{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:50:58Z","timestamp":1791175858497,"version":"4.1.0"},"reference-count":41,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Musculoskeletal Care"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The comparative effectiveness of adjunctive physical modalities alongside exercise for ankylosing spondylitis (AS) remains inadequately evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the relative association of focused extracorporeal shock wave therapy (ESWT) versus therapeutic ultrasound, both added to identical exercise\u2010based rehabilitation, with long\u2010term functional outcomes in AS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This assessor\u2010blinded randomized comparative trial (conducted March 2024\u2013August 2025) evaluated 106 AS patients with chronic lumbar stiffness (90 completed 12\u2010month follow\u2010up). Participants received either focused ESWT (weekly \u00d7 4\u00a0weeks,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a045) or ultrasound (3 \u00d7 \/week \u00d7 4\u00a0weeks,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a045), alongside identical 12\u2010week supervised exercise and stable pharmacotherapy. The primary outcome was functional capacity (BASFI). Secondary outcomes included disease activity (BASDAI), pain, spinal mobility (modified Schober) and disability (DFI). This trial was not prospectively registered and lacked an exercise\u2010only control arm; therefore, findings should be interpreted as exploratory.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both groups improved significantly across all outcomes (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). At 12\u00a0months, the ESWT group was associated with lower BASFI scores (2.2\u00a0\u00b1\u00a01.8 vs. 3.7\u00a0\u00b1\u00a02.3;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.001; Cohen's\n                      <jats:italic>d<\/jats:italic>\n                      \u00a0=\u00a00.72) and lower disability (DFI:\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.003;\n                      <jats:italic>d<\/jats:italic>\n                      \u00a0=\u00a00.63) than the ultrasound group. Lumbar mobility differed nominally (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.030) but did not survive correction for multiple secondary comparisons. No significant between\u2010group differences were observed for BASDAI (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.424) or pain (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.284).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>When added to identical exercise and pharmacotherapy, focused ESWT was associated with greater long\u2010term functional improvement compared with therapeutic ultrasound. However, in the absence of an exercise\u2010only control, the incremental benefit of either modality over exercise alone cannot be determined. Given the lack of prospective registration and other methodological limitations, these preliminary findings require confirmation through properly registered trials before any clinical recommendations can be made.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/msc.70269","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T03:53:41Z","timestamp":1791172421000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Focused Extracorporeal Shock Wave Therapy Versus Therapeutic Ultrasound as Adjuncts to Exercise\u2010Based Rehabilitation for Functional Limitation in Ankylosing Spondylitis: An Assessor\u2010Blinded Randomized Comparative Trial"],"prefix":"10.1002","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3507-6470","authenticated-orcid":false,"given":"Yasser A.","family":"Elmotaleb Gazar","sequence":"first","affiliation":[{"name":"Rheumatology and Rehabilitation Department Faculty of Medicine Al\u2010Azhar University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4465-1089","authenticated-orcid":false,"given":"Sherif","family":"Ismail","sequence":"additional","affiliation":[{"name":"Rheumatology and Rehabilitation Internal Medicine Department Medical Research and Clinical Studies Institute National Research Center  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5823-422X","authenticated-orcid":false,"given":"Saad","family":"Ghanem","sequence":"additional","affiliation":[{"name":"Rheumatology and Rehabilitation Department Faculty of Medicine Al\u2010Azhar University  Damietta Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0577-4884","authenticated-orcid":false,"given":"Taha Ibrahim","family":"Aladrosy","sequence":"additional","affiliation":[{"name":"Rheumatology and Rehabilitation Department Faculty of Medicine Al\u2010Azhar University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6619-8855","authenticated-orcid":false,"given":"Adel Ibrahim","family":"Azzam","sequence":"additional","affiliation":[{"name":"Rheumatology and Rehabilitation Department Faculty of Medicine Al\u2010Azhar University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,4]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1302\/2058\u20105241.5.190067"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.7326\/M17\u20100046"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(07)60635\u20107"},{"issue":"12","key":"e_1_2_13_5_1","first-page":"2281","article-title":"A New Approach 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