Efficacy of Telerehabilitation for Ankylosing Spondylitis: A Case Report

Ankylosing spondylitis (AS) is a chronic inflammatory disease that causes significant pain and mobility limitations. In Japan, patients with AS often face difficulties accessing specialized rehabilitation due to physical restrictions and the uneven distribution of healthcare resources. Telerehabilitation, utilizing information and communication technology, has emerged as a promising alternative to address these barriers. This case study reports on the implementation of telerehabilitation for a patient with AS experiencing substantial daily life limitations, which resulted in improvements in pain, physical function, and disease activity. A woman in her 20s, diagnosed with AS in September 2024, experienced exacerbated lower back pain and arthralgia in multiple joints, leading to marked restrictions in daily activities and reduced exercise tolerance. Because of her difficulty commuting to medical facilities, remote exercise instruction via information and communication technology (ICT) was initiated in late October 2024 with the approval of her attending physician. The intervention consisted of a combination of chair and floor exercises focusing on spinal mobility and core stability. Exercise intensity was adjusted based on perceived exertion and pain. Four 60-minute sessions were conducted remotely using ICT, at intervals of 7-14 days. Pain was assessed using the numerical rating scale (NRS), daily physical function with the Japanese version of the Health Assessment Questionnaire (J-HAQ), and disease activity with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Evaluations were performed at baseline and after the fourth session. At the final evaluation, NRS scores decreased in six of the seven self-reported painful sites, with lower back pain improving markedly from 7 to 3. The mean J-HAQ score decreased from 1.75 to 1.50, and the BASDAI score decreased from 5.20 to 4.10. The patient also gained independence in "dressing and grooming." However, shoulder joint pain increased from an NRS score of 3 to 5, and the duration of morning stiffness lengthened. No notable adverse events were observed. This single-case study suggests that remote exercise instruction via ICT can improve pain, daily physical function, and disease activity in patients with AS who have limited access to traditional rehabilitation. Although challenges such as increased shoulder pain were noted, this case highlights the potential of telerehabilitation as a feasible and effective means of providing ongoing specialist guidance and enhancing quality of life for individuals with AS. Future research with larger cohorts and objective assessments is warranted to establish the efficacy and generalizability of these findings.