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Kiefer D, Braun J, Kiltz U, Kolle N, Schneider L, Andreica I, Buehring B, Sewerin P, Herbold S, Baraliakos X. Patients' awareness towards physical activity in the treatment of axial spondyloarthritis. Joint Bone Spine 2023; 90:105585. [PMID: 37127259 DOI: 10.1016/j.jbspin.2023.105585] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/01/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION The course of axial spondyloarthritis (axSpA) is often characterized by impairments in physical function and mobility. Regular physical activity (PA) is a cornerstone of axSpA management. Recent European League Against Rheumatism (EULAR) recommendations for PA have stressed the importance of their implementation. OBJECTIVE Cohort study to investigate the awareness on and individual implementation of axSpA patients towards PA. METHODS Patients with axSpA and impaired physical function (Bath AS Functional Index [BASFI] score≥2.0) were recruited consecutively. All patients underwent a clinical examination including assessments of disease activity, physical function, mobility and global functioning. Patients also had to fill out structured questionnaires on knowledge, awareness and individual attitudes to PA. RESULTS Out of a total of 100 patients enrolled, 96 were included. Most respondents (n=82, 85.4%) were aware that PA has significant health benefits for patients with axSpA. Even though less than half of the patients (n=44, 42.7%) were aware that actual EULAR recommendations do exist, 45 patients (46.9%) did already fulfill these in terms of frequency/week. The majority of patients (n=61, 67.7%) had been informed about the benefits of PA by their physician, and physiotherapy had often been prescribed (n=61, 63.3%). Many patients (n=51, 53.1%) reported to perform individual exercise programs, and some (n=22, 22.9) supervised PA. CONCLUSION Even though the majority of axSpA patients are not aware of the recent EULAR recommendations for PA, many understand and agree that PA is beneficial for their health status. Health care providers should concentrate on the patients who are not active and do not know about the benefits of PA.
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Affiliation(s)
- David Kiefer
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany.
| | - Juergen Braun
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Niklas Kolle
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Lucia Schneider
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Ioana Andreica
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Bjoern Buehring
- Bergisches Rheuma-Zentrum Wuppertal, Ruhr-University Bochum, Wuppertal, Germany
| | - Philipp Sewerin
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany; Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Susanne Herbold
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum, Claudiusstrasse 45, 44649 Herne, Germany
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Klemm P, Preusler P, Hudowenz O, Asendorf T, Müller-Ladner U, Neumann E, Lange U, Tarner IH. Multimodal rheumatologic complex treatment in patients with spondyloarthritis - a prospective study. Eur J Intern Med 2021; 93:42-49. [PMID: 34344550 DOI: 10.1016/j.ejim.2021.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/05/2021] [Accepted: 07/15/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Aim of this study was to prospectively assess the effects of multimodal rheumatologic complex treatment (MRCT), a special concept of in-patient physical treatment (PT) for treating spondyloarthritis (SpA), namely radiographic (r-) and non-radiographic (nr-) axial (ax-) SpA and psoriatic arthritis (PsA). METHODS r-, nr-axSpA and PsA patients receiving a 16-day MRCT were eligible. MRCT was delivered to participants over 64 PT sessions of various modalities with a minimum of 1,400 min of treatment. Primary outcome was a change in pain levels measured on a numeric rating scale (NRS, 0 - 10) between baseline and discharge. Secondary outcomes were assessments of i) disease activity ii) functional disabilities iii) serum cytokine levels iv) analgesic usage v) patient global health assessment and patients' satisfaction with their therapeutic response to MRCT from baseline to discharge and over a 12-week follow-up. RESULTS 50 patients completed the study and were analysed. Pain levels were improved significantly (p < 0.001, 95% confidence interval -2.25 to -0.8,). Further analyses revealed no influencing factors or relevant inter-group differences. Positive effects of MRCT lasted up to 12 weeks after discharge. Analgesic usage was reduced compared to baseline. Patient global health assessment continued to be improved throughout the whole follow-up. No MRCT-related harms were recorded. CONCLUSION MRCT as a multimodal treatment concept with a strong emphasis on PT reduces pain in SpA meaningfully and facilitates reduced analgesic usage.
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Affiliation(s)
- Philipp Klemm
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany.
| | - Paulina Preusler
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Ole Hudowenz
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, 37073 Göttingen, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Elena Neumann
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Uwe Lange
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Ingo H Tarner
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
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Braun J, Baraliakos X, Kiltz U. Treat-to-target in axial spondyloarthritis - what about physical function and activity? Nat Rev Rheumatol 2021; 17:565-576. [PMID: 34312518 DOI: 10.1038/s41584-021-00656-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 02/07/2023]
Abstract
In patients with axial spondyloarthritis (axSpA), pain, functional and structural impairments, reduced mobility and potential deformity of the axial skeleton are the most prominent health concerns. Limitations in physical function and spinal mobility are caused by both inflammation and structural damage, and therefore restrictions to physical function must be monitored throughout a patient's life. Consequently, the assessment of physical function is recommended as a key domain in the Assessment of Spondyloarthritis International Society-OMERACT Core Outcome Set. However, in comparison with disease activity, physical function seems to be a relatively neglected target of intervention in patients with axSpA, even though physical function is a major contributor to costs and disability in this disease. This Review aims to reacquaint rheumatologists with the targets for physical function, physical activity and performance by giving guidance on determinants of physical function and how physical function can be examined in patients with axSpA.
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Affiliation(s)
- Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne, Ruhr Universität Bochum, Bochum, Germany.
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Herne, Ruhr Universität Bochum, Bochum, Germany
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne, Ruhr Universität Bochum, Bochum, Germany
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4
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Abstract
ZusammenfassungSchmerz als Hauptsymptom vieler chronisch-entzündlicher Erkrankungen stellt für den Patienten, aber auch für den behandelnden Arzt besonders in seiner chronifizierten Form eine große Herausforderung dar. Es gibt leider keine „Wunderpille“ mit der man Schmerzen für jeden gleich zuverlässig beseitigen kann. Es gibt aber viele Ansätze pharmakologischer als auch nicht-pharmakologischer Art und deren Kombination, um für den einzelnen Patienten wirksame Behandlungsstrategien zu finden. Um diese Strategien für jeden Patienten individuell optimal festzulegen, bedarf es zum einen eines fundamentierten Wissens über das Spektrum zur Verfügung stehender Mittel, zum anderen aber auch Erkenntnis darüber, wie diese sinnvoll nach Art der vorliegenden Schmerzformen einzusetzen sind. In dieser Übersicht wird beides behandelt, mit einem Fokus auf die medikamentöse Therapie von Schmerzen bei entzündlich-rheumatischen Erkrankungen. Dabei wird herausgearbeitet, dass es für die in diesem Zusammenhang relevantesten Formen des Schmerzes, akut-entzündlich nozizeptiv, neuropathisch und durch periphere und zentrale Sensibilisierung chronifizierte Schmerzen, jeweils andere wirksame Konzepte gibt.
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Affiliation(s)
- Georg Pongratz
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf
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Belz D, Moinzadeh P, Riemekasten G, Henes J, Müller‐Ladner U, Blank N, Koetter I, Siegert E, Pfeiffer C, Schmalzing M, Zeidler G, Schmeiser T, Worm M, Guenther C, Susok L, Kreuter A, Sunderkoetter C, Juche A, Aberer E, Gaebelein‐Wissing N, Ramming A, Kuhr K, Hunzelmann N. Large Variability of Frequency and Type of Physical Therapy in Patients in the German Network for Systemic Sclerosis. Arthritis Care Res (Hoboken) 2020; 72:1041-1048. [DOI: 10.1002/acr.23998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 05/28/2019] [Indexed: 11/07/2022]
Affiliation(s)
- D. Belz
- University Hospital Cologne Cologne Germany
| | | | | | - J. Henes
- University Hospital Tübingen Tübingen Germany
| | - U. Müller‐Ladner
- Justus Liebig University Giessen Campus Kerckhoff Bad Nauheim Germany
| | - N. Blank
- University Hospital Heidelberg Heidelberg Germany
| | | | - E. Siegert
- Charité, Universitätsmedizin Berlin Berlin Germany
| | | | | | - G. Zeidler
- Johanniter‐Krankenhaus im Fläming Treuenbrietzen Treuenbrietzen Germany
| | | | - M. Worm
- Charité, Universitätsmedizin Berlin Berlin Germany
| | - C. Guenther
- University Hospital Carl Gustav Carus Dresden Germany
| | - L. Susok
- St. Josef Hospital Bochum Bochum Germany
| | - A. Kreuter
- Helios St. Elisabeth Klinik Oberhausen Oberhausen Germany
| | | | - A. Juche
- Immanuel Krankenhaus Berlin‐Buch Berlin Germany
| | - E. Aberer
- Medical University of Graz Graz Austria
| | | | - A. Ramming
- University Hospital Erlangen Erlangen Germany
| | - K. Kuhr
- University of Cologne Cologne Germany
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Klemm P, Hudowenz O, Asendorf T, Dischereit G, Müller-Ladner U, Lange U, Tarner IH. Evaluation of a special concept of physical therapy in spondyloarthritis: German multimodal rheumatologic complex treatment for spondyloarthritis. Clin Rheumatol 2020; 39:1513-1520. [DOI: 10.1007/s10067-019-04887-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/20/2019] [Accepted: 12/09/2019] [Indexed: 12/27/2022]
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Klemm P, Hudowenz O, Asendorf T, Müller-Ladner U, Lange U, Tarner IH. Multimodale rheumatologische Komplexbehandlung bei rheumatoider Arthritis – eine monozentrische Retrospektivanalyse. MANUELLE MEDIZIN 2019. [DOI: 10.1007/s00337-019-0554-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Multimodale rheumatologische Komplexbehandlung bei rheumatoider Arthritis – eine monozentrische Retrospektivanalyse. Z Rheumatol 2019; 78:136-142. [DOI: 10.1007/s00393-019-0593-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Rheumatic diseases usually progress towards morphological and functional deficits and thus cause impairment of physical health and function. Based on this fact, physiotherapeutic options are elementary and indispensable. This article focuses on the significance and importance of physiotherapy in inflammatory and degenerative rheumatic diseases. Furthermore, an overview is presented on the consequences of rheumatic diseases, the reality of supply of physiotherapy, the principles and therapeutic options, and the evidence.
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