To evaluate the effect of physiotherapy on functional limitation in an observational cohort of early axial spondyloarthritis.

Design: prospective population-based cohort study. Patients: 708 patients with early axial spondyloarthritis between 2007 and 2010 naive of TNF blockers. Intervention: early physiotherapy defined by at least eight supervised sessions of physical therapy during the first six months. Measurements: the primary outcome was functional improvement defined by a relative improvement of at least 20% in BASFI at six months. Secondary outcomes were improvement in BASFI at one and two years and ASAS20 response criteria at six months. Statistical analysis: a propensity score of having physiotherapy was developed and multivariate analysis using propensity score weighting were used to assess the effect of physiotherapy on outcome.

Overall, 166 (24%) patients had physiotherapy during the first six months. After using propensity score weighting, there was no functional improvement on the primary outcome in patients treated with early physical therapy (relative risk [IC95%]: 1.15 [0.91–1.45]). No differences were observed on secondary outcomes (relative risk [IC95%]: 0.94 [0.80–1.11]).

It seems there is no functional benefit for patients with early spondyloarthritis to be treated early by physiotherapy in daily practice, even though the efficacy of physiotherapy has been shown in several randomized controlled studies.