POS0973 CONTEXTUAL FACTORS SHOULD COMPLETE THE ASSESSMENT OF FUNCTIONING IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS (axSpA)
Authors: U. Kiltz, E. Ahomaa, B. Buehring, X. Baraliakos, D. Kiefer, J. D. Leicht, J. Braun
Journal: Annals of the Rheumatic Diseases (2021)

Background: Functioning of patients (pts.) with axial spondyloarthritis (axSpA) is influenced by a variety of factors. In contrast to clinical factors, the influence of contextual factors on functioning has not been well studied. According to the According to the International Classification of Functioning, Disability and Health (ICF), functioning is a complex interaction between health status and contextual factors such as social support, relationships and attitudes. Objectives: The aim of this study is to understand limitations in participation and to investigate barriers and facilitators of contextual factors in pts. with axSpA. Methods: Consecutive axSpA pts. underwent a standardized assessment with collection of patient and disease characteristics, patient-reported outcomes (ASDAS, BASFI, BASMI, PHQ-9, ICF Measure of Participation and ACTivities questionnaire (IMPACT-S (0-100%)), ASAS Health Index (ASAS HI and environment factor item set (EFIS) (1). The EFIS contains 9 dichotomous questions addressing ICF categories of products and technologies (e1), support and relationship (e3), attitudes (e4) and health services (e5). Validated cut-offs of ASAS HI were used to categorize global functioning. Results: A total of 200 axSpA pts. were included: 69% males, 44.3±12.5 years, symptom duration 17.9±12.6 years, ASDAS 2.5±1.1, BASFI 4.0±2.7, BASMI 3.5±1.8, ASAS HI 7.0±4.1. Pts. reported limitations in the IMPACT-S activity and participation domain (82.3% (15.2) and 83.5% (16.8), respectively. The majority of pts. reported as barrier that treatment of axSpA requires time (e4, 58.5%). A minority of pts. but quite a few reported as barrier the need for support by family members (e3, 43.5%), the need to modify home and work environment (e1, 39.5%) and that they cannot rely on family members for help (e3, 22%). Some pts. (&lt; 20%) reported that they have problems to be understood by health care professionals when experiencing a flare (e5, 18.5%), that pts. at home are not adequately taken care of (e4, 18.5%), disliking friends’ behavior toward them (e4, 13.5%), and that friends are too demanding (e4, 13%). The majority of pts. (e4, 75.9%) identified attitudes of friends as the only and major facilitator. All pts. reporting at least one barrier had significantly worse global functioning (ASAS HI, IMPACT-S), and depression (PHQ-9) compared to patients who reported no barriers in the respective ICF categories (p&lt; 0.01). Similarly, pts. with poor functioning are more likely to report barriers in contextual factors compared to pts. with good functioning (Table 1). Pts. having to ask for more support from their families expressed the feeling that they cannot rely on that. Conclusion: Barriers more than facilitators of contextual factors are present in pts. with axSpA. This study shows that barriers in contextual factors are more common in pts. with impairments in self-reported and performed functioning as in those without impairments. This underlines the importance of contextual factors in the management of axSpA pts. References: [1]Kiltz et al. Ann Rheum Dis 2013;72(s3):572 Table 1. Presence of contextual factors, stratified for global functioning categories ICF category EFIS Item Global Functioning (ASAS HI 0-17 ) Good ≤ 5 (n= 69 ) Moderate &lt;5 to &lt;12 (n= 106 Poor ≥ 12 (n= 25 ) e3 EFIS 1: As a result of my rheumatic disease, the children take more responsibility for household tasks. 11 (15.9) 55 (51.9) 21 (84) e3 EFIS 2: I don’t like the way my friends acts around me. 0 (0) 15 (14,2) 12 (48,0) e3 EFIS 3: I can’t count on my relatives to help me with my problems 11 (15,9) 24 (22,6) 9 (36) e1 EFIS 4: I modify my home and work environments. 16 (23,2) 47 (44,3) 9 (36) e5 EFIS 5: I have difficulties getting worsening of my disease acknowledged by a health care professional 3 (4,3) 21 (19,8) 16 (64) e5 EFIS 6: Treatment of my rheumatic disease is taking up time 22 (31,9) 73 (68,9) 22 (88) e4, EFIS 7: My friends expect too much of 1 (1,4) 18 (17,0) 7 (28) e4 EFIS 8: No one pays much attention to me at home 10 (14,5) 20 (18,9) 7 (28) e4 EFIS 9: My friends understand me 56 (17,4) 83 (78,3) 12 (48) values given as number (%) Disclosure of Interests: None declared.