Effectiveness of a supervised group exercise therapy based on the biopsychosocial model
introduced simultaneously with anti-TNF therapy in anti-TNF-naive patients with active
ankylosing spondylitis

Ünal, Edibe; Karaca, Nur Banu; Karakaya, Jale; Kalyoncu, Umut; KİRAZ, SEDAT

doi:10.55730/1300-0144.5359

Effectiveness of a supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with anti-TNF therapy in anti-TNF-naive patients with active ankylosing spondylitis

Nur Banu KARACA, (Hacettepe Üniversitesi, Fizik Tedavi ve Rehabilitasyon Fakültesi, Fizyoterapi ve Rehabilitasyon Bölümü, Ankara, Türkiye)

Edibe ÜNAL, (Hacettepe Üniversitesi, Fizik Tedavi ve Rehabilitasyon Fakültesi, Fizyoterapi ve Rehabilitasyon Bölümü, Ankara, Türkiye)

Jale KARAKAYA, (Hacettepe Üniversitesi, Tıp Fakültesi, Biyoistatistik Anabilim Dalı, Ankara, Türkiye)

Umut KALYONCU, (Hacettepe Üniversitesi, Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Ankara, Türkiye)

Sedat KIRAZ (Hacettepe Üniversitesi, Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Ankara, Türkiye)

Turkish Journal of Medical Sciences

1 1

Yıl: 2022 Cilt: 52 Sayı: 3 Sayfa Aralığı: 667 - 676 Metin Dili: İngilizce DOI: 10.55730/1300-0144.5359 İndeks Tarihi: 27-07-2022

Effectiveness of a supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with anti-TNF therapy in anti-TNF-naive patients with active ankylosing spondylitis

Öz:

Background/aim: This study aimed to investigate the effectiveness of a supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with antitumor necrosis factor (TNF) therapy in anti-TNF-naive patients with active ankylosing spondylitis (AS). Materials and methods: Forty-eight patients were divided into two groups: the control group (CG; n = 36) received only anti-TNF therapy, and the study group (SG; n = 12) received the supervised exercise therapy based on the biopsychosocial model in addition to anti-TNF therapy. The measurements of disease activity and functionality were evaluated by The Bath AS Disease Activity Index (BASDAI) and The Bath AS Functional Index (BASFI) respectively. Other outcome measures evaluated biopsychosocial status, emotional state, spinal mobility, pain, fatigue, sleep, and quality of life. All measurements were applied to both groups at baseline and repeated 12 weeks later. Results: BASDAI and BASFI analyses revealed significant differences between groups in favor of the SG (p < 0.05). At the end of the 12 weeks, the results showed that there were additional improvements in all outcome measurement parameters in the SG compared to the CG. Conclusion: The supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with anti-TNF therapy is more effective than only anti-TNF therapy in anti-TNF-naive patients with active AS.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Braun J, Sieper J. Ankylosing spondylitis. The Lancet 2007; 369 (9570): 1379-1390. doi: 10.1016/s0140-6736(07)60635-7
2. Pahwa D, Chhabra A, Arora MK. Anaesthetic management of patients with ankylosing spondylitis. Trends in Anaesthesia and Critical Care 2013; 3 (1): 19-24. doi: 10.1016/j.tacc.2012.11.001
3. Kotsis K, Voulgari PV, Drosos AA, Carvalho AF, Hyphantis T. Health-related quality of life in patients with ankylosing spondylitis: a comprehensive review. Expert Review of Pharmacoeconomics & Outcomes Research 2014; 14 (6): 857- 872. doi: 10.1586/14737167.2014.957679
4. Özdemir O. Quality of life in patients with ankylosing spondylitis: relationships with spinal mobility, disease activity and functional status. Rheumatology International 2011; 31 (5): 605-610. doi: 10.1007/s00296-009-1328-2
5. Martindale J, Shukla R, Goodacre J. The impact of ankylosing spondylitis/axial spondyloarthritis on work productivity. Best Practice & Research Clinical Rheumatology 2015; 29 (3): 512- 523. doi: 10.1016/j.berh.2015.04.002
6. Günaydin R, Karatepe AG, Çeşmeli N, Kaya T. Fatigue in patients with ankylosing spondylitis: relationships with disease-specific variables, depression, and sleep disturbance. Clinical Rheumatology 2009; 28 (9): 1045-1051. doi: 10.1007/ s10067-009-1204-1
7. Brophy S, Davies H, Dennis MS, Cooksey R, Husain MJ et al. Fatigue in ankylosing spondylitis: treatment should focus on pain management. Seminars in Arthritis and Rheumatism 2013; 42 (4): 361-367. doi: 10.1016/j.semarthrit.2012.06.002
8. Aydin E, Bayraktar K, Turan Y, Omurlu I, Tasbatan E et al. Sleep quality in patients with ankylosing spondylitis. Revista Brasileira de Reumatologia 2015; 55: 340-345. doi: 10.1016/j. rbre.2014.12.007
9. Ertenli I, Ozer S, Kiraz S, Apras SB, Akdogan A et al. Infliximab, a TNF-alpha antagonist treatment in patients with ankylosing spondylitis: the impact on depression, anxiety and quality of life level. Rheumatology International 2012; 32 (2): 323-330. doi: 10.1007/s00296-010-1616-x
10. Gatchel RJ, Kishino ND. The Biopsychosocial Approach to Pain Management 2008
11. Booth J, Moseley GL, Schiltenwolf M, Cashin A, Davies M et al. Exercise for chronic musculoskeletal pain: A biopsychosocial approach. Musculoskeletal Care 2017; 15 (4): 413-421. doi: 10.1002/msc.1191
12. Sari I, Ozturk MA, Akkoc N. Treatment of ankylosing spondylitis. Turkish Journal of Medical Sciences 2015; 45 (2): 416-430. doi: 10.3906/sag-1401-79
13. Braun J, van der Berg R, Baraliakos X, Boehm H, Burgos-Vargas R et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Annals of the Rheumatic Diseases 2011; 70 (6): 896-904. doi: 10.1136/ ard.2011.151027
14. Lubrano E, D’Angelo S, Spadaro A, Palazzi C, Olivieri I. Rehabilitation for ankylosing spondylitis in the era of biologics: any room left for this treatment? The Journal of Rheumatology 2011; 38 (7): 1228-1230. doi: 10.3899/jrheum.110362
15. Geenen R, Overman CL, Christensen R, Asenlöf P, Capela S et al. EULAR recommendations for the health professional’s approach to pain management in inflammatory arthritis and osteoarthritis. Annals of the Rheumatic Diseases 2018; 77 (6): 797-807. doi: 10.1136/annrheumdis-2017-212662
16. Varela H, Villamanan E, Plasencia C, Romero JA, Ruano M et al. Safety of antitumour necrosis factor treatments in chronic rheumatic diseases: therapy discontinuations related to side effects. Journal of Clinical Pharmacy and Therapeutics 2016; 41 (3): 306-309. doi: 10.1111/jcpt.12393
17. Pécourneau V, Degboé Y, Barnetche T, Cantagrel A, Constantin A et al. Effectiveness of exercise programs in ankylosing spondylitis: A meta-analysis of randomized controlled trials. Archives of Physical Medicine and Rehabilitation 2018; 99 (2): 383-389. doi: 10.1016/j.apmr.2017.07.015
18. Lubrano E, Spadaro A, Amato G, Benucci M, Cavazzana I et al. Tumour necrosis factor alpha inhibitor therapy and rehabilitation for the treatment of ankylosing spondylitis: a systematic review. Seminars in Arthritis and Rheumatism 2015; 44 (5): 542-550. doi: 10.1016/j.semarthrit.2014.09.012
19. Kisacik P, Unal E, Akman U, Yapali G, Karabulut E et al. Investigating the effects of a multidimensional exercise program on symptoms and antiinflammatory status in female patients with ankylosing spondylitis. Complementary Therapies in Clinical Practice 2016; 22: 38-43. doi: 10.1016/j. ctcp.2015.11.002
20. Karatepe AG, Akkoc Y, Akar S, Kirazli Y, Akkoc N. The Turkish versions of the bath ankylosing spondylitis and dougados functional indices: reliability and validity. Rheumatology International 2005; 25 (8): 612-618. doi: 10.1007/s00296-004- 0481-x
21. Akkoc Y, Karatepe AG, Akar S, Kirazli Y, Akkoc N. A Turkish version of the bath ankylosing spondylitis disease activity index: reliability and validity. Rheumatology International 2005; 25 (4): 280-284. doi: 10.1007/s00296-003-0432-y
22. Küçükdeveci AA, Sahin H, Ataman S, Griffiths B, Tennant A. Issues in cross-cultural validity: Example from the adaptation, reliability, and validity testing of a Turkish version of the Stanford Health Assessment Questionnaire. Arthrit Care and Research 2004; 51 (1): 14-19. doi: 10.1002/art.20091
23. Ünal E, Arın G, Karaca NB, Kiraz S, Akdoğan A et al. Romatizmalı hastalar için bir yaşam kalitesi ölçeğinin geliştirilmesi: madde havuzunun oluşturulması. Journal of Exercise Therapy and Rehabilitation 2017; 4 (2): 67-75 (in Turkish)
24. Verep U. Determination of the validity, reliability and responsiveness of the cognitive exercise therapy approach scale in patients with a diagnosis of ankylosing spondylitis. Master’s Thesis, Hacettepe University, Ankara, Turkey, 2020
25. Aydemir Ö, Güvenir T, Kuey L, Kültür S. Hospital Anxiety and Depression Scale Turkish Form: validation and reliability study. Turkish Journal of Psychiatry 1997; 8 (4): 280-287
26. Ağargün MY, Kara H, Anlar Ö. The validity and reliability of the Pittsburgh Sleep Quality Index. Turkish Journal of Psychiatry 1996; 7 (2): 107-115
27. Kocyigit H. Reliability and validity of the Turkish version of short form-36 (SF-36): a study in a group of patients will rheumatic diseases. Turkish Journal of Drugs Therapy 1999; 12: 102-106
28. Noureldin B, Barkham N. The current standard of care and the unmet needs for axial spondyloarthritis. Rheumatology 2018; 57 (6): vi10-vi7. doi: 10.1093/rheumatology/key217
29. Atzeni F, Carriero A, Boccassini L, D’Angelo S. AntiIL-17 Agents in the Treatment of Axial Spondyloarthritis. ImmunoTargets and Therapy 2021; 10: 141. doi: 10.2147/ITT. S259126
30. Liang H, Li WR, Zhang H, Tian X, Wei W et al. Concurrent intervention with exercises and stabilized tumor necrosis factor inhibitor therapy reduced the disease activity in patients with ankylosing spondylitis: a meta-analysis. Medicine 2015; 94 (50): e2254. doi: 10.1097/MD.0000000000002254
31. Spadaro A, De Luca T, Massimiani MP, Ceccarelli F, Riccieri V et al. Occupational therapy in ankylosing spondylitis: shortterm prospective study in patients treated with anti-TNF-alpha drugs. Joint Bone Spine 2008; 75 (1): 29-33. doi: 10.1016/j. jbspin.2007.07.006
32. Masiero S, Bonaldo L, Pigatto M, Nigro AL, Ramonda R et al. Rehabilitation treatment in patients with ankylosing spondylitis stabilized with tumor necrosis factor inhibitor therapy. A randomized controlled trial. The Journal of Rheumatology 2011; 38 (7): 1335-1342. doi: 10.3899/jrheum.100987
33. Yigit S, Sahin Z, Demir SE, Aytac DH. Home-based exercise therapy in ankylosing spondylitis: short-term prospective study in patients receiving tumor necrosis factor alpha inhibitors. Rheumatology International 2013; 33 (1): 71-77. doi: 10.1007/ s00296-011-2344-6
34. So MW, Heo HM, Koo BS, Kim YG, Lee CK et al. Efficacy of incentive spirometer exercise on pulmonary functions of patients with ankylosing spondylitis stabilized by tumor necrosis factor inhibitor therapy. The Journal of Rheumatology 2012; 39 (9): 1854-1858. doi: 10.3899/jrheum.120137
35. Ciprian L, Nigro AL, Rizzo M, Gava A, Ramonda R et al. The effects of combined spa therapy and rehabilitation on patients with ankylosing spondylitis being treated with TNF inhibitors. Rheumatology International 2013; 33 (1): 241-245. doi: 10.1007/s00296-011-2147-9
36. Masiero S, Poli P, Bonaldo L, Pigatto M, Ramonda R et al. Supervised training and home-based rehabilitation in patients with stabilized ankylosing spondylitis on TNF inhibitor treatment: a controlled clinical trial with a 12-month follow-up. Clinical Rehabilitation 2014; 28 (6): 562-572. doi: 10.1177/0269215513512214
37. Coksevim NH, Durmus D, Kuru O. Effects of global postural reeducation exercise and anti-TNF treatments on disease activity, function, fatigue, mobility, sleep quality and depression in patients with active Ankylosing spondylitis: A prospective follow-up study. Journal of Back and Musculoskeletal Rehabilitation 2018; 31 (6): 1005-1012. doi: 10.3233/BMR170901

APA	Karaca N, Ünal E, Karakaya J, Kalyoncu U, KİRAZ S (2022). Effectiveness of a supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with anti-TNF therapy in anti-TNF-naive patients with active ankylosing spondylitis. , 667 - 676. 10.55730/1300-0144.5359
Chicago	Karaca Nur Banu,Ünal Edibe,Karakaya Jale,Kalyoncu Umut,KİRAZ SEDAT Effectiveness of a supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with anti-TNF therapy in anti-TNF-naive patients with active ankylosing spondylitis. (2022): 667 - 676. 10.55730/1300-0144.5359
MLA	Karaca Nur Banu,Ünal Edibe,Karakaya Jale,Kalyoncu Umut,KİRAZ SEDAT Effectiveness of a supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with anti-TNF therapy in anti-TNF-naive patients with active ankylosing spondylitis. , 2022, ss.667 - 676. 10.55730/1300-0144.5359
AMA	Karaca N,Ünal E,Karakaya J,Kalyoncu U,KİRAZ S Effectiveness of a supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with anti-TNF therapy in anti-TNF-naive patients with active ankylosing spondylitis. . 2022; 667 - 676. 10.55730/1300-0144.5359
Vancouver	Karaca N,Ünal E,Karakaya J,Kalyoncu U,KİRAZ S Effectiveness of a supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with anti-TNF therapy in anti-TNF-naive patients with active ankylosing spondylitis. . 2022; 667 - 676. 10.55730/1300-0144.5359
IEEE	Karaca N,Ünal E,Karakaya J,Kalyoncu U,KİRAZ S "Effectiveness of a supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with anti-TNF therapy in anti-TNF-naive patients with active ankylosing spondylitis." , ss.667 - 676, 2022. 10.55730/1300-0144.5359
ISNAD	Karaca, Nur Banu vd. "Effectiveness of a supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with anti-TNF therapy in anti-TNF-naive patients with active ankylosing spondylitis". (2022), 667-676. https://doi.org/10.55730/1300-0144.5359

APA	Karaca N, Ünal E, Karakaya J, Kalyoncu U, KİRAZ S (2022). Effectiveness of a supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with anti-TNF therapy in anti-TNF-naive patients with active ankylosing spondylitis. Turkish Journal of Medical Sciences, 52(3), 667 - 676. 10.55730/1300-0144.5359
Chicago	Karaca Nur Banu,Ünal Edibe,Karakaya Jale,Kalyoncu Umut,KİRAZ SEDAT Effectiveness of a supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with anti-TNF therapy in anti-TNF-naive patients with active ankylosing spondylitis. Turkish Journal of Medical Sciences 52, no.3 (2022): 667 - 676. 10.55730/1300-0144.5359
MLA	Karaca Nur Banu,Ünal Edibe,Karakaya Jale,Kalyoncu Umut,KİRAZ SEDAT Effectiveness of a supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with anti-TNF therapy in anti-TNF-naive patients with active ankylosing spondylitis. Turkish Journal of Medical Sciences, vol.52, no.3, 2022, ss.667 - 676. 10.55730/1300-0144.5359
AMA	Karaca N,Ünal E,Karakaya J,Kalyoncu U,KİRAZ S Effectiveness of a supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with anti-TNF therapy in anti-TNF-naive patients with active ankylosing spondylitis. Turkish Journal of Medical Sciences. 2022; 52(3): 667 - 676. 10.55730/1300-0144.5359
Vancouver	Karaca N,Ünal E,Karakaya J,Kalyoncu U,KİRAZ S Effectiveness of a supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with anti-TNF therapy in anti-TNF-naive patients with active ankylosing spondylitis. Turkish Journal of Medical Sciences. 2022; 52(3): 667 - 676. 10.55730/1300-0144.5359
IEEE	Karaca N,Ünal E,Karakaya J,Kalyoncu U,KİRAZ S "Effectiveness of a supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with anti-TNF therapy in anti-TNF-naive patients with active ankylosing spondylitis." Turkish Journal of Medical Sciences, 52, ss.667 - 676, 2022. 10.55730/1300-0144.5359
ISNAD	Karaca, Nur Banu vd. "Effectiveness of a supervised group exercise therapy based on the biopsychosocial model introduced simultaneously with anti-TNF therapy in anti-TNF-naive patients with active ankylosing spondylitis". Turkish Journal of Medical Sciences 52/3 (2022), 667-676. https://doi.org/10.55730/1300-0144.5359