SEEK: Salford Environment for Expertise and Knowledge

June 2015

Participation in valued life activities in people with rheumatoid arthritis: A comparison between the UK and Sweden

Prior, Y & Ahlstrand, I & Bjork, M 2015, 'Participation in valued life activities in people with rheumatoid arthritis: A comparison between the UK and Sweden', Annals of Rheumatic Disease, 74:73.



Background The Valued Life Activities Scale (VLAs) is a measure of difficulties in participation and daily activities1. Originally developed in the USA, this measure was linguistically and culturally adopted for use in people with rheumatoid arthritis (RA) in the UK and Sweden2. According to the International Classification of Functioning3, participation requires interaction with social environment, and it is contextual.

Objectives This study aimed to compare participation restrictions in valued life activities experienced by people with RA in the UK and Sweden.

Methods Secondary analysis was conducted on data collected in VLAs in the UK (n=340) and Sweden (n=737). Participants were recruited from the rheumatology outpatient clinics in the UK and from the Rheumatology's Quality Registry (SRQ) in Sweden. People aged 18 years and over with a clinical diagnosis of RA were included. The 33 item version of the VLAs was used. The proportion of people reporting restriction in VLAs were calculated using the Chi-squared (X2) test, and performance in VLAs were calculated as median (IQR) and tested using Mann Whitney-U between the countries.

Results Both the UK and Swedish study population had similar demographics (UK= Mean age: 62 years (SD12); female: 251 (74%); disease duration: 14 years (SD12); and Sweden= age: 63 years (SD12) female: 539 (74%); disease duration: 16 years (SD11)). Compared to the UK, the participants in the Swedish study reported significantly less pain (3.7 vs 4.7) (p<0.001) measured by the Visual Analogue Scale (VAS) on a scale 0-10. Medication use among participants in the UK and Sweden were for biologics: 25 (7.4%) vs 62 (8.4%); mono-therapy: 91 (27%) vs 205 (28%); combination therapy: 190 (56%) vs 413 (56%); and 34 (10%) vs 57 (8%) were not on any DMARDs. At least one valued life activity was affected by RA reported by the nine out of ten participants in both countries, and most difficulties were experienced in “minor house repairs” and “gardening”, “physical recreation” and “heavy house work”. The activities with the least difficulties were: “eating”, “leisure at home”, “meeting people” and “household business” in both countries. In general, the patients in the UK experienced significantly more difficulties in the majority of the valued life activities. The total mean score of VLAs (0-3) was significantly lower in the Swedish cohort (0.53) compared to the UK cohort (0.73) (p<0.001).

Conclusions People with RA in the UK reported more difficulties in performing valued activities than the comparable Swedish cohort. In both countries, participation restrictions were mostly reported in social and recreational activities. The findings of this study is in line with the ICF model of functioning, suggesting that contextual factors play an important ole in participation in valued life activities amongst people with RA.


  1. Katz et al (2009)Journal of Clinical Epidemiology 62:158-166 [33 item scale]

  2. Bjork et al (2013) Annals of Rheumatic Disease 72 (suppl3):785

  3. WHO:ICF (2001) Geneva: WHO Publications

Acknowledgements We would like to thank to EULAR for the Health Professionals Educational Grant, which was awarded to Dr Prior in 2014 to visit Dr Bjork in Sweden. This comparative study was conducted as a result of this collaborative visit.


SEEK Members

External Authors

Mathilda Bjork

Inger Ahlstrand

Publication Details

Annals of Rheumatic Disease, 74:73.