Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease affecting predominantly sacroiliac joints and axial skeleton. axSpA progression being irregular and hardly predictable, identifying functional decline is particularly important in patient with axSpA to allow delivery of timely and targeted interventions. Pain, reduced range of motion or altered posture can have adverse consequences on gait. Although gait has previously been used as a sensitive measure of physical outcomes in elderly and pathological populations, to the best of our knowledge, no study has used gait as a predictor of physical function in patients with axSpA. The objective of our study is hence to determine if gait parameters measured in patients with axSpA could predict the evaluation at 18 months of physical function as assessed by the Bath Ankylosing Spondylitis Functional Index (BASFI). This is a prospective and longitudinal study. Sixty patients with axSpA and 30 healthy age- and sex-matched controls will be included. Patients should be aged 18–65 years at time of their first evaluation, followed at Grenoble Alpes University Hospital for axSpA or ankylosing spondylitis, able to walk 180 m without technical help and with stable treatment for at least 12 months. Clinical characteristics, BASFI, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), clinical and laboratory measurements of gait will be assessed during four visits (at baseline and at months 6, 12, and 18). Similar assessments will be performed once for the healthy control group. A linear mixed model at 6, 12 and 18 months will be constructed to answer to the first objective, with the BASFI as dependent variable and gait parameters as explanatory variables. The data collection started in August 2018 and will be completed with the inclusion and follow-up of all the participants. We believe that the combination of clinical and laboratory measurements of gait in patients with axSpA could strengthen the capacity to monitor disease’s evolution and to predict changes in patients’ physical function. Results of the present study could ultimately allow delivering targeted, timely, personalized interventions and treatment in patients with axSpA.
Trial registration: The study was approved by local ethic committee (CPP Ile De France 1, RCB: 2017-A03468-45, date of agreement: July 17th, last version: V4.0, 2018, March 5th, 2019) and is retrospectively registered in Clinical trials (NCT03761212).
Ankylosing spondylitis Axial spondyloarthritis Spondylarthritis Walking Wearable sensors 6-Minute Walk Test Timed Up and Go 10-Meter Walk Test Instrumented gait
10-Meter Walk Test
Bath Ankylosing Spondylitis Functional Index
Bath Ankylosing Spondylitis Disease Activity Index
Global Physical Activity Questionnaire
Instrumented Timed Up and Go
Instrumented 6-Minute Walk Test
International Physical Activity Questionnaire
Short Form 36
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All authors have contributed to the design of this project. JS and NV wrote the manuscript and all authors read and approved this manuscript.
This study is part of the Ph.D. thesis of the first author Julie Soulard (Univ. Grenoble Alpes, AGEIS, France and Grenoble Alps University Hospital, Grenoble, France). This work is supported by the French Ministry of Health and Solidarity with the “Nursing and Paramedical Hospital Research Program” year 2016 (PHRIP-16-0528) and by the French National Research Agency in the framework of the “Investissements d’avenir” program (ANR-10-AIRT-05 and ANR-15-IDEX-02). The sponsors had no involvement in the design of the study, the collection, analysis and interpretation of data, and in writing the manuscript. This work further forms part of a broader translational and interdisciplinary research program, GaitAlps.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no proprietary, financial, professional, or other competing interests regarding this study and the publication of this paper.
Ethics approval and consent to participate
The study was approved by local ethic committee (CPP IDF1, RCB: 2017-A03468-45, date of agreement: July 17th, last version: V4.0, 2018, March 5th, 2019). This study protocol is registered on ClinicalTrials.gov, with the following ID: NCT03761212 and follow the SPIRIT checklist. Written informed consent will be obtained from all participants by the physiotherapist or a medical doctor. Any modification to the initial protocol will be presented to the local ethics committee and has to be accepted before application and will be registered on ClinicalTrials.gov.
Data of the participants are anonymized with a participant number. A clinical research associate, mandated by the Grenoble Alpes University Hospital, will monitor the study depending on inclusion rhythm and following a pre-prepared plan. Each monitoring will be associated with a written record. Besides, an audit or an inspection by health authorities can be conducted, independently of the sponsor and promotor, at any time to ensure research quality, result validity, and law respect.
The data collection started in August 2018 and will be completed with the inclusion and follow-up of all the participants (60 patients with axSpA and 30 healthy controls). We plan the results of this study to be presented at international oriented scientific and clinical conferences and to be published in peer-reviewed scientific journals.
Poddubnyy D, Haibel H, Listing J et al (2012) Baseline radiographic damage, elevated acute-phase reactant levels, and cigarette smoking status predict spinal radiographic progression in early axial spondylarthritis. Arthritis Rheum 64:1388–1398. https://doi.org/10.1002/art.33465CrossRefGoogle Scholar
Bennett AN, McGonagle D, O’Connor P et al (2008) Severity of baseline magnetic resonance imaging-evident sacroiliitis and HLA-B27 status in early inflammatory back pain predict radiographically evident ankylosing spondylitis at eight years. Arthritis Rheum 58:3413–3418. https://doi.org/10.1002/art.24024CrossRefGoogle Scholar
Oostveen J, Prevo R, den Boer J, van de Laar M (1999) Early detection of sacroiliitis on magnetic resonance imaging and subsequent development of sacroiliitis on plain radiography. A prospective, longitudinal study. J Rheumatol 26:1953–1958Google Scholar
Zochling J (2011) Measures of symptoms and disease status in ankylosing spondylitis: ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS-G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S). Arthritis Care Res Hoboken 63(Suppl 11):S47–S58. https://doi.org/10.1002/acr.20575CrossRefGoogle Scholar
Ward MM (2002) Predictors of the progression of functional disability in patients with ankylosing spondylitis. J Rheumatol 29:1420–1425Google Scholar
de Hooge M, Ramonda R, Lorenzin M et al (2016) Work productivity is associated with disease activity and functional ability in Italian patients with early axial spondyloarthritis: an observational study from the SPACE cohort. Arthritis Res Ther 18:265. https://doi.org/10.1186/s13075-016-1162-3CrossRefGoogle Scholar
López-Medina C, Garrido-Castro JL, Castro-Jiménez J et al (2018) Evaluation of quality of life in patients with axial spondyloarthritis and its association with disease activity, functionality, mobility, and structural damage. Clin Rheumatol 37:1581–1588. https://doi.org/10.1007/s10067-018-4112-4CrossRefGoogle Scholar
Montero-Odasso M, Schapira M, Soriano ER et al (2005) Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older. J Gerontol A Biol Sci Med Sci 60:1304–1309CrossRefGoogle Scholar
Abellan van Kan G, Rolland Y, Andrieu S et al (2009) Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging 13:881–889CrossRefGoogle Scholar
Calin A, Garrett S, Whitelock H et al (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21:2281–2285Google Scholar
Calin A, Nakache JP, Gueguen A et al (1999) Defining disease activity in ankylosing spondylitis: is a combination of variables (Bath Ankylosing Spondylitis Disease Activity Index) an appropriate instrument? Rheumatol Oxf Engl 38:878–882CrossRefGoogle Scholar
Garrett S, Jenkinson T, Kennedy LG et al (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21:2286–2291Google Scholar
Boonstra AM, Schiphorst Preuper HR, Reneman MF et al (2008) Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res Int Z Rehabil Rev Int Rech Readapt 31:165–169. https://doi.org/10.1097/MRR.0b013e3282fc0f93Google Scholar
Escalante A, Lichtenstein MJ, White K et al (1995) A method for scoring the pain map of the McGill Pain Questionnaire for use in epidemiologic studies. Aging Milan Italy 7:358–366Google Scholar
van Trijffel E, van de Pol RJ, Oostendorp RA, Lucas C (2010) Inter-rater reliability for measurement of passive physiological movements in lower extremity joints is generally low: a systematic review. J Physiother 56:223–235CrossRefGoogle Scholar
Berthelot J-M, Laslett M (2009) Par quels signes cliniques s’assurer au mieux qu’une douleur est bien d’origine sacro-iliaque (sensu lato)? Rev Rhum 76:741–749CrossRefGoogle Scholar
Williams R, Binkley J, Bloch R et al (1993) Reliability of the modified-modified Schöber and double inclinometer methods for measuring lumbar flexion and extension. Phys Ther 73:33–44Google Scholar
Perneger TV, Leplège A, Etter JF, Rougemont A (1995) Validation of a French-language version of the MOS 36-Item Short Form Health Survey (SF-36) in young healthy adults. J Clin Epidemiol 48:1051–1060CrossRefGoogle Scholar
Kaminska M, Jobin V, Mayer P et al (2010) The Epworth Sleepiness Scale: self-administration versus administration by the physician, and validation of a French version. Can Respir J J Can Thorac Soc 17:e27–e34Google Scholar
Pichot P, Brun JP (1984) Brief self-evaluation questionnaire for depressive, asthenic and anxious dimensions. Ann Med Psychol (Paris) 142:862–865Google Scholar
Martins NA, Furtado GE, Campos MJ et al (2014) Exercise and ankylosing spondylitis with New York modified criteria: a systematic review of controlled trials with meta-analysis. Acta Reumatol Port 39:298–308Google Scholar