Abstract

Objective:To explore the effects of manual mobilization on thoracic spine mobility, respiratory function and disease activity in patients with ankylosing spondylitis (AS). Methods:Two groups, each consisting of 12 patients, were treated with standard physiotherapy during a regular inpatient stay. After randomization, one group was also treated with manual mobilization of the thoracic spine for an average of 6 sessions, whereas the other group only received conventional physiotherapy. The primary outcome parameter was the mobility of the thoracic spine represented by the Ott's sign. The secondary outcome parameters were pain (VAS), respiratory function (differences of chest expansion and inspiratory vital capacity - IVC), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Functional Index (BASFI). Results:Mobility of the thoracic spine (Ott's sign) increased significantly within the group of manually mobilized patients compared to baseline (hospital admission) at each of the follow-up visits (p_discharge < 0.002, p_1month < 0.002, p_3months < 0.004). No significant impact on thoracic spine mobility could be found in the control group. Comparing both groups, manually mobilized patients had significantly improved mobility at the time of discharge from the hospital (p < 0.002) as well as 1 month later (p < 0.009). No difference could be shown after 3 months. The group treated with manual mobilization showed also a significant pain reduction compared to baseline (p_discharge < 0.006, p_1month < 0.005, p_3months < 0.013). Parameters of the respiratory function test increased during therapy with manual mobilization. Compared to baseline, chest expansion improved at all follow-up visits (p_discharge < 0.001, p_1month < 0.026, p_3months < 0.005). The therapy also had a positive impact on the IVC at the time of discharge (p < 0.003) and after 3 months (p < 0.008). Regarding the scores (BASDAI, BASFI), a significant decrease was detected, thus reflecting a general improvement of the manually treated patients in terms of disease activity and function. Overall, the observed effects on most outcome parameters lasted until the follow-up visit at 1 month after discharge but could be observed up to 3 months later. Conclusion:The results show that physiotherapy including manual mobilization of the thoracic spine promotes mobility, improves respiratory function and has a positive influence on disease activity and physical function. Therefore, manual mobilization of the spine (without ankylosis) should be included in the physical therapy concept of patients with AS. Since the effects appear to last for approximately 3 months, manual mobilization should be strongly considered as an additive physiotherapeutic option.

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