Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies


Objective: The objective of this systematic EBM review is to determine “Is Cryotherapy with Exercise Therapy More Effective than Exercise Therapy Alone in Reducing Symptoms Associated with Ankylosing Spondylitis?”

Study Design: A comprehensive review of three randomized controlled trials (RCTs).

Data Sources: PubMed database was used to find all three articles referenced in this review. Each article was published in a peer-reviewed journal and published after 2010.

Outcome Measured: The outcome considered for this review was subjective reduction in disease activity measured using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) which consists of 6 questions regarding clinical manifestations of AS. BASDAI was calculated using a numerical rating scale of 0 (no symptoms) to 10 (very severe).

Results: Stanek et al. demonstrated a greater reduction in disease activity after intervention with cryotherapy compared to exercise therapy alone, with the difference in ending BASDAI being 1.4 and a p-value of 0.001. Straburzyńska-Lupa et al. also demonstrated statistical significance of cryotherapy over exercise therapy, although the difference in ending BASDAI was not as large at 0.39, and a p-value of 0.041. Księżopolska-Orłowska et al. demonstrated not only greater significance of cryotherapy over exercise therapy directly post trial, but also lasting significant reduction in BASDAI three months post-trial, with a p-value of < 0.001 at the three-month mark, compared to the exercise therapy only group which did not demonstrate significance at this assessment.

Conclusion: All three RCTs considered in this study showed cryotherapy in addition to exercise therapy resulted in a statistically significant greater reduction in symptomatic disease activity as compared to exercise therapy alone. Several limitations were identified, and further studies arewarranted to confirm validity, however systemic cryotherapy demonstrates significant potential as a therapeutic agent in the treatment of AS.