gms | German Medical Science

Background: Our research aims to identify optimal non-pharmacological therapy approaches for different stages of axSpA by exploring under-researched concepts such as manual spinal mobilisation, resistance training and balance in separate clinical trials and comparing outcomes to existing standard of care at the RNHRD to inform clinical practice.

Our research responds to Wendling et al’s (2018) [1] substantial research agenda in his recommendations for Spondyloarthritis management calling for evaluation of the effects physiotherapy has on patients without radiographic changes.

Methods: Participants: Patients with diagnosed axSpA registered at RNHRD in Bath, UK will form the cohort from which eligible samples will be identified with a proposed start in October 2019 (Figure 1 [Fig. 1]).

Proposed Methods: Cohort multiple RCT design (cmRCT) (Figure 2 [Fig. 2]), developed by Relton et al. [2] and best suited for examining long term conditions, will be used to address our aims, conducting several pragmatic RCTs, drawing samples from the same cohort [TwiCs].

This unique design provides opportunities to research several competing interventions over time, offering outcome comparison between trials to inform clinical practice as consistent outcome measures including spinal mobility (BASMI & DorsaVi), BASDAI for disease activity, BASFI as functional index are regularly taken across the cohort.

One trial will explore manual mobilisation of the spine, another one resistance training with several ideas for future trials being currently considered. All eligible patients with axSpA will be identified within the cohort, the intervention participants will be randomly selected from this eligible sample, with the remaining eligible patients functioning as control group.

Follow up envisioned: 6 to 12 months.

Discussion/Relevance to practice:

• Abundance of exercise programs researched has still not resulted in establishing detailed clear guidelines to what specific exercises and treatments are effective to optimise treatment outcomes which this study aims to provide.
• The under-researched manual physiotherapy and resistance exercises could be a missing piece in optimal treatment

Conclusion: Results of this novel study will inform clinical practice and provide treatment guidance for optimal treatment in different stages of axSpA. We would be happy to give a presentation in addition to our poster.