Time frame: 3 minutes, through study completion, an average of 8 weeks, change from baseline illness perception at 8 weeks.
Evaluation of Physical Performance
Ankylosing Spondylitis Performance Index (ASPI): Objective measurement of functional level ASPI consists of standardized performance tests of 3 items evaluated with patient feedback in the BASFI form: (1) picking up 6 pencils one by one by bending forward at the waist; (2) put on socks (3 repetitions); and (3) standing from supine position (3 repetitions). During tests, patients are allowed to use a chair or desk/table to sit or lean on. The time to complete a task is measured and recorded in seconds for each test. Additionally, for each test, test-related pain and effort are recorded with patient-reported scores (numerical rating scale (NRS) and Borg scale, respectively).
Time frame: 10-15 minutes, through study completion, an average of 8 weeks, change from baseline physical performance at 8 weeks.
Evaluation of rib cage mobility: Chest Expansion Measurement
Chest expansion is an ASAS recommended assessment to measure rib cage mobility. The patient is asked to place his hands behind his head. Chest circumference is measured at the fourth intercostal space during maximal inspiration and maximal expiration. Two repetitions are made and the better value is recorded.
Time frame: 2 minutes, through study completion, an average of 8 weeks, change from baseline chest expansion at 8 weeks.
Side Bridge Endurance Test: Evaluation of spinal stabilization
Side bridge tests are measured by recording the time in seconds in which the patient maintains the position in which he/she is lying on his/her side on the mat, extending both legs straight and lifting his hips off the mat with the support he receives from his elbows and feet. The test is terminated when the person cannot maintain this position. Both sides are measured and averaged.
Time frame: Testing time depends on the patient, through study completion, an average of 8 weeks, change from baseline spinal stabilization at 8 weeks.
Exercise Self-Efficacy Scale (ESES): Assessment of exercise self-efficacy
The ESES scale, developed by Bandura (1997), consists of 18 items that question a person's beliefs about their competence in exercising. The participant scores his/her self-confidence between 0 and 100 for each item asked. The validity and reliability of the scale in Turkish was conducted by Bozkurt et al.
Time frame: 5 minutes, through study completion, an average of 8 weeks, change from baseline self-efficacy at 8 weeks.
ASAS (Assessment of SpondyloArthritis International Society) Health Index (ASAS-HI): Evaluation of health and disability
The ASAS Health Index was developed by the International Society for the Assessment of SpondyloArthritis (ASAS) to assess the health of patients with all forms of spondyloarthritis (especially radiographic and non-radiographic axial SpA). It is a self-report survey and measures functionality and health in patients with 17 questions. It has Turkish validity and reliability.
Time frame: 5 minutes, through study completion, an average of 8 weeks, change from baseline disability at 8 weeks.
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