Ankylosing spondylitis is a type of arthritis of the spine. It causes swelling between the vertebrae, the disks that make up the spine, and in the joints between the spine and pelvis. Ankylosing spondylitis is an autoimmune disease where the immune system, normally protective of the body from infection, attacks a body's own tissues. The disease is more common and more severe in men, and often runs in families. Early symptoms include back pain and stiffness, which often start in late adolescence or early adulthood. Over time, ankylosing spondylitis can fuse vertebrae together, thus limiting movement. Symptoms can worsen, improve or stop altogether. The disease has no cure, but medicines can relieve the pain, swelling and other symptoms. Exercise can also help.

A study by Luszcynska and colleagues described an intervention designed to enhance preaction self-efficacy beliefs--the beliefs you have about your ability to initiate behaviors to manage a given situation--and tested it in patients with spondylosis in relation to initiation of exercises recommended by a consultant in orthopedic rehabilitation. Sixty patients (age 28-83 years) with spondylosis who had not previously performed exercises for degenerative spine diseases were randomly assigned to a control or intervention group. Three weeks later, intervention patients performed recommended exercises more frequently than control patients. Analysis for all patients showed that preintervention, preaction self-efficacy predicted exercise. Age and preintervention self-efficacy moderated the intervention effects. Among older patients, only those with weak preintervention, preaction self-efficacy beliefs benefited from the intervention, whereas among younger patients, only those with strong preintervention, preaction self-efficacy beliefs benefited from the intervention.

COMMENT: Normally, self-efficacy beliefs is measured at the beginning and end of a study and treated as an outcome. In self-management, the aim is to see if self-efficay is involved in a person’s ability to perform these skills changes from before to after training. In this study, however, the examiners looked at how beliefs held before intervention were later influenced by the intervention. The results are somewhat conflicting between older and younger patients, but nevertheless interesting. They suggest a way to predict which patients may do well or less well when later taught self-management.

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A. Luszczynska et al. Effects of a self-efficacy intervention on initiation of recommended exercises in patients with spondylosis. Journal of Aging and Physical