Physiotherapy in Axial Spondyloarthritis (PaxSpA): Informing clinical practice by identifying effectiveness of manual spinal mobilisation therapy for patients with axial spondyloarthritis

: (Alternative Format Thesis)

Abstract

Individuals with axial spondyloarthritis (axSpA) are at an increased risk of developing restrictions of spinal mobility through structural damage such as joint ankylosis, caused by an autoimmune mediated inflammatory process, compared to the general population. AxSpA is a chronic progressive inflammatory disease of the spine with a multitude of comorbidities, requiring multidisciplinary therapies for optimal treatment outcome. Despite emerging prospective clinical trial evidence of the effects of manual spinal mobilisation therapy (MSM) in patients having already progressed to the advanced form of axSpA, the efficacy of this form of treatment has yet to be comprehensively studied in individuals on the wider spectrum of axSpA. The aim of this thesis was to determine if the short-term and long-term effects of MSM are beneficial to these patients and improve spinal mobility, therefore informing physiotherapeutic treatment guidelines in axSpA within the PaxSpA trial (Physiotherapy in Axial Spondyloarthritis). In Chapter 3, a methodological paper, the cohort multiple randomised controlled trial (RCT) design in our study is presented and concluded to be an appropriate design for our pragmatic study, examining the effects of MSM intervention in a population with a chronic progressive disease, requiring long-term management. In Chapter 4, the embedded RCT found that MSM has significant positive short-term effects on spinal mobility, disease activity and sleep, compared to the control group at 10 weeks. Significance was also observed immediately after one intervention session in the intervention group compared to the control group for spinal mobility. No significant correlations were found between BASFI data, work productivity and quality of life for both groups. Significant long-term effects of the trial intervention (six months, plus follow up) are presented in Chapter 5, concluding that MSM physiotherapy is highly effective and suggests that it is beneficial to patients with axSpA to help improve spinal mobility, disease activity, sleep and quality of life.

Date of Award	24 Apr 2024
Original language	English
Awarding Institution	University of Bath
Sponsors	Royal National Hospital for Rheumatic Diseases
Supervisor	Dario Cazzola (Supervisor) & Raj Sengupta (Supervisor)