Physiotherapy in ankylosing spondylitis: what is the evidence?

Evidence on the value of some cur rent physiotherapeutic practices and the in effectiveness of others is accumulating . This paper addresses the best evidence available on the efficacy and effective ness of physiotherapeutic modalities in ankylosing spondylitis. General issues in the assessment of physiother apy in this disease are briefly discussed. Core sets for assessments are nowa d ay s ava i l abl e. A recent Coch rane rev i ew on this topic supports the (at least short-term) positive ef fects of physio therapy, in particular exercise, in the management of ankylosing spondylitis. Some details of the included studies are provided. Ankylosing spondylitis, the prototype of the group of related diseases that are collectively labeled as spondylarthr opathies, is one of the most frequent in flammatory rheumatic conditions. Like r h e u m atoid art h ri t i s , the disease is a s s o c i a ted with significant disa b i l i t y and increased socioeconomic costs. Currently available conventional therapies for ankylosing spondylitis are pal liative at best, and often fail to control symptoms at the long run. Phy s i c a l t h e rapy including exe rcises is often considered as a necessary adjunct to drug ther apy. Ho wever, the paucity of data makes it dif ficult to identify the best administration mode of these interventions based upon scientific evi dence. Nowadays, the question whether or not physiotherapy is effective for patients with musculoskeletal diseases in gen eral and ankylosing spondylitis in par ticular recei ves consider able attention. P u bl i c ation of ra n d o m i zed trials and s y s t e m atic rev i ews in phy s i o t h e r apy for the whole field of musculoskeletal conditions has increased spectacular over the past few ye a rs. More than 2700 randomized trials and systemic rev i ews in phy s i o t h e r apy are now available of which more than 800 ha ve been published since 1997 (1). A large