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      Effects of central and unilateral posteroanterior mobilization on cervical lordosis, muscle stiffness and ROM in patient with ankylosing spondylitis: case study

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          Abstract

          [Purpose] The aim of this study was to determine the effects of central and unilateral posteroanterior (PA) mobilization on cervical lordosis, muscle stiffness and range of motion in a patient with ankylosing spondylitis (AS). [Subject and Methods] The subject of this case study was diagnosed with AS in 1997. At baseline, variance was measured without any intervention during the first 3 days (2016.6.13–2016.6.15). Cervical PA mobilization was applied to each segment from C2–C7 from the 4th to the 11th day for 8 days. Intervention was not performed from the 12th to the 15th days for 4 days. Variances were measured a final time without intervention on the 16th day (2016.6.28). [Results] Cervical lordosis was seen to have increased. Muscle stiffness was significantly decreased after intervention and the effect of treatment lasted for five days without any additional intervention. The cervical flexion and extension angles were increased. However these increases were not statistically significant. Both the lateral flexion and left rotation angle were significantly increased and the effects of treatment lasted for five days without any additional intervention. [Conclusion] These results suggest that central and unilateral PA mobilization is effective in increasing cervical lordosis and range of motion, and decreasing muscle stiffness in patients with AS.

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          Most cited references21

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          Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial.

          BACKGROUND Treatment options for patients with ankylosing spondylitis are few. We aimed to assess the effectiveness of infliximab, an antibody to tumour necrosis factor (TNF)-alpha, in treatment of such patients. In this 12-week placebo-controlled multicentre study, we randomly assigned 35 patients with active ankylosing spondylitis to intravenous infliximab (5 mg/kg) and 35 to placebo at weeks 0, 2, and 6. One patient in the infliximab group was withdrawn from the study. Our primary outcome was regression of disease activity of at least 50%. To assess response, we used validated clinical criteria from the ankylosing spondylitis assessment working group, including disease activity (BASDAI), functional indices (BASFI), metrology (BASMI), and quality of life (short form 36). Analyses were done by intention to treat. 18 (53%) of 34 patients on infliximab had a regression of disease activity at week 12 of at least 50% compared with three (9%) of 35 on placebo (difference 44% [95% CI 23-61], p<0.0001). Function and quality of life also improved significantly on infliximab but not on placebo (p<0.0001 and p<0.0001, respectively). Treatment with infliximab was generally well tolerated, but three patients had to stop treatment because of systemic tuberculosis, allergic granulomatosis of the lung, or mild leucopenia. Our results show that treatment with infliximab is effective in patients with active ankylosing spondylitis. Since there are some potentially serious adverse effects, we recommend that this treatment mainly be used in co-operation with rheumatological centres.
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            The outcome of ankylosing spondylitis: a study of 100 patients.

            The outcome was studied in 100 patients with adult-onset primary ankylosing spondylitis (AS). After a mean disease duration of 16 yr, 51.5% of the patients were employed in full-time work. Cessation of work occurred at a mean disease duration of 15.6 yr, and was significantly associated with female sex, low levels of education, acute anterior uveitis, 'bamboo spine' and the co-existence of non-rheumatic diseases. Functional outcome was studied by analysing activities of daily living, and revealed similar findings in males and females. Most of the loss of function occurred during the first 10 yr of disease, and correlated significantly with the occurrence of peripheral arthritis, spinal X-ray changes of AS and development of 'bamboo spine'. After > 20 yr of disease, > 80% of the patients still complained of daily pain and stiffness, and > 60% reported daily use of drugs.
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              Reliability of pain and stiffness assessments in clinical manual lumbar spine examination.

              The purpose of this study was to determine the intertherapist reliability of judgments of stiffness and pain at L-1 to L-5 made using posteroanterior (PA) central pressure testing. Three pairs of manipulative physical therapists with a minimum of 5 years of experience were asked to rate pain and stiffness in a total of 90 patients with low back pain. Each pair of therapists assessed 30 patients within their own clinic, using their preferred technique to perform an examination using the PA central pressure test at the five lumbar levels. Each pair of therapists recorded their ratings of pain and stiffness. Reliability of judgments was evaluated by intraclass correlation coefficients (ICC) and percentage of exact agreement scores. The ICC values for pain judgments for the group as a whole ranged from .67 to .72, with agreement scores ranging from 31% to 43%. The ICC values for stiffness judgments ranged from .03 to .37, with agreement scores ranging from 21% to 29%. Judgments of stiffness made by experienced manipulative physical therapists examining patients in their own clinics were found to have poor reliability, whereas pain judgments had good reliability. Further investigation of this test is required in order to develop a more reliable method of assessing PA stiffness.
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                Author and article information

                Journal
                J Phys Ther Sci
                J Phys Ther Sci
                JPTS
                Journal of Physical Therapy Science
                The Society of Physical Therapy Science
                0915-5287
                2187-5626
                15 July 2017
                July 2017
                : 29
                : 7
                : 1276-1280
                Affiliations
                [1) ] Department of Physical Therapy, Pohang College, Republic of Korea
                [2) ] Department of Physical Therapy, College of Medical Health, International University of Korea, Republic of Korea
                [3) ] Department of Physical Therapy, Institute for Elderly Health and Welfare, Namseoul University, Republic of Korea
                [4) ] Department of Social and Welfare, Chang Shin University, Republic of Korea
                Author notes
                [* ]Corresponding author. Wan-Suk Choi, Department of Physical Therapy, College of Medical Health, International University of Korea: Dongbu-ro, Munsan-eap, Jinju-si, Republic of Korea. (E-mail: y3korea@ 123456empal.com )
                [a]

                These authors contributed equally to this work.

                Article
                jpts-2017-130
                10.1589/jpts.29.1276
                5509608
                28744064
                65e106b0-2750-4689-b2ae-bc5dc660e30f
                2017©by the Society of Physical Therapy Science. Published by IPEC Inc.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License. (CC-BY-NC-ND 4.0: https://creativecommons.org/licenses/by-nc-nd/4.0/ )

                History
                : 13 March 2017
                : 30 April 2017
                Categories
                Case Study

                ankylosing spondylitis,posteroanterior mobilization,cervical lordosis

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