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Hand Function and Activity Limitation According to Health Assessment Questionnaire in Patients with Rheumatoid Arthritis and Healthy Referents: 5-Year Followup of Predictors of Activity Limitation (The Swedish TIRA Project)
Linköping University, Department of Neuroscience and Locomotion, Occupational Therapy. Linköping University, Faculty of Health Sciences. The Vårdal Foundation, The Swedish Institute for Health Sciences.ORCID iD: 0000-0002-1607-187X
Linköping University, Department of Molecular and Clinical Medicine, Rheumatology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Molecular and Clinical Medicine, Rheumatology. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-0153-9249
Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Pain and Occupational Centre, Pain and Rehabilitation Centre.
2007 (English)In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 34, no 2, 296-302 p.Article in journal (Refereed) Published
Abstract [en]

Objective: This study identifies baseline predictors of future activity limitation in rheumatoid arthritis (RA). To reinforce the utility of instruments assessing functional ability/activity limitation, we used reference data from healthy referents.

Methods: This study includes 189 patients (69% women) with recent-onset RA (onset of joint swelling not more than 12 months at diagnosis) in a prospective cohort ("the Swedish TIRA project") during 27 months from 1996 through 1998. Regular followups were done for a period of 5 years, and 123 healthy persons (50% women) were recruited as referents. Hand function was assessed by the "grip ability test (GAT)" and "signals of functional impairment" (SOFI). Grip force was measured with the electronic device GrippitTM. Activity limitation was assessed with the Swedish version of the Health Assessment Questionnaire (HAQ).

Results: Throughout the study and for both sexes, GAT, grip force, SOFI-hand, and HAQ were significantly different for the patients compared to healthy referents. In the healthy referents, HAQ was mainly related to age and GAT, whereas in RA HAQ was most obviously linked to grip force. Five years after diagnosis only 8% of HAQ outcome was explained by the baseline measures: HAQ, grip force, SOFI-lower limb, sex, walking speed, and GAT.

Conclusion: Our study provides valuable reference data for several functional ability and activity limitation measures. The HAQ score was explained by different variables in healthy referents compared to patients with RA. Five years after diagnosis only 8% of HAQ outcome was explained by the variables assessed at inclusion.

Place, publisher, year, edition, pages
Toronto, Ontario, Canada: Journal of Rheumatology Publishing Co. Ltd. , 2007. Vol. 34, no 2, 296-302 p.
Keyword [en]
Rheumatoid Arthritis, Disabilty, Longitudinal studies, Sex differences, Reference values
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13328ISI: 000244112900012OAI: oai:DiVA.org:liu-13328DiVA: diva2:18350
Available from: 2008-06-02 Created: 2008-06-02 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Aspects of Disability in Rheumatoid Arthritis: a five-year follow-up in the Swedish TIRA project
Open this publication in new window or tab >>Aspects of Disability in Rheumatoid Arthritis: a five-year follow-up in the Swedish TIRA project
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Rheumatoid arthritis (RA) is a progressive disease, often leading to disability. Because the disease course develops rapidly during the first years after diagnosis, more knowledge is needed about the early disease course to minimize later disability. This thesis describes the course of disability in early RA such as hand function, pain intensity, activity limitation and sick leave. In addition, this thesis compares disability between women and men and compares disability between RA patients and referents.

This thesis is primarily based on data from the 320 patients that were included in the multi-centre project in Sweden called ‘Early interventions in rheumatoid arthritis’ (TIRA). A wide range of outcome variables was registered between 1996 and 2006 during regular follow-ups from time for diagnosis through the eight-year follow-up. Outcome regarding disease activity and disability of RA patients still remaining in TIRA at the three and five year follow-up respectively are used in this thesis. Data concerning sick leave were obtained for the patients during six years (1993-2001) – three years before and three years after diagnosis. Referents were included in two of the studies. Data regarding disability in referents were obtained according to hand function and activity limitation using the Health Assessment Questionnaire (HAQ). Data for sick leave were obtained for six years in referents, for the same period as the RA patients.

For most variables, disability in RA was most pronounced at time of diagnosis but before intervention started. Disability was then reduced already at the 3-month follow-up and thereafter affected but stable during the following five years. The exception was participation, reflected by sick leave, a variable that was stable from inclusion to three years from diagnosis. Activity limitation, pain intensity and sick leave in RA that represents different aspects of disability were explained by other aspects of disability and contextual factors rather than by disease activity. RA affects women and men differently in some aspects. Women had more severe course of activity limitations than men according to HAQ. Men were more affected than women in range of motion, although the differences were small in a clinical perspective. However, pain intensity and frequency of sick leave did not differ between women and men. Patients with RA have pronounced disability in relation to referents although several variables improve soon after diagnosis. This discrepancy refers to hand function as well as activity limitations and sick leave. The frequency of sick leave increased during the year before diagnosis in relation to referents and was thereafter high compared to sick leave in referents.

Place, publisher, year, edition, pages
Linköping University Electronic Press, 2008
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1063
Keyword
Rheumatoid arthritis (RA), disability, hand function, pain intensity, ADL, sick leave, prediction
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:liu:diva-11956 (URN)978-91-7393-908-9 (ISBN)
Public defence
2008-06-05, Berzeliussalen, Ingång 65, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2008-06-02 Created: 2008-06-02 Last updated: 2015-11-19

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Björk, MathildaThyberg, IngridSkogh, ThomasGerdle, Björn

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