Non-pharmacological interventions for patients with axial spondyloarthritis: a meta-analysis

Non-pharmacological interventions (NPIs) are recommended in current international clinical practice guidelines for the management of axial spondyloarthritis (axSpA) as a complementary therapy.

To assess the comparative impact of different NPIs on the clinical outcomes of patients with axSpA.

Network meta-analysis and traditional meta-analysis of randomized controlled trials (RCTs).

We searched systematically PubMed, EMBASE, the Cochrane Library, Web of Science, and Chinese Biological Medical Database up to May 2023, and included these RCTs of patients with axSpA receiving the managements of NPIs. The risk of bias of individual RCT was assessed through a modified version of the Cochrane Risk of Bias Tool. Bayesian random-effects network meta-analysis and traditional meta-analysis were performed to calculate the mean difference.

A total of 51 RCTs involving 3457 patients with axSpA were included in this study. Both supervised combined exercises and neuromuscular training showed a significant reduction in disease activity (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI): 1.13 lower, 1.17 lower, respectively), physical function (Bath Ankylosing Spondylitis Functional Index (BASFI): 1.0 lower, 0.88 lower, respectively), and spinal mobility (Bath Ankylosing Spondylitis Metrology Index (BASMI): 0.7 lower, 1.35 lower, respectively), compared to standard care. Both supervised combined exercises and neuromuscular training also presented more significant improvement than conventional exercises in disease activity (BASDAI: 0.91 lower, 0.95 lower, respectively), physical function (BASFI: 0.67 lower, 0.56 lower, respectively), and spinal mobility (BASMI: 0.18 lower, 0.82 lower, respectively). A traditional meta-analysis demonstrated that supervised combined exercise and neuromuscular training could significantly reduce BASDAI, BASFI, and BASMI scores when compared to unsupervised exercise or standard care. Aerobic exercise, supervised combined exercise, and conventional exercise could significantly reduce pain scores, compared to standard care.

Compared to either standard care or conventional exercises, supervised combined exercises and neuromuscular training were more beneficial for ameliorating disease activity, physical function, and spinal mobility in patients with axSpA. The choice of exercise modalities may depend on patient values and preferences.

PROSPRO: CRD42021251219.