Analaysis of posture, balance and GAİT i̇n patients with axial spondyloarthri̇ti̇s and related factors

Introduction and Aim: Axial Spondyloarthritis (AkSpA) is a chronic, painful and inflammatory disease that can progress with peripheral joint and extra-articular involvements, mainly sacroiliac joint and spine, and may lead to spinal fusion and limitation in spinal mobility. With the progression of the disease, the spine, which is stiff from the occiput to the sacrum and whose movements are restricted, may cause postural changes and limitation in activities of daily living. Balance and gait are the most frequently used activities of daily life. In our study, we aimed to comprehensively analyze the posture, balance and gait in AkSpA patients with quantitative data and to examine the factors associated with these. Materials and Method: Our study included 51 patients aged 18-65 years who met the criteria for ASAS Spondyloarthritis, without known balance and gait disorders, and 51 healthy participants who were similar in terms of age and gender. Sociodemographic information of all participants was questioned. In AkSpA patients; for disease activities Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP), for their functional capacity Bath Ankylosing Spondylitis Functional Index (BASFI), for spinal mobility and flexibility Bath Ankylosing Spondylitis Metrology Index (BASMI), for determining the sensitivity of enthesis points Maastrich Ankylosing Spondylitis Enthesitis Score (MASES), for measuring activity levels International Physical Activity Questionnaire) (IPAQ), and for assessing quality of life Ankylosing Spondylitis Quality of Life Questionnaire ( ASQoL) and Short form-36 (SF-36) were used. DIERS formetric 3D / 4D (Diers International GmbH, Schlangenbad, Germany) Video-Raster-Stereography (VRS) device was used for posture analysis of AkSpA patients and healthy control group. For balance analysis, the HUR BTG4 balance platform (HUR-labs Oy, Kokkola,Finland) was used to measure postural balance and limit of stability (LOS). Functional balance was evaluated with Berg balance scale (BDI), functional reach test (FUT), and timed get up and go test (TUG). Gait analysis of the participants was performed with the Zebris FDM type 3 (Zebris Medical GmbH, Germany) gait platform. Results: There was no statistical difference between AkSpA and control groups in terms of age, gender and body mass index. No fall was detected in the last one year in either group and all sub-parameters of IPAQ of AkSpA patient group and control group were similar. In Posture parameters, Sagittal imbalance and cervical depth distance were worsened in the AkSpA group compared to the healthy population. There was no significant difference in the other posture parameters (Coronal imbalance VP-DM, Pelvic Oblicity, Pelvic Torsion, lumbar depth distance, Kyphotic angle ICT-ITL and Lordotic angle ITL-ILS). Among the Posturography parameters obtained with the force platform, there was no significant difference in the other parameters except lateral oscillation in the stable platform with eyes closed. LOS forward, backward, right and left were significantly lower in AkSpA patients compared to the healthy control group. Functional balance parameters were lower in the AkSpA patient group than in the control group, BDI and vii FUT were lower in the AkSpA group; TUG was longer in the AkSpA patient group than in the control group. In gait analysis, foot angles and stride width increased in the AkSpA group compared to the control group; step lenght and stride lengths were found to be decreased. Left stance phase, left swing phase, double stance phase and walking speed were found to be decreased in AkSpA group. When AkSpA was analyzed as non-radiographic AkSpA and radiographic AkSpA, clinical assessment scales, posture, balance and gait parameters were found to be similar. Conclusions: To our knowledge, this is the first study to comprehensively evaluate posture, balance and gait in AkSpA patients with quantitative data. In the quantitative analysis, it was observed that the sagittal imbalance and cervical depth distance, which are posture parameters, increased in the AkSpA group. In the posturographic balance parameters obtained with the force platform, it was observed that the parameters except eye-closed lateral sway were similar to those of healthy controls. It was observed that AkSpA patients performed worse in clinical functional balance tests and limit of stabilty test. In gait analysis, it was determined that stride length and walking speed decreased, and stride width and foot angle increased in AkSpA patients. Balance assessment parameters were found to be correlated with age, height, BMI, BASMI and MASES scores. In the gait analysis, it was noteworthy that double stride length was correlated with height, BASDAI, BASFI and BASMI scores. It was observed that non radiographic AkSpA patients had a similar disease burden as radiographic AkSpA patients, as well as their posture, balance and gait parameters were similarly affected. Keywords: Axial spondyloarthritis, Ankylosing Spondylitis, Posture, Postural balance, Balance, Gait