Physical Activity in Ankylosing Spondylitis: evaluation and analysis of an eHealth tool

Jess Shelagh Tyrrell, Clare Helen Redshaw, Wiebke Schmidt, Daniel H. Williams


Background Ankylosing spondylitis (AS) is a chronic inflammatory condition characterised by spinal arthritis and exercise is often recommended to reduce the symptoms and improve mobility. However, very little evidence exists for the value of exercise in AS.

Objectives Firstly, this pilot study aimed to evaluate an eHealth tool, the AS Observer, specifically designed to monitor symptoms, quality of life and physical activity in AS, in terms of patient experience and suitability in generating data for epidemiological studies. Secondly, it also investigated the collected data to determine if physical activity benefited individuals with AS.

Methods The AS Observer was designed to enable weekly monitoring of AS symptoms and exercise using a web based platform. Participants with AS (n = 223) were recruited to use the AS observer. They provided baseline data and completed online weekly data entry for 12 weeks (e.g. Bath Ankylosing Spondylitis Activity Index (BASDAI), howRu, International Physical Activity Questionnaire (IPAQ)). Panel data analysis with fixed effects models investigated associations between variables. Activity type data and exit questionnaires were subjected to qualitative thematic analysis.

Results In general, the AS Observer was well received and considered useful by participants, with 66% providing a positive response. The collected data suggested that IPAQ is inversely associated with total BASDAI, stiffness, tenderness and pain, but not fatigue. Stratified analysis demonstrated differential associations between BASDAI, IPAQ and howRU based on sex, HLA-B27 status and disease duration. Approximately half of the participants frequently did therapy and three-quarters undertook at least some vigorous activity ranging from formal exercise to recreation and (house) work. Despite some technical challenges, tool evaluation suggested that the AS Observer was a useful self-monitoring tool for participants.

Conclusions This pilot study demonstrated that increased exercise intensity and duration were associated with an improved BASDAI symptom score in a cohort of participants with AS. Furthermore, it provided further evidence of the value of using eHealth tools for clinical purposes and data collection for research, inclusive of the development of treatment pathways and disease management strategies.


Ankylosing spondylitis; e-health; physical activity;

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Moll J, HASLOCK I, Macrae I and Wright V. Associations between ankylosing spondylitis, psoriatic arthritis, Reiter’s disease, the intestinal arthropathies, and Behcet’s syndrome. Medicine 1974;53:343–64. PMid:4604133.

Dean LE, Jones GT, MacDonald AG, Downham C, Sturrock RD and Macfarlane GJ. Global prevalence of ankylosing spondylitis. Rheumatology 2014;53:650–7. PMid:24324212.

Boonen A and van der Linden SM. The burden of ankylosing spondylitis. The Journal of Rheumatology 2006;78:4–11.

Dagfinrud H, Kvien T and Hagen K. Physiotherapy interventions for ankylosing spondylitis. The Cochrane Database of Systematic Reviews 2008;(1):CD002822. PMid:18254008.

Braun J and Pincus T. Mortality. Course of disease and prognosis of patients with ankylosing spondylitis. Clinical and Experimental Rheumatology. 2002;20:S-16.

Feldtkeller E, Khan M, van der Heijde D, van der Linden S and Braun J. Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatology International 2003;23:61–6. PMid:12634937.

Robinson PC and Brown MA. The genetics of ankylosing spondylitis and axial spondyloarthritis. Rheumatic Disease Clinics of North America 2012;38:539–53. PMid:23083754.

Fernández-de-Las-Peñas C, Alonso-Blanco C, Alguacil-Diego IM and Miangolarra-Page JC. One-year follow-up of two exercise interventions for the management of patients with ankylosing spondylitis: a randomized controlled trial. American Journal of Physical Medicine & Rehabilitation 2006;85:559–67. PMid:16788386.

Brophy S, Cooksey R, Davies H, Dennis MS, Zhou S-M and Siebert S. The effect of physical activity and motivation on function in ankylosing spondylitis: a cohort study. Seminars in Arthritis and Rheumatism 2013;42(6):619–26.

van den Berg R, Baraliakos X, Braun J and van der Heijde D. First update of the current evidence for the management of ankylosing spondylitis with non-pharmacological treatment and non-biologic drugs: a systematic literature review for the ASAS/EULAR management recommendations in ankylosing spondylitis. Rheumatology 2012;51:1388–96. PMid:22513148.

Paré G, Jaana M and Sicotte C. Systematic review of home telemonitoring for chronic diseases: the evidence base. Journal of the American Medical Informatics Association 2007;14:269–77. PMid:17329725 PMCid:PMC2244878.

Kummervold PE, Chronaki CE, Lausen B, Prokosch HU, Rasmussen J, Santana S et al. eHealth trends in Europe 2005–2007: a population-based survey. Journal of Medical Internet Research 2008;10(4):e42.

Baker TB, Gustafson DH and Shah D. How can research keep up with eHealth? Ten strategies for increasing the timeliness and usefulness of eHealth research. Journal of Medical Internet Research. 2014;16(2):e36.

Williams D. The myClinicalOutcomes website: providing realtime, patient-level PROMs data. Bulletin of the Royal College of Surgeons of England 2012;94:20–21.

Department for Health. Patient Reported Outcome Measures (PROMs) in England: A Methodology for Identifying Potential Outliers. London:Department for Health, 2012:12.

Calin A, Garrett S, Whitelock H, Kennedy LG, O’Hea J, Mallorie P et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the bath ankylosing spondylitis functional index. The Journal of Rheumatology 1994;21:2281–5. PMid:7699629.

Benson T, Sizmur S, Whatling J, Arikan S, McDonald D and Ingram D. Evaluation of a new short generic measure of health status: howRu. Inform Prim Care. 2010; 18: 89-101.

Benson T PH, Whatling JM and Patterson D. Direct comparison of usability of two measures of health related quality of life using howRU and a validated tool, EQ-5D. Informatics in Primary Care 2013;21(1):12. PMid:24629651.

International Physical Activity Questionnaire. Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire (IPAQ) – Short and Long Forms. Available from: Accessed July 2014.

Jakes RW, Day NE, Khaw KT, Luben R, Oakes S, Welch A et al. Television viewing and low participation in vigorous recreation are independently associated with obesity and markers of cardiovascular disease risk: EPIC-Norfolk population- based study. European Journal of Clinical Nutrition 2003;57:1089–96. PMid:12947427.

Elo S and Kyngäs H. The qualitative content analysis process. Journal of Advanced Nursing 2008;62:107–15. PMid:18352969

Braun V and Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology 2006;3:77–101.

Dagfinrud H, Mengshoel AM, Hagen KB, Loge JH and Kvien TK. Health status of patients with ankylosing spondylitis: a comparison with the general population. Annals of the Rheumatic Diseases 2004;63:1605–10. PMid:15547084 PMCid:PMC1754848.

Braun J, van den Berg R, Baraliakos X, Boehm H, Burgos- Vargas R, Collantes-Estevez E et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Annals of the Rheumatic Diseases 2011;70:896–904. PMid:21540199 PMCid:PMC3086052.

Da Costa D, Dritsa M, Ring A and Fitzcharles MA. Mental health status and leisure-time physical activity contribute to fatigue intensity in patients with spondylarthropathy. Arthritis and Rheumatism 2004;51:1004–8. PMid:15593104.

Baysal O, Durmuş B, Ersoy Y, Altay Z, Senel K, Nas K et al. Relationship between psychological status and disease activity and quality of life in ankylosing spondylitis. Rheumatology International 2011;31:795–800. PMid:20221605.

Martindale J, Smith J, Sutton CJ, Grennan D, Goodacre L and Goodacre JA. Disease and psychological status in ankylosing spondylitis. Rheumatology (Oxford, England) 2006;45:1288–93. PMid:16595514.

Hamilton-West KE and Quine L. Living with ankylosing spondylitis: the patient’s perspective. Journal of Health Psychology 2009;14:820–30. PMid:19687119.

Ward MM. Health-related quality of life in ankylosing spondylitis: A survey of 175 patients. Arthritis Care & Research 1999;12:247–55.<247::AID-ART3>3.3.CO;2-8.<247::AID-ART3>3.0.CO;2-H.

Roussou E and Sultana S. Spondyloarthritis in women: differences in disease onset, clinical presentation, and bath ankylosing spondylitis disease activity and functional indices (BASDAI and BASFI) between men and women with spondyloarthritides. Clinical Rheumatology 2011;30:121–7. PMid:20882310

Steinberg DM, Levine EL, Lane I, Askew S, Foley PB, Puleo E et al. Adherence to self-monitoring via interactive voice response technology in an eHealth intervention targeting weight gain prevention among Black women: randomized controlled trial. Journal of Medical Internet Research 2014;16:e114.

Askari S, Zhang M and Won DS. An EMG-based system for continuous monitoring of clinical efficacy of Parkinson’s disease treatments. Conf Proc IEEE Eng Med Biol Soc. 2010;2010: 98–101.

Kontos E, Blake KD, Chou WY and Prestin A. Predictors of eHealth usage: insights on the digital divide from the Health Information National Trends Survey 2012. Journal of Medical Internet Research 2014;16:e172.



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