Factors Associated with Person-Perceived Disability in Adults Aged 18+ with Rheumatoid Arthritis
Greenhill, Y & Hammond, A & Tyson, S 2012, 'Factors Associated with Person-Perceived Disability in Adults Aged 18+ with Rheumatoid Arthritis ', Rheumatology.
Rheumatoid Arthritis (RA) is associated with high risk of disability (1). Loss of independence is negatively correlated with the person’s health and wellbeing (2). The International Classification of Health and Functioning (ICF) suggests that the relationship between impairment and disability is largely modified by social and environmental factors. Understanding the mechanisms of the disablement process can help to reduce or prevent the negative effects of RA on people’s lives. This study aimed to establish key factors associated with person-perceived disability in adults with RA using the ICF as a framework.
Participants with RA over 18 years were recruited from 14 rheumatology clinics. They completed a postal questionnaire including demographic questions, life satisfaction, mood, pain, stiffness and fatigue numeric rating scales (0-10), the Evaluation of Daily Activities Questionnaire (EDAQ), SF-36v2, and RA Quality of Life scale (RAQOL). Person-perceived disability was measured by asking “Do you consider yourself to have a disability? (YES/NO)” Questionnaire items were linked to the ICF. The prevalence of perceived disability was calculated overall and for age and gender and tested using the X2test. Univariable and multivariable logistic regression was used to assess associations between person-perceived disability and body functions and structures; activity limitation; personal and environmental factors. A parsimonious model of key factors associated with perceived disability was fitted using backwards-stepwise binary logistic regression. Adjusted odds ratios with 95% confidence intervals were calculated to determine the strength of association for each variable.
413 people responded (mean age: 60 years (SD: 11.5); 73% female; average disease duration: 13 years (SD: 10.7)); 242 (58%) of whom reported perceived disability, which was more common in women than men (p=0.04). There was no relationship with age (p=0.97). The parsimonious model was a reasonable fit for the data (X2 = 5.65, p=0.69). Key factors associated with perceived disability were: dissatisfaction with life (Adj. OR: 3.5; 95% CI 1.6, 7.8), low mood (Adj. OR: 2.9; 95% CI 1.3, 6.7), pain when moving (Adj. OR: 2.5; 95% CI 1.2, 4.9), and limitation in moving round outdoors/ shopping (Adj. OR: 1.3; 95% CI 1.2, 1.4). Additionally, the odds of reporting perceived disability were twice as high in those with RA duration >10 years compared to <10 years (adj. OR: 1.9 95% CI: 1.0, 3.9).
Half of adults with RA in this study considered themselves disabled. Psychosocial factors, pain and activity limitation contributed to disability across the age and gender range. Recognition of key factors associated with person-perceived disability could be helpful in rehabilitation, specifically focusing on improving: satisfaction with life (through enabling people to achieve occupational balance and meaningful goals); mood; and outdoor mobility; and reducing pain when moving. This might then help people to feel less disabled by RA.
1. Eurenius et al Arthrit Rheum-Arthr 2005, 53 (1):48–55
2. Covinsky et al. Am Geriatr Soc. 2008, January; 56(1): 23–28