Axial Spondyloarthritis is associated with changes in lumbosacral loading during daily activities.

BACKGROUND: There is currently little insight in lumbar spine loading during activities of daily living in patients with axial spondyloarthritis. Furthermore, it is unclear how inflammation or ankylosis-related mobility limitations in patients with axial spondyloarthritis affect lumbosacral loading, and if lumbar movement profiles have an effect on lumbosacral loading as well. Therefore, the aim of this study is to get more insight in the differences in peak and cumulative lumbosacral loading in patients with axial spondyloarthritis during activities of daily living. METHODS: Three-dimensional motion analysis with integrative force-plates was used to calculate peak lumbosacral moment (peak loading) and lumbosacral moment impulse (cumulative loading), of 19 patients with axial spondyloarthritis and 23 healthy controls during forward bending, sit-to-stand and two lifting tasks (symmetric/asymmetric). We compared inflammatory (n = 7) and ankylosed (n = 12) patients with axial spondyloarthritis and controls. Patients were also classified into Flexion or Lordotic profile. FINDINGS: Both inflammatory and ankylosed patients generated significantly larger lumbosacral moment impulses than healthy controls in all movements, except during sit-to-stand, where the inflammatory group showed larger moment impulse than both other two groups. Patients with a Lordotic profile showed lowered peak lumbosacral moments and moment impulses compared to those with a Flexion profile. INTERPRETATION: Both inflammatory and ankylosed patients experienced more cumulative loading depending on the activity. But our findings suggest that classification of patients into different movement profiles might be more interesting to clinically target specific loading adaptations related to pain and fear of movement.

Differences in multi-segmental spine kinematics between patients with different stages of axial spondyloarthritis and healthy controls.

BACKGROUND: The effects of inflammation and ankylosis on spinal kinematics of patients with axial spondyloarthritis (axSpA) are poorly understood. Furthermore, existence of (mal)adaptive movement profiles within axSpA, and differences between movement profiles in sensation of pain or fear of movement has never been investigated. OBJECTIVES: To investigate differences in range of motion in six spinal regions and the hips between inflammatory and ankylosed patients with axSpA, and to increase insight in different movement profiles of patients with axSpA and their association with pain and fear. DESIGN: Observational, cross-sectional. METHODS: Three-dimensional motion analysis was performed in 20 patients with axSpA and 23 healthy controls during range of motion tasks in all three planes. We compared patients with inflammatory (n = 8) and ankylosed (n = 12) axSpA, and controls. Patients were also classified into Flexion or Lordotic profile. Questionnaires regarding pain and fear of movement were conducted. RESULTS/FINDINGS: Both inflammatory and ankylosed axSpA patients have limited spinal ROM and reduced movement speed compared to healthy controls. Patients with a Lordotic profile showed significantly less ROM in lumbar regions and experienced more pain during forward bending than patients with a Flexion profile. CONCLUSIONS: Both inflammation and ankylosis contribute to spinal mobility impairment, and axSpA patients with a lordotic profile experienced more pain. This profile may be a maladaptive movement strategy to prevent further pain increase. Suggesting that pain and fear of movement, might be better variables to specify patients' spinal mobility limitations for individual physical therapy and rehabilitation patient profiling.

Multi-segment spine and hip kinematics in asymptomatic individuals during standardized return from forward bending versus functional box lifting.

Clinically, sagittal spinal mobility is objectively assessed by forward bending range of motion (ROM) tests such as the modified-Schober test (m-Schober test). However, evidence comparing ROM during forward bending and daily activities is limited. In this study, a kinematic model including six spinal regions, pelvic/sacral and femur segment was used to characterize associations between m-Schober test and return from forward bending (RFB), and between RFB and lifting. No significant correlations were found between m-Schober test and lumbar ROM during RFB. Furthermore, we found significantly smaller ROM in all spinal regions during lifting compared to RFB, except in the upper thoracic spine, lumbosacral (L5/S1) and hip joints. However, we observed moderate to very strong correlations between the two movements tasks for all lumbar regions. Furthermore, cross-correlation between L5/S1 and lower lumbar spine regions showed no segmental redundancy of L5. These results suggest that an m-Schober test provides insufficient insight into lumbar mobility and that multi-segmental spine measurements should be introduced clinically. Furthermore, this study has demonstrated that RFB can be used as a reference for lumbar regions during lifting, with use of the current multi-segmental spine model and that the inclusion of L5/S1 provides more detailed information on lumbar kinematics.

Mobile Health Features Supporting Self-Management Behavior in Patients With Chronic Arthritis: Mixed-Methods Approach on Patient Preferences.

BACKGROUND: Patients with chronic arthritis (CA) ideally apply self-management behaviors between consultations. This enduring, tedious task of keeping track of disease-related parameters, adhering to medication schemes, and engaging in physical therapy may be supported by using a mobile health (mHealth) app. However, further research is needed to determine which self-management features are valued most by adult patients with CA patients. OBJECTIVE: The aim of this study was to determine the preference of features for an mHealth app to support self-management behavior in patients with CA. In addition, we aimed to explore the motives behind these ratings. METHODS: A mixed-methods approach was used to gather information from 31 adult patients (14 females), aged 23 to 71 years (mean 51 [SD 12.16]), with CA. Structured interviews were conducted to gather data pertaining to preferences of app features. Interviews were analyzed qualitatively, whereas ratings for each of the 28 features studied were analyzed quantitatively. RESULTS: In general, patients with CA favored the use of features pertaining to supporting active and direct disease management, (eg, medication intake and detecting and alarming of bad posture), helping them to keep a close watch on their disease status and inform their health care professional (eg, providing a means to log and report disease-related data) and receiving personalized information (eg, offering tailored information based on the patient's health data). Patients strongly disliked features that provide a means of social interaction or provide incentivization for disease-related actions (eg, being able to compare yourself with other patients, cooperating toward a common goal, and receiving encouragement from friends and/or family). Driving these evaluations is the finding that every patient with CA hurts in his/her own way, the way the disease unfolds over time and manifests itself in the patient and social environment is different for every patient, and patients with CA are well aware of this. CONCLUSIONS: We have offered an insight into how patients with CA favor mHealth features for self-management apps. The results of this research can inform the design and development of prospective self-management apps for patients with CA.

Activity Limitations in Patients with Axial Spondyloarthritis: A Role for Fear of Movement and (Re)injury Beliefs.

OBJECTIVE: To determine whether fear of movement and (re)injury [FOM/(R)I] beliefs, measured with the Tampa Scale for Kinesiophobia 11-item version (TSK-11), influence activity limitations and mediate the relationship between pain severity and activity limitations in axial spondyloarthritis (axSpA). METHODS: In 173 patients with axSpA, these data were collected: sex, body mass index, disease duration, medication, activity limitations (BASFI; Bath Ankylosing Spondylitis Functional Index), disease activity [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); BASDAIinf, items 5 and 6; BASDAIpain, items 2 and 3; C-reactive protein and physician's global assessment], spinal mobility (BASMI; Bath Ankylosing Spondylitis Metrology Index), and FOM/(R)I (TSK-11). Scaling assumptions and reliability of TSK-11 were tested with item-to-total correlations, item variances, and Cronbach's alpha coefficient. Hypothesis testing determined TSK-11's construct validity. Multiple linear regression showed the contribution of TSK-11 to BASFI (enter and backward modeling). Mediation by TSK-11 was analyzed (bias-corrected bootstrapping and Sobel test). RESULTS: Adequate scale (Cronbach's alpha = 0.80) and item internal consistency (range item-scale correlations 0.41-0.58, except for item 5, r = 0.23), equal item-scale correlations, and item variances were found for TSK-11. Construct validity was confirmed, except for the hypothesized positive relationship between TSK-11 and BASMI. Regression models (enter method, adjusted R2 range 53-74%) consistently identified TSK-11 as a determinant of BASFI (ß range 0.155 to 0.321, p < 0.05), although BASMI (ß range 0.441 to 0.537) and disease activity (ß range 0.243 to 0.571, p < 0.05) were the largest determinants. TSK-11 partially mediated the BASDAIpain/BASFI relationship (B = 0.107; Sobel test, p = 0.004; bias-corrected CI 0.046-0.197). CONCLUSION: TSK-11 is a promising and valid tool to assess fearful beliefs in relation to activity limitations in axSpA. Future research applying TSK-11 may reveal FOM/(R)I as a novel treatment target in axSpA.