The effect of electronic moxibustion combined with rehabilitation nursing on the lumbar pain and stiffness of ankylosing spondylitis patients (2024)

Abstract

Objective: To investigate the effect of electronic moxibustion combined with rehabilitation nursing on the lumbar pain and stiffness of ankylosing spondylitis patients. Methods: Ninety-four ankylosing spondylitis patients were recruited as the study cohort and randomly assigned into a control group, which underwent rehabilitation nursing, and a research group, which underwent electronic moxibustion combined with rehabilitation nursing. The clinical effects in the two groups were compared, and the occipital-wall distances, finger-floor distances, spine mobility, morning stiffness durations, overall morning stiffness levels, lower back pain, motor performance of the upper and lower limbs, and the quality of life were compared between the two groups before and after the intervention. Results: The effective rate in the research group was significantly higher than it was in the control group (91.49% vs. 74.47%, P < 0.001). The research group patients had significantly greater occipital-wall distances, better spine mobility and shorter finger-floor distances than the control group after the intervention (all P < 0.05). The research group patients also showed significantly shorter morning stiffness durations, lower overall morning stiffness levels, and the lower visual analogue scale (VAS) lower back scores than the control group (all P < 0.05). The motor performance of the upper and lower limbs in the research group was significantly better than it was in the control group after the intervention (P < 0.05). The research group had significantly higher quality of life scores than the control group (all P < 0.05). Conclusion: Electronic moxibustion combined with rehabilitation nursing in ankylosing spondylitis patients shows significant advantages compared with rehabilitation nursing alone. The combination, which can improve the quality of life, and the motor performance of the upper and lower limbs, and relieve patients’ lumbar pain and stiffness, is worthy of further promotion and application.

Keywords: Morning stiffness duration, motor performance, ankylosing spondylitis, rehabilitation nursing, electronic moxibustion

Introduction

Ankylosing spondylitis as a chronic progressive autoimmune disease mainly manifested as spinal deformity, restricted mobility, stiffness and low back pain; in severe cases, ankylosis can affect the paravertebral soft tissues, the spine, the sacroiliac joints and other axial joints [1,2]. Men around the age of 30 in top mental and physical shape are those most susceptible of getting ankylosing spondylitis, and the patients often also suffer from psychological disorders such as anxiety or depression [3,4]. Electronic moxibustion, which was developed based on traditional moxibustion, has a promising heat penetration depth and a specific heating mode. As a technology in the field of traditional Chinese medicine, electronic moxibustion has shown promising clinical efficacy on lots of diseases such as diabetic peripheral neuropathy, primary dysmenorrhea, knee osteoarthritis, and periarthritis of the shoulder [5]. Applying effective nursing methods to ankylosing spondylitis patients can improve their clinical symptoms to a certain extent, but there are few published studies on the combined application of electronic moxibustion and rehabilitation nursing. Therefore, this study applied electronic moxibustion combined with rehabilitation nursing to ankylosing spondylitis patients to explore their effects and to provide a theoretical basis for the clinical treatment.

Materials and methods

General data

A total of 94 ankylosing spondylitis patients were prospectively enrolled from June 2018 to June 2020. The patients were randomly assigned into a control group or a research group, with 47 cases in each group. The patients in the control group ranged in age from 18-49 years old, with an average age of (33.7±2.3) years old. The patients in the research group ranged in age from 20-48 years old, with an average age of (33.9±2.2) years old. This study was approved by the ethics committee of our hospital, and written informed consent forms were obtained from all the patients.

The patients were eligible if they were 18 years old or older, signed the informed consent, were diagnosed with early or mid-stage ankylosing spondylitis according to the Guidelines for the Diagnosis and Treatment of Ankylosing Spondylitis promulgated by the Chinese Medical Association in 2010, had favorable compliance, were not allergic to adhesive bandages, had undamaged skin at the treatment sites, and did not take any immunosuppressants, corticosteroids, or other drugs which may impact their conditions within the previous month before their enrollment [6].

The patients were excluded if they had a mental illness, severe primary cardio-cerebrovascular disease, hematopoiesis, liver or kidney disease, or if they had severe complications, were pregnant or lactating, had poor compliance, refused to receive acupoint application, had an allergic constitution or a local skin ulceration and redness, or had other rheumatic diseases or seronegative spondyloarthropathy.

Methods

The control group underwent rehabilitation nursing interventions for a month, including rehabilitation guidance, exercising, diet and psychological health guidance, as well as information on disease-related knowledge and an awareness of patient rehabilitation.

The research group was given electronic moxibustion combined with rehabilitation nursing for a month. The nursing staff were systematically trained to be familiar with the electronic moxibustion technique. During and after the treatment, the patients were asked if they had any symptoms or discomfort. The local skin and the patients’ conditions were closely observed and inspected. An electronic moxibustion apparatus (YZB/Su 1186-2013, produced by Suzhou Haobo, China), was used for the intervention. The main and matching acupoints were fixed with the binding band, and the moxa sheets were fixed on the moxa cavity. Then, the apparatus was powered on and the temperature (55-60°C) and treatment time were set. The patients were kept warm during the treatment, and the treatment was performed once a day, 30 min each time.

Outcome measures

First, the two groups’ general data were compared.

Second, the clinical efficacy in the two groups was compared. It was considered ineffective when there was no improvement in the peripheral joint swelling and no relief from the joint or lumbosacral pain, the laboratory test indicators did not return to normal, there was no improvement or even an aggravation of the clinical symptoms, which severely affected the patients’ normal lives and work. It was considered effective when the peripheral joint swelling was improved, the joint and lumbosacral pain was alleviated, the laboratory examination indicators were basically normal, the clinical symptoms that affected the patients’ normal lives and work improved only to a certain extent. It was considered markedly effective when there was no swelling at the peripheral joints, no pain in the joints and the lumbosacral area, the laboratory indicators were basically normal, the clinical symptoms were significantly improved or generally disappeared and did not affect the patients’ lives and work. Effective rate = (number of markedly effective + number of effective)/total number of cases * 100% [6].

Third, the changes in the clinical symptoms between the two groups were compared, including the occipital-wall distances, the finger-floor distances, and the spine mobility (evaluated using the Schober test). The Schober test was evaluated before and after the intervention by the same recorder using the Bath Ankylosing Spondylitis Metrology Index for spine mobility. A mark was made at the level of the spina iliace on the midline of the patient’s back (origin point) when patients were in a standing position with their hands next to their legs. Mark B was 5 cm below the origin point, and mark A was 10 cm above the origin point. The patients bent forward as much as possible while keeping their legs upright, and the distances from A to B were measured and recorded. A distance < 2 cm was recorded as 2 points, 2-4 cm as 1 point, and > 4 cm as 0 points [6].

Fourth, the changes in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) between the two groups were evaluated before and after the intervention, including the morning stiffness durations and the overall morning stiffness and lower back pain levels. The duration of the morning stiffness (min) was calculated by the patients themselves. It referred to the start of feeling stiffness after waking up in the morning to the time when they felt a significant alleviation of the stiffness. Both the overall morning stiffness and lower back pain levels were assessed using the visual analogue scale (VAS). A scale from 0 to 10 was used to access the degree of morning stiffness and pain by the patients themselves after standard explanation of the assessment criteria was given. The larger the number was, the worse the morning stiffness and pain were [7].

Fifth, the changes in motor performance between the two groups were compared. The motor performance of the lower limbs and upper limbs of the two groups of patients were evaluated both before and after intervention using their Fugl-Meyer scores. The highest possible score was 34 points for the lower limbs, and 66 points for the upper limbs. The higher the score, the better the motor performance [8].

Finally, the quality of life changes were compared using the SF-36 questionnaire before and after the intervention, with a total possible score of 100 points. There were 9 aspects: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, mental health, and health transition. The higher the score, the better the quality of life [9].

Statistical methods

SPSS 18.0 was used for the data processing. The measurement data conforming to a normal distribution were expressed as x̅ ± sd. The comparisons between the two groups were carried out using independent sample t-tests, and the comparisons within a group between before and after the interventions were done using paired t-tests. The count data were expressed as (n, %) and compared using χ² tests. The hypothesis test standard was α=0.05. P < 0.05 was considered statistically significant.

Results

Comparison of the general data

The average ages, the genders, the positive sacroiliac X-ray rates, or the positive HLA-B27 rates in the two groups of patients were not significantly different (all P > 0.05), so the two groups were comparable. See Table 1.

Table 1.

Comparison of the general data (n)

Group	Control group	Research group	χ²	P
Number of cases	47	47
Average age (years)	33.7±2.3	33.9±2.2	6.489	0.267
Sex
Male/Female	36/11	34/13	2.168	0.089
Positive sacroiliac X-rays	25	24	1.643	0.067
Positive HLA-B27	22	23	1.643	0.067

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Comparison of clinical efficacy

The effective rate in the research group was significantly higher than the effective rate in the control group (91.49% vs. 74.47%, P < 0.001). See Table 2.

Table 2.

Comparison of the clinical efficacy (n, %)

Group	Control group	Research group	χ²	P
Number of cases	47	47
Markedly effective	23 (48.94)	29 (61.70)
Effective	12 (25.53)	14 (29.79)
Ineffective or deteriorated	12 (25.53)	4 (8.51)
Effective rate	35 (74.47)	43 (91.49)	17.473	< 0.001

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Comparison of the changes in the clinical symptoms

There were no significant differences in the occipital-wall distances, the finger-floor distances, or the spine mobility between the two groups before the intervention (all P > 0.05). After the intervention, the occipital-wall distances and the spine mobility in the two groups were both significantly greater than they were before the intervention, and the finger-floor distance was significantly shorter than it was before the intervention (all P < 0.001). The research group showed greater occipital-wall distances and spine mobility as well as shorter finger-floor distances than the control group after the intervention (P < 0.01). See Table 3 and Figure 1.

Table 3.

Comparison of the clinical symptoms (cm, x̅ ± sd)

Group	Control group	Research group	t	P
Number of cases	47	47
Occipital-wall distance
Before intervention	3.40±0.46	3.35±0.51	3.402	0.619
After intervention	4.06±0.57***	4.72±0.86***	4.386	< 0.001
Finger-floor distance
Before intervention	18.78±1.22	18.68±1.12	0.414	0.680
After intervention	14.48±0.94***	12.22±1.04***	11.052	< 0.001
Spine mobility
Before intervention	4.26±0.69	4.33±0.74	0.4731	0.636
After intervention	5.34±0.73***	5.96±1.09***	3.240	0.002

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Note: Compared with before the intervention within the same group;

^***

P < 0.001.

The effect of electronic moxibustion combined with rehabilitation nursing on the lumbar pain and stiffness of ankylosing spondylitis patients (1)

Comparison of the BASDAI

There were no significant differences in the morning stiffness durations, the overall morning stiffness levels, or the lower back VAS scores between the two groups before the intervention (all P > 0.05). After the intervention, the morning stiffness durations, the overall morning stiffness levels, and the lower back VAS scores were significantly lower than they were before the intervention, and the indices were significantly lower in the research group than in the control group (all P < 0.001). See Table 4.

Table 4.

Comparison of the changes in BASDAI (x̅ ± sd)

Group	Control group	Research group	t	P
Number of cases	47	47
Duration of morning stiffness (min)
Before intervention	31.36±6.16	31.62±6.10	0.206	0.838
After intervention	15.17±3.47***	8.27±1.32***	12.742	< 0.001
Overall level of morning stiffness (points)
Before intervention	4.11±0.98	4.32±0.95	1.055	0.294
After intervention	2.23±0.31***	0.95±0.10***	26.940	< 0.001
Lower back VAS score (points)
Before intervention	4.23±0.84	4.39±0.95	0.866	0.389
After intervention	3.36±0.63***	1.79±0.37***	14.7314	< 0.001

Comparison of the motor performance

There was no significant difference in the motor performance of the lower and upper limbs between the two groups before the intervention (both P > 0.05). Compared with before the intervention, the motor performance of the two groups after the intervention was significantly improved (both P < 0.001). The research group had significantly better motor performance in the lower and upper limbs than the control group (both P < 0.001). See Table 5.

Table 5.

Comparison of the motor performance (points, x̅ ± sd)

Group	Control group	Research group	t	P
Number of cases	47	47
Lower limbs
Before intervention	8.68±1.30	8.64±1.18	0.156	0.876
After intervention	21.43±2.37***	31.14±2.70***	18.529	< 0.001
Upper limbs
Before intervention	11.36±2.45	11.44±2.58	0.154	0.878
After intervention	37.69±4.07***	56.53±3.48***	24.120	< 0.001

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Note: Compared with before the intervention within the same group;

^***

P < 0.001.

Comparison of the quality of life changes

There was no significant difference in the quality of life between the two groups before the intervention (all P > 0.05). The quality of life scores in the two groups were improved significantly after the intervention (all P < 0.001). The improvements were more significant in the research group than they were in the control group (all P < 0.001). See Table 6.

Table 6.

Comparison of the quality of life (points, x̅ ± sd)

Items	Control group	Research group
Physical functioning
Before intervention	51.57±6.98	52.01±5.92
After intervention	65.62±6.75***	72.39±8.77***,###
Role-physical
Before intervention	50.26±5.63	50.59±5.30
After intervention	60.48±7.91***	69.69±70.21***,###
Bodily pain
Before intervention	52.96±5.91	51.97±5.83
After intervention	65.28±7.35***	70.61±8.22***,###
General health
Before intervention	55.37±6.24	55.72±4.88
After intervention	65.17±6.48***	75.14±6.52***,###
Vitality
Before intervention	53.02±5.19	54.27±4.95
After intervention	63.39±6.82***	73.63±6.74***,###
Social functioning
Before intervention	49.28±5.73	48.24±5.88
After intervention	59.47±6.81***	64.33±8.07***,###
Role-emotional
Before intervention	50.35±7.01	51.01±7.55
After intervention	62.38±6.11***	71.29±7.16***,###
Mental health
Before intervention	54.22±5.19	55.41±4.30
After intervention	64.32±6.04***	70.34±8.42***,###
Health transition
Before intervention	56.21±5.65	56.32±4.42
After intervention	61.34±6.24***	71.36±8.49***,###

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Note: Compared with before the intervention within the same group;

^***

P < 0.001.

Compared with the control group after the intervention;

^###

P < 0.001.

Discussion

Patients with ankylosing spondylitis usually have symptoms such as decreased chest expansion, limited lumbar motion, morning stiffness, muscle spasms around the joints and pain. Improving joint mobility and relieving the symptoms are the main treatment goals for ankylosing spondylitis.

Rehabilitation nursing according to the patient’s condition can help the patients to enhance the movement of the diaphragm, increase the thoracic activity, and adjust the patient’s diet by explaining the dietary precautions. Physical dysfunction can also result in various degrees of mental disorders in patients. Therefore, psychological interventions such as encouragement and the establishment of a good nurse-patient relationship were conducted, as this can help patients to have a positive mood, improve the patients’ social and psychological adaptability and establish confidence in overcoming the disease. Rehabilitation nursing should be carried out step by step using scientific methods in order to achieve the best results [10,11].

Electronic moxibustion as a modern electronic technology combines heat, magnetism, far infrared, and moxa following the principles of traditional moxibustion [12-14]. The apparatus mainly includes three parts: a host, a moxibustion head and a moxibustion piece. The moxibustion head includes a heating device, a temperature sensor device, a magnetic emission device and a fixing device. During the moxibustion, the specific moxa stick was placed at the fixing device of the moxa head, and the heat of the moxa was transmitted to the local skin and acupoints of the patient through the temperature sensing device and the magnetic emission device under the action of electric heat. The moxa stick can directly exert its effect on the lesion by promoting blood circulation and qi, clearing dampness, dispelling coldness, warming the meridians and dredging the collaterals [15-17]. Electronic moxibustion has lots of advantages: first, it increases the time of moxibustion at each acupoint and the amount of moxibustion, and it is able to be used on multiple acupoints at the same time. Second, it is easy, reliable and safe which causes few adverse events such as scalds. Third, staff are not necessary for the process, which economizes on manpower and reduces the negative stimulation from moxa smoke on the nursing staff and patients. Fourth, it has an electromagnetic field effect. Fifth, it works better with the wider infrared spectrum. Finally, it has a strong and constant warming effect [18-20].

In this study, the control group was given rehabilitation nursing, and the research group was given electronic moxibustion combined rehabilitation nursing. Both groups showed greater occipital-wall distances and spine mobility, and shorter finger-floor distances after the intervention than before the intervention, indicating that the clinical symptoms were effectively improved after the intervention. Compared with the control group, the research group showed more significant improvement in the three indices above. Therefore, rehabilitation nursing plus electronic moxibustion therapy can exert a synergistic effect, improve patients’ muscle and bone function, and is more effective at relieving the clinical symptoms and signs.

In this study, the morning stiffness durations, the overall morning stiffness levels, and the lower back VAS score of the two groups were lower after the intervention than they were before the intervention. Compared with the control group, the above indicators were decreased in the research group. Therefore, electronic moxibustion combined with rehabilitation nursing can better relieve pain in ankylosing spondylitis patients and improve the disease activity index. Rehabilitation nursing improves circulation and helps to promote blood circulation and clear collaterals. Rehabilitation exercises and psychological and diet interventions have a positive effect on patients’ moods and their prognoses. Electronic moxibustion increases the secretion of joint fluid, prevents and relieves muscle spasms, pain and inflammation, dredges the meridians, prevents stiffness in the spine and limbs and increases the joints’ range of motion, thereby improving the local and general conditions, especially the patients’ morning stiffness [21-23].

Rehabilitation nursing can effectively and promptly recover the functions, improve patient compliance, and help the patients pay more attention to the importance of rehabilitation. Comprehensive and scientific rehabilitation nursing interventions based on the actual needs of patients can better exert nursing effects. Meanwhile, favorable patient acceptance and compliance helps to conduct electronic moxibustion. The electronic moxibustion apparatus acts directly on the acupoints in the form of spectral irradiation and reaches the whole body through the effect of moxibustion, which can actively improve the motor performance of the upper and lower limbs of the patients [24,25]. Our data showed that, compared with before the intervention, the motor performance of the upper and lower limbs was improved in both groups after the intervention. Compared with the control group, the research group showed greater improvement in motor performance after the intervention. Therefore, electronic moxibustion combined with rehabilitation nursing can better promote local blood circulation as well as improve joint function and motor performance.

This study has the limitations of a small sample size and a short observation time. We will conduct further research with more in-depth discussion and a bigger sample size.

In summary, electronic moxibustion combined with rehabilitation nursing for ankylosing spondylitis patients shows significant advantages as compared to rehabilitation nursing alone. The combination, which can improve the quality of life and the motor performance of the upper and lower limbs, as well as relieve patients’ lumbar pain and stiffness, is worthy of further promotion and application.

Acknowledgements

This work was supported by the Qingdao Key Medical and Health Discipline Construction Project.

Disclosure of conflict of interest

None.

References

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