High-quality research on physical therapy in psoriatic arthritis is needed: a systematic review

Abstract

Objectives: Although physical therapy is recommended as part of the non-pharmacological management of patients with psoriatic arthritis (PsA), the evidence is still unclear. Therefore, this study aimed to systematically review and appraise the quality of research on physical therapy in the management of patients with PsA. Methods: In June 2024, a systematic literature search using four different databases (Medline, Embase, Web of Science and the Cochrane Library) was performed to include interventional and observational studies examining physical therapy in patients with PsA (PROSPERO ID 255501). A risk of bias assessment was conducted. Due to the wide variety of interventions and outcomes, a narrative synthesis was used. Results: Of 9442 abstracts, 15 papers examining physical therapy uptake in clinical practice (N = 2) and different physical therapy interventions (N = 13) were included: cardiorespiratory exercises (N = 5), resistance exercises (N = 2), therapeutic modalities (N = 4) and mixed rehabilitation programs (N = 2). A low risk of bias was scored in only one RCT assessing cardiorespiratory exercises. The well-tolerated 11-week high-intensity interval training resulted in a long-term increase in peak oxygen uptake and a short-term decrease in truncal fat percentage in patients with low disease activity. Resistance training in patients with active disease did not increase muscle strength, but improved functional capacity, disease activity, pain and general health after the intervention. Evidence for other modalities was inconclusive. Conclusion: High-quality evidence on physical therapy in PsA was scarce. Cardiorespiratory and resistance exercises demonstrated promising results to positively influence cardiometabolic risk as well as disease-related outcomes. Future research on physical therapy in PsA with adequate methodological quality is needed. Lay Summary What does this mean for patients? Although physical therapy is recommended as part of the management of patients with PsA, the scientific evidence is still unclear. Current physical therapy guidelines are mainly supported by research in patients with other rheumatic diseases or based on expert opinion. Therefore, this study aimed to systematically review and appraise the quality of research on physical therapy in patients with PsA. In the results, we discussed 15 studies with different study designs and an overall high risk of bias. Different physical therapy programs (e.g. cardio-training, strength exercises, physiotherapeutic modalities, and mixed rehabilitation programs) were evaluated. We concluded that high-quality evidence on physical therapy in PsA was scarce. Studies assessing cardio-training and strength exercises demonstrated promising results to positively influence risk factors for cardiovascular (e.g. heart infarction) and metabolic diseases (e.g. obesity and diabetes mellitus type II) as well as disease-related outcomes in patients with PsA. More research with adequate study quality on physical therapy in the management of PsA is needed. Especially, the potential of physical therapy treatments to improve residual (non-inflammatory) pain, risk factors for cardiovascular and metabolic diseases as well as physical functioning and participation should be examined in future research.