gms | German Medical Science

Objective: Polyarthritis (cP) and spondylarthritis (SpA) are the most common chronic inflammatory rheumatic diseases leading to substantial impairment of activity and participation in various areas of life [1]. Regular physical activity results in various health related improvements [2] without causing enhanced joint damage or disease activity [3]. To overcome the often inactive lifestyle of these patients [4], support of the initiation and long-term adherence to physical activity is needed. The present study involved an intensive strength, endurance and coordination training during in-patient rheumatic rehabilitation that was performed in fixed groups with systematic motivational activities based on the transtheoretical model of behavior change [5] to promote independent physical activity in everyday life after discharge from the clinic. Physical, psychological and sociomedical improvements were examined at one-year follow up.

Material/Methods: This prospective controlled sequential study addressed patients with cP or SpA in two rehabilitation clinics in Germany who were asked to fill in questionnaires at four (control group [CG]) and five points in time (intervention group [IG]), respectively. Of 555 patients who were asked to take part in the study before the onset of rehabilitation, 418 participants (75 %) agreed initially. Data of the one-year follow up are available from 326 of 418 participants (78 %). The sample characteristics at the beginning of rehabilitation (T1) were: mean age 47 [± 9] years, 64 % women, 71 % cP, 29 % SpA, mean disease duration 9 [± 8] years, 81 % employed. The following statistical techniques were used: Student’s t-test, MANOVA for repeated measures, multiple linear regression analyses.

Results: At T1 health or activity related variables showed no differences between CG and IG. At the end of rehabilitation (T2) improvements in all surveyed features compared with T1 were found in both groups (p<.01). Several aspects of the rehabilitation, such as different treatments, global rating and the recommendations for future exercises, were evaluated better by the IG than by the CG (p<.01). After one year (T5) all patients reported stable enhancements regarding health-related quality of life (SF-36), psychological well-being (HADS-D), motivation to and performance of physical activity (FFkA) (p<.01). Additionally, IG participants produced lower indirect costs by absenteeism from work (p<.05) and showed greater improvements in terms of their overall physical activity, especially in everyday life (FFkA) (p<.05). Recommendations of physical activity were met more often by IG participants (p<.05). Subgroup analyses showed the activity specific efficacy of the intervention for both sexes and diagnostic groups as well as for younger and older patients.

Conclusion: Results of the study showed long-term positive changes in many health related features after rehabilitation in patients with the most common chronic inflammatory rheumatic diseases. Twelve months after discharge, IG participants reported more physical activity in everyday life than CG without effects of sex, age or diagnostic group. Indirect costs (especially because of disability pension) were lower in the IG. Thus, intensive training exercises in fixed groups combined with systematical motivation regarding physical activity is an efficient strategy to support long-term physical activity and reduce indirect costs.