OP0143-HPR EFFECTIVENESS OF LONGSTANDING EXERCISE THERAPY VERSUS USUAL CARE IN PEOPLE WITH AXIAL SPONDYLOARTHRITIS AND SEVERE FUNCTIONAL LIMITATIONS: A RANDOMIZED CONTROLLED TRIAL (L-EXSPA) (2024)

Abstract

Background: Exercise therapy is a proven effective and safe treatment for people with axial spondyloarthritis (axSpA) to improve physical function and performance of daily activities. Nonetheless, previous studies have predominantly included patients with a relatively favorable health status. Individuals with sustained disease activity, severe ankylosis or deformities of the spine, and/or significant comorbidities remain under-represented in research. In particular these patients may be in need of longstanding treatment, tailored to their individual functional limitations that may fluctuate over time.

Objectives: To evaluate the effectiveness of longstanding (>52 weeks) personalized, supervised exercise therapy compared with usual care (UC) in people with axSpA and severe functional limitations in daily activities.

Results: Of the 426 people that were screened, 215 were enrolled, with 1 patient excluded later because a diagnosis other than axSpA. The 214 included axSpA patients (49% female, age 52 (SD 12) years), of whom 41% had five or more comorbidities and 67% had active disease according to a Bath Ankylosing Spondylitis Disease Activity Index ≥4, were randomized to the intervention (n=110) and UC (N=104) groups. Baseline characteristics are shown in Table 1. In the intervention group 93% (n=102) participants started with the intervention, using on average 41 treatment sessions (SD 15). Table 2 shows the results at 52 weeks. The improvement of the PSC1 in the intervention group was statistically significantly greater compared to the UC group (mean difference [95% CI]; -1.8 [-2.4 to -1.2]; ES 0.8). The intervention group also showed statistically greater improvements in all secondary outcomes at 52 weeks compared to the UC group (ES ranging 0.4-0.7), except for the SF-36 MCS (ES 0.1). No (S)AE occurred during the intervention period.

Conclusion: Longstanding, personalized, supervised exercise therapy was more effective than UC after 52 weeks of treatment in people with axSpA and severe functional limitations. Improvements were consistently observed in all outcomes on both physical functioning and physical quality of life.

Acknowledgements: Funding: This project is financially supported by the Netherlands Organization for Health Research and Development (ZonMw; 852004019), Ministry of Health, Welfare and Sport (Ministerie van Volksgezondheid, Welzijn en Sport), the Royal Dutch Society for Physical Therapy (KNGF) and the Dutch Arthritis Society (ReumaNederland).

Disclosure of Interests: M.A.T. van Wissen: None declared, C.H.M. van den Ende: None declared, M.G.J. Gademan: None declared, M.M.H. Teuwen: None declared, W.F. Peter: None declared, E.A.M. Mahler: None declared, D. van Schaardenburg: None declared, F. A. van Gaalen Abbvie, ASAS, BMS, Galapagos, Janssen, Lilly, Novartis, Pfizer, UCB, but not applicable for this study., J.P.L Spoorenberg Pfizer, Abbvie, Novartis, UCB, Lilly, Galapagos, but not applicable for this study, Pfizer, Abbvie, Novartis, but not applicable for this study, W.B. van den Hout: None declared, Astrid van Tubergen: None declared, T.P.M. Vliet Vlieland: None declared, S.F.E. van Weely: None declared.