Physiotherapy for Ankylosing Spondylitis: Systematic Review and a Proposed Rehabilitation Protocol

Ankylosing Spondylitis (AS) is a chronic inflammatory disease with gradual onset, largely affecting the axial skeleton. As leads to varying degrees of restricted spinal mobility, pain and loss of functional capacity. Rehabilitation, especially physiotherapy and exercises, are considered integral components of its management. Various rehabilitation modalities are available for the benefit of individuals with AS, but a sequenced protocol has not been reported. A scientific review was performed using the following search engines: MEDLINE (Pubmed), COCHRANE Library and Physiotherapy Evidence Database (PEDro). Studies, which had at least one of the groups receiving rehabilitation, and the major outcomes studied including pain, stiffness, mobility (spine and chest wall) and physical function (disease activity, ADL, QOL and global function) were selected. A total of 28 studies were shortlisted for the review which included a total of 1926 subjects with AS. The review of literature showed that individuals with AS had beneficial effects from exercise programmes compared to no exercise. Patient education, active involvement and motivation of individuals with AS played an important role in the overall treatment outcomes. Based on the review, a four-phase sequenced rehabilitation protocol has been laid down for the benefit of individuals with AS.