Matylda Sierakowska

Evaluation of quality of life in chronic, progressing rheumatic diseases based on the example of osteoarthritis and rheumatoid arthritis.

Background Rheumatic diseases, irrespective of etiology and clinical course, influence different areas of a patient’s life. Adapting to disability and limitations caused by an illness is very difficult for many patients. The main goal of a therapeutic procedure should be improvement of health-related quality of life (QoL). Objective Evaluation of the factors that influence the QoL that are conditioned by the state of health of patients with osteoarthritis (OA) and rheumatoid arthritis (RA). Methods The study group consisted of 198 patients diagnosed with OA, according to the American College of Rheumatology criteria (1988), and 100 patients diagnosed with RA, according to the American College of Rheumatology criteria (2010). A diagnostic survey using visual analog scale of pain, health assessment questionnaire disability index, and 36-item short form health survey were used in this study. Results The average age of patients with OA was 59.16 (±15.87) years and patients with RA was 55.22 (±14.87) years. The average duration of illness examined for OA was 5.5 (±4.32) years, whereas for RA, it was slightly more at 6.8 (±5.21) years. Overall the QoL in both study groups was of medium level. Among patients with OA and RA, lower evaluation of QoL was mainly affected by age (OA – physical sphere [PCS] rs=−0.177, P<0.012; MCS rs=−0.185, P=0.008; RA – PCS rs=−0.234, P=0.019; MCS rs=−0.208, P=0.038), the level of physical disability (OA – PCS rp=−0.532, P<0.001; MCS rs=−0.467, P<0.001; RA – PCS rp=−0.326, P<0.001; MCS rs=−0.229, P<0.001), and pain (OA – PCS rp=−0.425, P<0.001; mental sphere/mental functioning (MCS) rs=−0.359, P<0.001; RA – PCS rp=−0.313, P<0.001; MCS rp=−0.128, P<0.001). Conclusion Patients with OA, despite their average older age, had a higher evaluated QoL than patients with RA. Overall QoL in terms of mental functioning in both rheumatic diseases was assessed at a higher level than in the area of physical functioning.

Utility of the Care Dependency Scale in predicting care needs and health risks of elderly patients admitted to a geriatric unit: a cross-sectional study of 200 consecutive patients

Objective The aim of the study was to evaluate the usefulness of the Polish version of the Care Dependency Scale (CDS) in predicting care needs and health risks of elderly patients admitted to a geriatric unit. Methods This was a cross-sectional study of 200 geriatric patients aged ≥60 years, chronologically admitted to a geriatrics unit in Poland. The study was carried out using the Polish version of the CDS questionnaire to evaluate biopsychosocial needs and the level of care dependency. Results The mean age of the participating geriatric patients was 81.8±6.6. The mean result of the sum of the CDS index for all the participants was 55.3±15.1. Detailed analysis of the results of evaluation of the respondents’ functional condition showed statistically significant differences in the levels of care dependency. Evaluation of the patients’ physical performance in terms of the ability to do basic activities of daily living (ADL) and instrumental ADL (I-ADL) showed statistically significant differences between the levels of care dependency. Patients with high dependency were more often prone to pressure ulcers – 13.1±3.3, falls (87.2%), poorer emotional state – 6.9±3.6, mental function – 5.1±2.8, and more often problems with locomotion, vision, and hearing. The results showed that locomotive disability, depression, advanced age, and problem with vision and hearing are connected with increasing care dependency. Conclusion CDS evaluation of each admitted geriatric patient enables us to predict the care needs and health risks that need to be reduced and the disease states to be improved. CDS evaluation should be accompanied by the use of other instruments and assessments to evaluate pressure ulcer risk, fall risk, and actions toward the improvement of subjective well-being, as well as correction of vision and hearing problems where possible and assistive devices for locomotion.

Common measure of quality of life for people with systemic sclerosis across seven European countries: a cross-sectional study

Objectives The aim of this study was to adapt the Systemic Sclerosis Quality of Life Questionnaire (SScQoL) into six European cultures and validate it as a common measure of quality of life in systemic sclerosis (SSc). Methods This was a seven-country (Germany, France, Italy, Poland, Spain, Sweden and UK) cross-sectional study. A forward–backward translation process was used to adapt the English SScQoL into target languages. SScQoL was completed by patients with SSc, then data were validated against the Rasch model. To correct local response dependency, items were grouped into the following subscales: function, emotion, sleep, social and pain and reanalysed for fit to the model, unidimensionality and cross-cultural equivalence. Results The adaptation of the SScQoL was seamless in all countries except Germany. Cross-cultural validation included 1080 patients with a mean age 58.0 years (SD 13.9) and 87% were women. Local dependency was evident in individual country data. Grouping items into testlets corrected the local dependency in most country specific data. Fit to the model, reliability and unidimensionality was achieved in six-country data after cross-cultural adjustment for Italy in the social subscale. The SScQoL was then calibrated into an interval level scale. Conclusion The individual SScQoL items have translated well into five languages and overall, the scale maintained its construct validity, working well as a five-subscale questionnaire. Measures of quality of life in SSc can be directly compared across five countries (France, Poland Spain, Sweden and UK). Data from Italy are also comparable with the other five countries although require an adjustment.

Identification of demographic factors and health problems that affect the acceptance of disease and health behaviors of patients with osteoarthritis

Introduction Osteoarthritis (OA) is one of the most common causes of musculoskeletal system’s ailments. In the prevention of the disease and in its comprehensive treatment, proper health-related behavior becomes an extremely important factor for maintaining an optimal health condition. The aim of the study is to assess the relationship between the reported pain and the disability level, and the health-related behaviors undertaken by OA patients as well as their acceptance of the disease. Materials/Methods The study group consisted of 198 patients with diagnosed OA, according to ACR criteria (1988). The method used in the study employed a Pain VAS (0-10), Health Assessment Questionnaire Disability Index (HAQ DI 0-3), Acceptance of Illness Scale (AIS 8-40) and Health and Behavior Inventory (IZZ 24-120). Results The average age among respondents with OA has been 59.16 years of age (±15.87), duration of disease 5.5 years (±4.32). Pain experienced both during movement (rs = 0.319, p < 0.001) and at rest (rs = 0.382, p < 0.001) correlated positively with physical disability (HAQ DI). Studies indicated a positive linear correlation between the age and physical disability (rs = 0.200, p = 0.005). Acceptance of the disease (AIS) depends mostly on age (rs = − 0.325, p < 0.001), on pain in motion (rp = − 0.209, p < 0.001) and at rest (rp = − 0.218, p < 0.001) and on the disability levels (rp = − 0.353, p < 0.001). Analysis of the health-related behaviors (IZZ) indicates that the average severity of declared behavior is statistically significant with physical disability (HAQ DI) (p = 0.029). Conclusions The acceptance of illness is significantly reduced with age and progressive levels of disability as well as with the severity of pain. The progressive levels of disability and the younger age of the respondents motivate them to engage in health beneficial behavior.

Comparative analysis of educational needs of patients with rheumatic diseases selected based on the Polish version of the Educational Needs Assessment Tool (Pol-ENAT)

Objectives Chronic rheumatic diseases, which have a progressive course, lead to large deficits in physical, mental and social functioning. In the process of the planned and systematic education of patients/families, it is extremely important to identify patients’ health problems as well as their needs and expectations. Study objectives: To assess the learning needs of patients with rheumatoid arthritis (RA) and systemic sclerosis (SSc). Material and methods This was a multicenter, cross-sectional study conducted in seven rheumatology centers in Poland. Health problems were defined as disability (HAQ-DI), pain (Pain VAS), fatigue (Fatigue VAS) and severity of disease (0–100). The educational needs were measured using the Pol-ENAT (0–156). Statistical analysis was performed using PQStat v.1.4.2 and Excel. Results The study involved 277 patients with rheumatoid arthritis and 140 with systemic sclerosis. The average age of respondents was comparable in RA (53.3 ±13.0 years) and SSc (54.1 ±14.2 years). Patients suffered from RA on average for 13.7 ±10.6 years and from SSc for 10.9 ±10.3 years. With age and duration of disease, the health problems worsened (p < 0.05). The reported needs of education (Pol-ENAT) were generally at the secondary level – RA 66.4 ±29.3 – younger people (p = 0.008) and those with early RA (r = –0.151, p = 0.011); SSc 71.5 ±27.7 – regardless of age and duration of SSc. Educational needs of patients with SSc correlated with the severity of certain health problems and health evaluation (pain r = 0.334, p < 0.001; fatigue r = 0.243, p = 0.004; severity of disease r = 0.242, p = 0.004 and disability r = 0.291, p < 0.001). Conclusions All patients reported the need for education, although it was slightly higher in patients with SSc. There was a decline in interest in education with progressive disability in RA, while in SSc interest in education increased with the progress and severity of the disease.

Assessment of education requirements for patients with rheumatoid arthritis, based on the Polish version of the Educational Needs Assessment Tool (Pol-ENAT), in the light of some health problems – A cross-sectional study

INTRODUCTION Patients with chronic rheumatoid arthritis (RA) need advice in order to face the problems of everyday life, as well as suffering associated with the disease. Health professionals should attempt to raise the level of resourcefulness and independence of the patient. OBJECTIVE To assess the relationship between the deficit of knowledge about RA and the degree of pain, fatigue, morning stiffness, assessment of disease activity as well as functional efficiency. MATERIALS AND METHOD The study was conducted on 277 patients with RA in 7 rheumatologic centres in Poland. The method applied was the questionnaire Pol-ENAT (0-156); HAQ DI (0-3); analog scales (0-100). RESULTS Mean (SD) age was 53.28 (13.01) and disease duration 13.70 (10.63) years. The mean (SD) value was 54.93 (23.17) for pain, 52.97 (21.98) for fatigue, 48.28 (24.76) for morning stiffness (0-100 mm). HAQ DI was 1.40 (0.66), with an upward trend with duration of disease (p<0.001). There was a positive correlation between the demand for knowledge about the movement (r=0.194; p=0.001), self-care (r=0.134; p=0.026), assistance/support(r =0.163; p=0.006) and morning stiffness experienced. There was a negative correlation between the need for knowledge concerning managing pain, feelings and the arthritis process and daily ability assessed with HAQ DI. CONCLUSIONS The study shows that health education should be targeted at young patients with early RA. In the case of the severity of morning joints stiffness, there is a need to increase knowledge about the methods of mobility aids, self-care and the possibility of obtaining support.

AB1146-HPR Assessment of Health Problems and Quality of Life of Patients with Systemic Lupus Erythematosus

Background Systemic lupus erythematosus - SLE is a chronic autoimmune disease characterized by the involvement of many organs. Fundamental principle of treatment of SLE is a comprehensive and individualized treatment approach, taking into account the duration and severity of the organ damage. Because of systemic, chronic, progressive course SLE adversely affects the physical functioning of patients, as well as it decreases their mental and social condition in effect of QOL lowering. Objectives The aim of our work was to identify physical social, and psychological problems in patients suffering from lupus; assessment of quality of life; also to determine the degree of acceptance of the disease. Methods The study was conducted among patients with diagnosed, according to the grading criteria of ACR for SLE, on a total of 37 patients. The research method was a diagnostic based on the original questionnaire, Anxiety and Depression Scale - HADS (0-21pts), Acceptance of Illness Scale - AIS (8-40pts), Visual- Analogue Pain Assessment Scale VAS (0-100mm), Quality of Life questionnaire WHOQOL BREF Polish version (4-20pts). Results Most health problems which created troubles in the subjective assessment of respondents were: fatigue and weakness (91.9%), arthralgia and myalgia (81%), reduced resistance to illnesses (67.5%). Respondents inactive (1/3 of respondents) felt stronger pain (VAS ≥70mm). Patients with disease duration 0-5 years obtained a greater number of points in the HADS-D scale (mean 6.3) (p≤0.05) and inactive professionals in HADS-A scale (9.2) (p≤0.05). Patients with low education obtained higher value of the HADS-A and HADS-D (p≤0.05). Persons married also received higher scores at HADS-A (8.1) (p≤0.05). Patients with primary education/professional reported the worst acceptance of the disease (AIS - 19.5) (p≤0.05). People diagnosed with the disease at a younger age, single and with short duration of SLE (0-5 years) evaluated their worse functioning in all areas of QOL. The population of respondents with primary education/professional assessed the physical (9.1) and psychological (10.7) realm very low. Conclusions The most nagging health problem reported by respondents was fatigue and weakness, joint and muscle pain, and low resistance to illnesses. Pain intensity (VAS) depended on patients age and activity. The suspicion of existence of anxiety disorders (HADS-A) was observed more frequently in married and inactive patients. Respondents from all areas rated their physical and mental functioning lowest. Patients with short duration of SLE, alone, as well as with primary education/professional rated lowest their functioning in all areas of QOL. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1374