الفهرس 
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Abstract
Ankylosing spondylitis is an autoimmune disease and type of Spondyloarthropathy (SpA) that mainly involves spine joints, sacroiliac joints and paraspinl soft tissues, as ligaments and tendons. Loosing of flexibility due to fusion of spine because of calcification and fibrosis resulting from the inflammation ( 62). The management based on both pharmacological and non- pharmacological treatment .The cornerstone of non-pharmacological treatment of patients with AS include patient education and regular exercise(11,12) . Exercise is considered a fundamental tool for the management of ankylosing spondylitis patients that improve and control of signs and symptoms of this challenging disease (14) . The goals of exercise of AS are to reduce symptoms, maintain spinal flexibility and normal posture, reduce functional limitations, maintain work ability, and decrease disease complications(15). Exercises for patients with AS are usually include combination of muscle strengthening, range of motion, flexibility and cardiorespiratory exercises(16,17). The main role of nurses is to perform a comprehensive disease management to control disease activity, reduce symptoms and improve patient-preferred outcomes (31,32,33) . Nurses should identify, assess and address psychosocial issues to minimise the chance of patients‘ anxiety and depression (34,35) . Nurses should promote self-management skills in order that patients achieve a greater sense of control, self-efficacy and empowerment(36,37) . The Aim of the study is to: To evaluate the effect of therapeutic exercises intervention on the functional status for patients with ankylosing spondylitis. Research design: A quasi- experimental research design which had been used to evaluate effect of therapeutic exercises Intervention on the functional status for patients with ankylosing spondylitis. Setting: The study was conducted at the Physical Medicine and Rehabilitation Department at Tanta University Hospital. Subjects: The sample of this study was consisted of : A convenience sampling of (60) adult patients who are suffering from ankylosing spondylities in the above previously mentioned settings. The sample size was calculated based on the Epidemiological Information Program, based on the total of Ankylosing spondylitis patients per year according to review of Tanta Main University Hospital statistical records. They were divided randomly into two equal groups; each group consisted of (30) patients as following: group (1): Study group, it was consisted of (30) patients and they are exposed to the therapeutic exercise that was designed and implemented by the researcher. group (2): Control group, it was consisted of (30) patients and they are exposed to the routine hospital care. The following criteria will be used for selecting the study sample: - Inclusion criteria: -Adult patients. -Both sexes. -Had lumbar ankylosing spondylitis. - Independent ambulation without an assistive device. - Free from other chronic musculoskeletal diseases. -Being sedentary (not routinely involved in exercise activities during the last 3 months). Tools of the study: Four tools were used to evaluate the effect of therapeutic exercises intervention on the functional status for patients with ankylosing spondylitis, which include the following: Tool (I): Structured Interview Schedule: It was developed by the researcher after reviewing of the related literatures. It comprises of three parts:- Part (I): Socio- demographic data of the patients (164,165,166): which included; patient’s code, age, sex, marital status, level of education, occupation, residence and smoking habits. Part (II): patients’ clinical data(167,168): which included; height, weight, body mass index, past medical history, time of diagnosis, duration of symptoms, presence of morning stiffness methods of treatment, duration of disease, previous surgery, and medication and vital signs. Part (III): Patients Knowledge Assessment Sheet: - It was developed by the researcher after reviewing of the related literatures (168,169,170) to gather patients‘ knowledge regarding ankylosing spondylitis disease which included,(33)question regarding: definition, causes, risk factors, signs and symptoms, complication, diagnostic procedure, treatment, physical therapy, general information about the exercises, its benefits and types and how to carry out this exercises in the home, preparation of the patients before exercises, position, lifestyle changes. Tool (II): Bath Ankylosing Spondylitis Functional Index (BASFI) (171,172,173,174): The Bath Ankylosing Spondylitis Functional Index (BASFI) is an instrument used to assess degree of functional limitation in patients with Ankylosing Spondylitis. The BASFI is a set of 10 questions focused on the person‘s ability to perform specific functional tasks, the first 8 questions consider activities related to functional anatomy, such as putting on socks with or without help and climbing steps with or without using a handrail, the final two questions assess the patients‘ ability to cope with everyday life. Tool (III): Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (174,175):This tool will be designed for measuring disease activity in Ankylosing Spondylitis, consists of 10 cm horizontal visual analog scales, used to answer 6 questions pertaining to the 5 major symptoms of AS such as Fatigue, Spinal pain, Joint pain/swelling, Areas of localized tenderness, Morning stiffness. Tool (IV): The Numeric Pain Rating Scale (NPRS) (176,177,178,179):- The Numeric Pain Rating Scale is a unidimensional measure of pain intensity in adults including those with chronic pain due to rheumatic diseases. pain). Method A-Assessment phase: Assessment of the patient baseline data that was carried out by using the following: Tool (1); Part (I): Socio- demographic data of the patients. Part (II): patients’ clinical. Part (III): Patients Knowledge Assessment Sheet. Tool (II): Bath Ankylosing Spondylitis Functional Index (BASFI) : That was used to assess degree of functional limitation in patients with Ankylosing Spondylitis before implementation of patient program. Tool (III): Bath Ankylosing Spondylitis Disease Activity Index (BASDAI): This tool was used before implementation of patient program to assess disease activity in Ankylosing Spondylitis. Tool (IV): The Numeric Pain Rating Scale (NPRS) :- That was used to assess pain intensity in patients with Ankylosing Spondylitis before implementation of patient program. 2. Planning phase:- The planning phase included; preparing the content of patients educational program that was given to the patient by the researcher, preparing of the environment and preparing the content of patients educational program. -An illustrative structured colored booklet was prepared and written in simple Arabic language supported by illustrative pictures as a guide for the study group. -Therapeutic exercise were be used for the training of the patient after admission to the hospital; it was scheduled for three times each week for eight week (24) sessions. 3. Implementation phase:- - Therapeutic exercises were being carried out by the researcher for the study subjects throughout the eight weeks (24) sessions as the following:- - Session (1):: The researcher met each participant individually to assess condition of the patients and inform his/her about knowledge which includes; definition of the disease, risk factors, causes, complication, prevention, treatment, physical therapy and general information about the exercises, its benefits and types and how to carry out this exercises in the home. - Session (2-12): Primary level of therapeutic exercises which included; all of the following exercises in each session : Aerobics exercises ( walking) ,breathing exercises ( diaphragmatic and abdominal breathing) , Range of motion exercises (neck flexion , neck extension, neck rotation, neck side bending, body rotation, side bending with breathing, hip and pelvic rotation) Strengthening exercises (abdominal strengthening, upper back and shoulder girdle strengthening exercises, hip girdle strengthening exercises, neck flexors, neck extensors,spinal stabilization). Session (13-24): Secondary level of therapeutic exercises which included; all of the following exercises in each session : Aerobics exercises ( walking) ,breathing exercises ( diaphragmatic and abdominal breathing) , Range of motion exercises (neck flexion , neck extension, neck rotation, neck side bending, body rotation, side bending with breathing, hip and pelvic rotation) Strengthening exercises (abdominal strengthening, upper back and shoulder girdle strengthening exercises, hip girdle strengthening exercises, neck flexors, neck extensors,spinal stabilization). Stretching exercises (neck muscles stretches, shoulder girdle, latissimus muscles stretch, thoracic spine stretch, lumbar flexion stretch, hip flexors stretch, hip adductor stretch , hamstring stretch). For the control group:- The training of the control group was carried out according to the hospital management routine, which was prescribed by the doctors and administered to the patients by the nurse. 4. Evaluation phase:- - Every patient in both groups (study and control) will be assessed as the following:- The tools was used three times: First time before beginning the therapeutic exercises and second time 4 weeks after exercises begun and third time after 8 weeks to evaluate the functional status of the patients. The main Results: • The implementation of patients exercising program have a positive effect not only patients knowledge of ankylosing spondilities disease, but also patient movement and daily living practice . • There was statistically significant difference between study and control group from pre and post-test mean score of bath ankylosing spondylitis disease activity index regarding to putting on socks with or without help and climbing steps with or without using a handrail, the patients‘ ability to cope with everyday life • There was statistically significant difference between study and control group from pre and post-test mean score of bath ankylosing spondylitis functional index regarding to patients ability to pertaining to the 5 major symptoms of AS such as Fatigue, Spinal pain, Joint pain/swelling, Areas of localized tenderness, Morning stiffnes. • There was statistically significant difference between pre and post-test mean according to level of pain. • There were statistical significant correlation between Overall knowledge, Overall (BASFI) and Bath ankylosing spondylitis disease activity index and The (NPRS).