POS0071-HPR PHYSICAL THERAPY, PHYSICAL ACTIVITY AND PHYSICAL FITNESS IN PSORIATIC ARTHRITIS: A SYSTEMATIC REVIEW

Background

Patients with psoriatic arthritis (PsA) have a remarkable increased risk for cardiometabolic comorbidities impacting their disease management and functioning. Studies in the general population have demonstrated that higher levels of physical activity, better cardiorespiratory fitness and muscle strength improve cardiovascular and all-cause mortality risk.[1] Physical therapy is highly recommended as part of the non-pharmacological management of PsA patients.[2-4] Physical activity recommendations were composed but specific guidance on the type, duration or intensity was not provided.[5] Therefore, a summary of the available evidence on physical therapy, physical activity and physical fitness in PsA patients is needed to strengthen the non-pharmacological management.

Objectives

This study aimed to systematically review and appraise the quality of research on physical therapy, physical activity and physical fitness in PsA patients.

Methods

The protocol was prospectively registered at the PROSPERO database (ID 255501). A systematic literature search was performed in May 2022, using four different databases (Medline, Embase, Web of Science and Cochrane library). We included papers examining physical therapy, physical activity and physical fitness (cardiorespiratory and muscular fitness) in PsA patients, with a minimum age of 18 years and diagnosed by a physician, classification criteria or self-reported. A mixed population of patients with rheumatic and musculoskeletal diseases was allowed if the proportion of PsA patients was at least 10%. All eligible interventional or observational (quantitative or qualitative) studies with a full-text paper written in English or Dutch were included without restrictions regarding the publication year. The quality was assessed through the Newcastle-Ottawa Scale and the Revised Cochrane risk-of-bias tool for randomized trials. A meta-analysis was not possible due to the wide variety of interventions and outcomes. Therefore, a narrative synthesis was used.

Results

After deduplication, a total of 6026 abstracts were retrieved, of which 380 abstracts were selected for full-text analysis. Ultimately, 85 papers published between 1994 and 2022 were included, of which 6 papers were added from screening references. Most studies were cross-sectional (n=31) or randomized controlled trials (RCT; n=18). Forty-seven % of the studies consisted of PsA patients only. Low risk of bias was scored in 2 RCTs, 1 cohort study (n=3), 4 case-control (n=9) and 7 cross-sectional studies. The risk of bias was mainly increased due to selection bias, the use of non-validated and/or patient-reported outcomes and the lack of blinding possibilities in case of physical therapy intervention. In 23 papers physical activity was measured, of which 8 studies used a validated questionnaire and only 1 study used an objective method. Cardiorespiratory and muscular fitness were assessed in 5 and 9 studies respectively. A variety of physical therapy interventions were studied: resistance training (n=1), cardiorespiratory training (n=2), mind-body exercises (n=3), behavioural change programs (n=2), therapeutic modalities (n=4) and mixed rehabilitation programs (n=5). One RCT with low risk of bias evaluated an increase in cardiorespiratory fitness and a reduction in truncal fat percentage in PsA patients after 11 weeks of high intensity interval training. Qualitative research (n=11) emphasized the need of patients for education.

Conclusion

Scientific evidence on physical therapy, physical activity and physical fitness in PsA is limited. Further research is needed on non-pharmacological interventions and aspects in general, especially on physical fitness.

References

[1]Myers, J., et al., Prog Cardiovasc Dis, 2015. [2]Singh, J.A., et al., Arthritis Care Res (Hoboken), 2019. [3]Coates, L.C., et al., Nat Rev Rheumatol, 2022. [4]Gossec, L., et al., Ann Rheum Dis, 2020. [5]Rausch Osthoff, A.K., et al., Ann Rheum Dis, 2018.

Acknowledgements:

NIL.

Disclosure of Interests

None Declared.