Evaluation of balance disorder and associated factors in patients with ankylosing spondylitis

Year 2024, Volume: 37 Issue: 3, 332 - 337, 30.10.2024

Alparslan Ali İzki , Halim Yılmaz , Hamit Göksu

https://doi.org/10.5472/marumj.1573709

Abstract

ABSTRACT
Objective: The aim of this study was to investigate balance disorder and the factors associated with it in patients with ankylosing
spondylitis (AS).
Patients and Methods: The study included 75 patients diagnosed with AS and 75 healthy volunteers. Patients and controls were
analysed for demographic characteristics, and AS patients were also investigated for disease activity indices and disease duration.
Patient and control groups were compared using static and dynamic balance tests.
Results: The scores of AS patients were found to be worse than the control group (p=0.000) in terms of Static Double-Feet Balance
Index (SDFBI), Static Single-Feet Balance Index (SSFBI), Dynamic Balance Index (DBI), Timed Up and Go test (TUGT), Berg Balance
Scale (BBS), Functional Reach Test (FRT) and Hand to Ground Distance (HGD). Balance impairment was significantly higher in
patients with kyphosis and advanced stage of sacroiliitis. Kyphosis angle, stage of sacroiliitis, Bath Ankylosing Spondylitis Metrology
Index (BASMI), OWD (occiput-to-wall distance) scores, presence of contracture in hip or knee joint and Bath Ankylosing Spondylitis
Disease Activity Index (BASDAI) were correlated with poor balance when evaluated with balance evaluation scales for correlation.
Conclusions: Balance was impaired in AS patients. Appropriate treatment and rehabilitation protocols for spinal and peripheric joint
stiffness may improve balance disorder in AS patients.

Keywords

Ankylosing spondylitis, Posture, Balance

References

• Khan MA. Clinical features of ankylosing spondylitis. In: MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Hochberg Rheumatology. 3rd edition. Edinburgh: Mosby, 2003:1161-82.
• Davis JC, van der Heijde D, Dougados M, Woolley JM. Reduction in health-related quality of life in patients with ankylosing spondylitis and improvements with etanercept therapy. Arthritis Rheum 2005; 53:494-501. doi.org/10.1002/ art.21330
• Van Royen BJ, De Gast A, Smit TH. Deformity planing for sagittal plane corrective osteotomies of the spine in ankylosing spondylitis. Eur Spine J 2000; 9:492-8. doi.org/10.1007/ s005.860.000183
• Bot SD, Caspers M, Van Royen BJ, Toussaint HM, Kingma I. Biomechanical analysis of posture in patients with spinal kyphosis due to ankylosing spondylitis: a pilot study. Rheumatology 1999; 38:441-3. doi.org/10.1093/ rheumatology/38.5.441
• Russel AS. Ankylosing spondylitis history. In: Klippel JH, Dieppe PA, eds. Rheumatology. St Louis: Mosby, 1994: Section 6.
• Khan MA. Ankylosing spondylitis-the history of medical therapies. Clin Exp Rheumatol 2002;20(6 Suppl 28):S3-5
• Murray HC, Elliott C, Barton SE, Murray A. Do patients with ankylosing spondylitis have poorer balance than normal subjects? Rheumatology (Oxford) 2000;39:497-500. doi. org/10.1093/rheumatology/39.5.497
• Aydog E, Depedibi R, Bal A, Eksioglu E, Unlü E, Cakci A. Dynamic postural balance in ankylosing spondylitis patients. Rheumatology (Oxford) 2006;45:445-8. doi.org/10.1093/ rheumatology/kei192
• Adam M, Leblebici B, Erkan A.N, Bağış S, Akman M.N Ankylosing spondylitis and postural balance. Ann Rheum 2008; 23: 87-90.
• Durmus B, Altay Z, Ersoy Y, Baysal O, Dogan E. Postural stability in patients with ankylosing spondylitis. Disabil Rehabil 2010;32:1156-62. doi.org/10.3109/096.382.80903428310
• Gündüz OH, Özcan EE, Giray E, Yağcı İ. What Impairs balance in ankylosing spondylitis? Posture or disease activity? Arch Rheumatol 2017;3:221-6. org/10.5606/ ArchRheumatol.2017.6222
• Çınar E, Akkoç Y, Karapolat H, Durusoy R, Keser G.Postural deformities: potential morbidities to cause balance problems in patients with ankylosing spondylitis? Eur J Rheumatol 2016; 3: 5-9. doi.org/10.5152/eurjrheum.2015.15104
• Batur EB. Karataş GK. Do postural changes affect balance in patients with ankylosing spondylitis? J Rehabil Med 2017; 49: 437-40. org/10.2340/16501.977.2230.
• Alkan H, Yıldız N, Saesan A, et al. Fall risk in patients with ankylosing spondylitis. Turk J Rheumatol 2013;28:109-16. doi. org/10.5606/tjr.2013.2849
• Yağlı NV, Karaduman A ( 2007). Comparison of functional and static balance in patients with ankylosing spondylitis and osteoarthritis. Higher Education Council National Thesis Center: http://tez2.yok.gov.tr/ Accessed on
• Vergara ME, O’Shea FD, Inman RD, Gage WH. Postural control is altered in patients with ankylosing spondylitis. Clin Biomech (Bristol, Avon) 2012;27:334-40. doi.org/10.1016/j. clinbiomech.2011.10.016
• Swinkles AD, Dolan P. Spinal position sense and disease progression in ankylosing spondylitis patients: a longitudinal study. Spine 2004;29:1240-5. doi: 10.1097/00007.632.200406010-00014
• Gunay SM, Keser I, Bicer ZT. The effects of balance and postural stability exercises on spa based rehabilitation programme in patients with ankylosing spondylitis. Back Musculoskelet Rehabil 2018;31:337-46. doi:10.3233/BMR- 169755
• Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis International Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009; 68 Suppl ii:1-44. doi: 10.1136/ard.2008.104018
• Horak FB. Clinical assessment of balance disorders. Gait Posture1997; :76-84. doi:10.1016/S0966-6362(97)00018-0
• Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther 2000; 80:896-903. doi: 10.1093/ptj/80.9.896.
• Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: a new clinical measure of balance. J Gerontol 1990; 45:M192-7. doi: 10.1093/geronj/45.6.M192.
• Isles RC, Choy NL, Steer M, Nitz JC. Normal values of balance tests in women aged 20-80. J Am Geriatr Soc 2004; 52:1367- 72. doi: 10.1111/j.1532-5415.2004.52370.x.
• Nordin E, Rosendahl E, Lundin-Olsson L. Timed “Up & Go” test: reliability in older people dependent in activities of daily living—focus on cognitive state. Phys Ther 2006;86:646-55.
• Sahin F, Yilmaz F, Ozmaden A, Kotevoglu N, Sahin T, Kuran B. Reliability and validity of the Turkish version of the Berg Balance Scale. J Geriatr Phys Ther 2008;31:32-7.
• Vedantem R, Lenke LG, Keeney JA and Bridwell KH, Comperison of standing sagittal spinal alignment in an asymptomatic adolescent and adults. spine deformity. 1998:23:211-5.
• Van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthrit Rheum 1984; 27:361-8. doi: 10.1002/art.178.027.0401
• Özgöçmen S. Romatolojide sınıflama kriterleri ve kısa klinik metroloji. 1. baskı. Istanbul: Veri Medikal Yayıncılık, 2008:87- 119.
• Kornetti DL, Fritz SL, Chiu YP, Light KE, Velozo CA. Rating scale analysis of the Berg Balance Scale. Arch Phys Med Rehabil 2004; 85:1128-35. doi: 10.1016/j.apmr.2003.11.019
• Demontis A, Trainito S, Del Felice A, Masiero S. Favorable effect of rehabilitation on balance in ankylosing spondylitis: a quasi-randomized controlled clinical trial. Rheumatol Int 2016;36:333-9.