THU0367 ANALYSING IMPAIRMENTS IN PHYSICAL PERFORMANCE (AS ASSESSED BY THE AS PERFORMANCE INDEX (ASPI)) IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS
Authors: Eerik Ahomaa, Uta Kiltz, Björn Bühring, Xenofon Baraliakos, Salima van Weely, Juergen Braun
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> In patients with axial spondyloarthritis (axSpA) physical functioning is often impaired. The current gold standard to assess physical functioning is self-reported questionnaires (i.e. BASFI), which can be influenced by patients' subjective feelings. Therefore, a performance-based test-battery was designed to measure physical functioning more objectively: the ankylosing spondylitis (AS) Performance Index (ASPI)) [1]. Based on domains taken from BASFI tasks were designed to imitate activities of daily living (ADL). Although the ASPI has been evaluated a thorough analysis of the deficits of physical functioning and factors which influence the performance of patients with axSpA has not been performed to date. <h3>Objectives:</h3> The aim of the present study assesses the relation between self-reported assessments of physical functioning and actual performance of patients, and to detect influencing factors. <h3>Methods:</h3> Consecutive axSpA patients underwent standardized assessments concentrating on the following variables: patient and disease characteristics, patient-reported outcomes (ASDAS, BASFI, BASMI, ASAS Health Index (ASAS HI), PHQ-9, IPAQ), mSASSS and ASPI (ASPI 1: Bending, 2. Putting on socks, 3. Getting up from the floor) [1]. The performance was measured in seconds as time to complete a task based on published instructions. Impairment in physical performance was defined as inability of patients to perform ≥ 1 ASPI test. Spearman Rho correlation was used to compare self-reported functioning and performed physical functioning. Logistic regression analysis was used to identify factors associated with impaired physical performance. <h3>Results:</h3> A total of 200 patients (AS 66%, nr-axSpA 34%) was included: 69% males, 44.3±12.5 years old, mean symptom duration 17.9 ±12.6 years, BMI 27.2±5.5, mean ASDAS 2.5±1.1, BASFI 4.0±2.7, BASMI 3.5±1.8), ASAS HI 7.0±4.1, PHQ-9 8.8±6.2, and mSASSS (n=157) 10.2±18.8). 133 patients were treated with bDMARDs (66.5%). In total 44 patients (22%) were not able to perform one or more ASPI tests. The mean time for bending was 18.6±9.5 sec (n=179/90%), for putting on socks 12.8±6.4 sec (n=156/78%), and for getting up from floor 6.5±5.0 sec (n=187/94%). A significant correlation was found for all three ASPI-tests with BASFI (0.5-0,7), ASAS HI (0.4-0.6) and spinal mobility as assessed by BASMI (0.4-0.7). Self-reported physical activity (IPAQ) correlated weakly with ASPI (all 0.2) and structural damage correlated only with the task putting on socks (r=0.3), whereas the other tests did not correlate. Logistic regression showed influence of obesity, spinal mobility and global functioning on actual performance but not of disease activity and self-reported physical function, (Figure 1). <h3>Conclusion:</h3> This study confirms a good correlation of the ASPI with standard questionnaires but it showed a substantial floor effect strongly suggesting that additional information on actual performance is needed. Thus, to obtain a complete picture of function and impairments of patients with axSpA the actual performance needs also to be assessed. Moreover, obesity should be addressed as a potential modifying factor contributing to limitation in actual performance. <h3>Reference:</h3> [1] Van Weely SFE, Dekker J, Steultjens MPM, van Denderen JC, Nurmohamed MT, Dijkmans BAC, van der Horst-Bruinsma IE. Objective evaluation of physical functioning after tumor necrosis factor inhibitory therapy in patients with ankylosing spondylitis: a selection of 3 feasible performance-based tests. J Rheumatol. 2015 Apr;42(4):623-9. <h3>Disclosure of Interests:</h3> Eerik Ahomaa: None declared, Uta Kiltz Grant/research support from: AbbVie, Chugai, Eli Lilly, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche, and UCB., Consultant for: AbbVie, Chugai, Eli Lilly, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche, and UCB., Björn Bühring Grant/research support from: GE/Lunar and Kinemed., Consultant for: GE/Lunar and Lilly, Xenofon Baraliakos Grant/research support from: AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Centocor, Chugai, Janssen, MSD, Novartis, Pfizer Inc, Roche and UCB, Grant/research support from: AbbVie, Pfizer, Merck Sharp &amp; Dohme, UCB Pharma, Novartis, Consultant for: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Chugai, Janssen Biologics, Novartis, Pfizer, UCB Pharma, Galapagos, Speakers bureau: AbbVie, Chugai, Janssen, Novartis, Pfizer, UCB Pharma, Salima van Weely: None declared, Juergen Braun Shareholder of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB, Grant/research support from: Abbott, Bristol Myers Squibb, Celgene, Celltrion, Chugai, Johnson &amp; Johnson, MSD, Novartis, Pfizer, Roche, UCB Pharma, Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB, Grant/research support from: Abbvie (Abbott), Amgen, Baxter, Biogen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Hexal, Janssen, Lilly, Medac, MSD (Schering-Plough), Mylan, Mundipharma, Novartis, Pfizer (Wyeth, Hospira), Roche, Sanofi-Aventis and UCB, Consultant for: Abbvie (Abbott), Amgen, Baxter, Biogen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Hexal, Janssen, Lilly, Medac, MSD (Schering-Plough), Mylan, Mundipharma, Novartis, Pfizer (Wyeth, Hospira), Roche, Sanofi-Aventis and UCB, Consultant for: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB, Consultant for: Abbott, Bristol Myers Squibb, Celgene, Celltrion, Chugai, Johnson &amp; Johnson, MSD, Novartis, Pfizer, Roche, UCB Pharma, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB, Speakers bureau: Abbvie (Abbott), Amgen, Baxter, Biogen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Hexal, Janssen, Lilly, Medac, MSD (Schering-Plough), Mylan, Mundipharma, Novartis, Pfizer (Wyeth, Hospira), Roche, Sanofi-Aventis and UCB, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB