• lateral spinal fexion - The patient is standing with the heels and back resting against the wall, without fexion in the knees and without bending forward. A frst mark is placed on the right thigh, at the level of the patient’s middle fngertip. The patient is then asked to bend sideward to the right as far as possible without bending the knees or lifting the heels, and a second mark is placed again at the level of the patient’s middle fngertip. The distance between the two marks is measured in cm to the nearest 0.1 cm. The better of two tries is recorded. The same procedure is followed for the left side. The score for lateral spinal fexion is calculated by averaging the best values for the left and the right side • intermalleolar distance - The patient is lying with the legs separated as far as possible with the knees straight and the toes pointing upwards. The distance between the medial malleoli is measured in cm. Alternatively, the intermalleolar distance is measured with the patient standing erect and the legs separated as far as possible. The better of two tries is recorded. BASMI 3-point scale 0 Mild* 1 Moderate 2 Severe Lateral lumber fexion >10 cm 5–10 cm <5 cm Tragus to wall distance 15 cm 15–30 cm >30 cm Lumbar fexion (modifed Schober) >4 cm 2–4 cm <2 cm Maximal intermalleolar distance >100 cm 70–100 cm <70 cm Cervical rotation >70∞ 20–70∞ <20∞ Score=sum of points for all fve measurements * normal values ref: Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, et al. The Bath AS Metrology Index. J Rheumatol. 1994;21(9):1694–8. Additional ASAS recommended mobility measures • Occiput to wall distance - The patient is standing with the heels and back resting against the wall, with the hips and knees as straight as possible. The chin should be held at the usual carrying level. The patient is asked to put maximal effort to touch the head against the wall. The distance between occiput and wall is measured in cm to the nearest 0.1 cm. The OWD is measured twice, and the better of two tries is recorded. • Chest expansion - The patient is asked to rest his hands on or behind the head. The difference between maximal inspiration and expiration is measured at the fourth intercostal level anteriorly in cm to the nearest 0.1 cm. Chest expansion 2.5-5.5 cm is considered normal (normal values should be correlated to age and sex) and < 2.5 cm is considered abnormal. 23
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