Back Pain

The IBM SPSS Statistics for MAC, version 24 (IBM Corp., Armonk, N.Y., USA) was used for demographic description of the data and statistical tests were performed using the statistical analysis software SAS 9.4 for Windows (SAS Institute Inc., Cary, NC, USA). The level of significance was set at p < 0.05.
For inference testing of spinal parameters, all non-dichotomous spinal parameters were dichotomized according to the established cut off for degenerative findings for each classification system (Pfirrmann ≥ 3, Endplate defect score ≥ 2, Modic ≥ 1).
For comparison of training amount, thoracolumbar back pain, and spinal changes between groups; Fisher ´s Exact test (lowest 1-sided p-value multiplied by 2) was used for dichotomous variables and the Mantel–Haenszel Chi Square Exact test was used for ordered categorical variables. The Fisher ´s Non-Parametric Permutation Test was used for continuous variables. The cumulative number of IVDs/levels/vertebrae per participant were compared between the climbing and control group.
Intra-observer and inter-observer reliability measures were analyzed with Gwent’s agreement coefficient with type 1 utilized for nominal and dichotomous variables and type 2 for ordinal variables.

The EMRMS was established in November, 2016 to assist rheumatologists in conducting ASDAS assessments and comprehensively evaluating clinical outcomes in all patients with AS attending TCVGH. The EMRMS database contains information necessary to determite ASDAS, including CRP, level and erythrocyte sedimentation rate [ESR], patient comorbidities, patient history, and family history. The reliability and validity of the data have been verified^{14 (link)}.Patients with AS were consecutively enrolled in the TCVGH-AS cohort after they received a confirmed AS diagnosis from a TCVGH rheumatologist according to the 1984 modified New York criteria^{10 (link)}. The CRP and ESR data were automatically uploaded to the TCVGH healthcare information system (HIS) to reduce human error. The baseline information, which was collected by trained nurses during the initial visit, including clinical characteristics, onset age, comorbidities at presentation (hypertension, diabetes mellitus, hyperlipidemia, hepatitis B, hepatitis C, renal insufficiency, gout, coronary artery disease, stroke, periodontal disease, osteoporosis, and tuberculosis history), periarticular extraspinal features (synovitis, enthesitis, and dactylitis) and nonarticular manifestations (psoriasis, uveitis, and IBD), family history of autoimmune disease, and patient history of arthropathy, obtained through standardized questionnaires and worksheets to ensure reproducibility and adherence to good laboratory practice. The rheumatologist in charge then confirmed patients’ clinical characteristics, and nurses assisted the patients with AS to complete the self-assessment questionnaires for disease evaluation. The following measures were used: global assessment of disease activity on a numerical rating scale (NRS) of 0–10, back pain on an NRS of 0–10, duration of morning stiffness on an NRS of 0–10, and peripheral pain or swelling on an NRS of 0–10. Before every 3-month visiting clinic, the patient would first to have blood examination. Blood reports can be uploaded to EMRMS through the HIS system, trained nurses assist patient fills out the questionnaire on EMRMS, the assessment of disease activity completed before visiting the doctor. All laboratory data, including CRP and ESR, have been uploaded to the HIS. The IT at TCVGH help "feed-forward" the patient reported outcomes to HIS, and do the auto-calculation of ASDAS-ESR, ASDAS-CRP using the ESR, CRP data in HIS, then "feed-back" these data to both HIS and EMRMS, showing the data on the summary overview "dashboard" in the EMRMS, which was shown both in HIS and the devices (iPAD handled by a nurse in charge and smartphones of patients with AS).