1. ST05_Mar12 Normative values for the Bath Ankylosing Spondylitis Metrology Index (BASMI) Lucy Chilton-Mitchell 1 Anna Hart, 2 Jane Martindale, 1,2 Lynne Goodacre 3 1 Wrightington Wigan and Leigh NHS Foundation Trust, 2 Lancaster University, 3 R and D North West

2. Outline Background to study Methodology Results Discussion and implications for practice Limitations of study Future work Key messages Background Methodology Results Discussion Future Work Key messages

3. Spinal mobility in AS Natural history of AS ‘Progressive restriction in spinal mobility’ 1 Background Methodology Results Discussion Future Work Key messages Google image search ‘ Ankylosing Spondylitis and age’

4. Assessment of spinal mobility in AS Background Methodology Results Discussion Future Work Key messages Loss of spinal mobility important clinical sign - Modified NY criteria 2 - ASAS core domain 3 Recommended measure of spinal mobility (ASAS) – BASMI 3 Spinal mobility - Obtain baseline measurement 4 - Monitor change over time 4 - Assess the impact of clinical interventions 3

5. BASMI scoring systems BASMI 2 scoring system (4) BASMI 10 scoring system (5) BASMI linear scoring system (6) Background Methodology Results Discussion Future Work Key messages

6. BASMI 10 Are we correct to expect a score of zero is representative of normal spinal movement in a healthy population ? Background Methodology Results Discussion Future Work Key messages 0 = No mobility limitation 10 = Severe mobility limitation

7. Work informing this study Inter- and intra-rater reliability of BASMI 7 Incidental finding –Some healthy volunteers had worse BASMI scores than AS patients –7 healthy volunteers –BASMI scores ranged 0.7-2.0 –Mean BASMI score 1.3 This study suggests that a score of zero should not be expected in a healthy population Background Methodology Results Discussion Future Work Key messages

8. Spinal changes with age Background Methodology Results Discussion Future Work Key messages Google image search ‘ Spinal posture and age’

9. Literature on ageing…. If spinal ROM decreases with increasing age, should we expect the BASMI to increase with age also? Background Methodology Results Discussion Future Work Key messages Youdas et al 8 Chen et al 9 Finnsback et al 10 Moll & Wright 11 Saidu et al 12 Einkauf et al 13 Fitzgerald et al 14 Intolo et al 15

10. Aim To explore the normative values for total BASMI score in healthy men and women in a UK population Background Methodology Results Discussion Future Work Key messages

11. Methodology Cross-sectional study 168 participants recruited - UK population Stratified by gender and age 14 Physiotherapists involved in recruiting and measuring participants ASSIGNw consensus of measurement for each domain was followed 7 Exclusion criteria: – Pregnancy – Diagnosis of AS/Axial SpA, – Acute back problems – Chronic back problems, – Impairment limiting normal movement at time of measurement Age range18-3030-5050 and over GenderMaleFemaleMaleFemaleMaleFemale Number222222 Background Methodology Results Discussion Future Work Key messages

12. Statistical analysis Descriptive statistics were obtained: –Therapist experience –Total BASMI scores –BASMI component scores –Percentage scoring zero on the BASMI Age-specific centiles were calculated 16 - Centiles presented start at age 25 and increase in 10 year intervals Background Methodology Results Discussion Future Work Key messages

13. Results 168 participants (age range 18-85) - Males = 84, Females= 84 - 18-30 = 56, 30-50 = 56, 50+= 56 BASMI scores: 0 – 4.4 1.2% individuals scored 0 BASMI scores increased with increasing age Corresponding trends with BASMI component scores No gender differences Background Methodology Results Discussion Future Work Key messages

14. Total BASMI score <30 years30-50 years>= 50 years MFM & FMF MF Total BASMI score 0.8 1.01.4 1.2 2.21.6 2.0 Zero is not a ‘normal’ score for an individual from a healthy population Increase in total BASMI score with increasing age Background Methodology Results Discussion Future Work Key messages

15. Modified Schober’s Test < 30 years30-50 years>= 50 years MFM & FMF MF Modified Schober’s (cm) 6.56.6 6.5 66 6 5.56 6 Modified Schober’s BASMI score 11 1 22 2 32 2 Decrease in Modified Schober’s test with increasing age Corresponding increase in component BASMI score Background Methodology Results Discussion Future Work Key messages

16. Intermalleolar Distance < 30 years30-50 years>= 50 years MFM & FMF MF IMD (cm) 110117 115 113107.5 112 95104 102 IMD BASMI score 11 1 12 1 32 2 Decrease in intermalleolar distance with age Corresponding increase in component BASMI score Background Methodology Results Discussion Future Work Key messages

17. Cervical Rotation < 30 years30-50 years>= 50 years MFM & FMF MF Cx rotation (deg) 8682.5 85 81.582.8 82 70.076.8 73.8 Cx rotation BASMI score 01 0 11 1 21.5 2 Decrease in cervical rotation with age Corresponding increase in component BASMI score Background Methodology Results Discussion Future Work Key messages

18. Tragus-to-wall distance < 30 years30-50 years>= 50 years MFM & FMF MF Tragus-to- wall (cm) 10.610.0 10.3 10.510.3 10.5 12.610.2 11.5 Tragus-to- wall BASMI score 11 1 11 1 11 1 Small increase in tragus-to-wall distance with age No change in component BASMI score Suggests this measure is disease specific Background Methodology Results Discussion Future Work Key messages

19. Lumbar side flexion < 30 years30-50 years>= 50 years MF M & F MF MF Lx lateral flexion (cm) 21.721.5 20.319.8 20.0 14.816.5 15.8 Lx lateral flexion BASMI score 00 0 01 1 32 3 Decrease in lumbar side flexion with age Corresponding increase in component BASMI score Background Methodology Results Discussion Future Work Key messages

20. Centiles of total BASMI score Background Methodology Results Discussion Future Work Key messages

21. Centiles of total BASMI score Background Methodology Results Discussion Future Work Key messages

22. Implications for practice Illustrate to patients what a ‘normal’ age-matched individual would score on the BASMI -Important in newly diagnosed -Inform expectations about treatment effects Potentially accounts for influence of age -Not just disease process -Important when assessing change over time Background Methodology Results Discussion Future Work Key messages

23. Limitations of study Measurements taken by a number of different therapists UK population only Sample size Did not account for factors such as height 17, activity level etc. Background Methodology Results Discussion Future Work Key messages

24. Future work Larger sample size Assess height, weight, activity level UK and other populations Background Methodology Results Discussion Future Work Key messages

25. Key ‘take-home’ messages A total BASMI score of zero is not normal in the healthy adult population The BASMI score increases with age in healthy individuals The normative values shown will aid interpretation of BASMI scores in individuals with AS/ Axial SpA Background Methodology Results Discussion Future Work Key messages

26. Acknowledgements Supervisory team – Dr Jane Martindale and Dr Lynne Goodacre Anna Hart (medical statistician) WWL (especially CEO and Physiotherapy Lead) Lancaster Medical School, Lancaster University ASSIGNw volunteers Our ‘normal’ participants! NIHR

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28. Thank you for listening Any Questions? Chilton-Mitchell L, Martindale J, Hart A, Goodacre L. Normative values for the Bath Ankylosing Spondylitis Metrology Index in a UK population. Rheumatology 2013 52 (11) 2086-2090