Signals Of Functional Impairment Research Articles

Reported disability in relation to observed activity limitation, grip strength and physical function in women and men with rheumatoid arthritis

BackgroundThe self-reported Health Assessment Questionnaire (HAQ) is specifically designed to assess disability in arthritic patients. In many studies women report higher functional disability than men. The reasons for this difference are suggested to be multifactorial. We therefore evaluated functional disability assessed by HAQ in women and men with rheumatoid arthritis (RA) in relation to observed disability, grip force and physical function.MethodsPatients with RA, 51 women and 49 men, completed the HAQ on three occasions, some weeks apart. Between HAQ1 and HAQ2, all patients performed 17 of the 20 activities (7 domains) included in the HAQ under observation in a specially designed environment, the observed HAQ. During the same day, grip force, measured by GRIPPIT and physical function assessed by the SOFI (Signals of Functional Impairment) index were evaluated. Differences between groups were studied by the chi-square test, Mann-Whitney U test and Wilcoxon Sign Rank test. Correlations were analysed by Spearman rank correlation. Comparisons between repeated measures were performed using Friedman’s test.ResultsMedian (IQR) total HAQ1 score was 0.50 (0.88) for women and 0.25 (0.84) for men, p = 0.038, and the observed HAQ score (7 domains) 0.57 (0.9) for women and 0.43 (0.96) for men, p = 0.292. The correlations between reported HAQ1 score (7 domains) and observed HAQ score were strong, r = 0.860, p < 0.001 in women, and r = 0.820, p < 0.001 in men. For some activities the patients, both women and men, reported lower difficulty than that observed. Women had lower grip force than men, median (IQR), right and left 126 (84) Newton, versus 238 (146), p < 0.001, and there was a negative correlation between grip force and most of the separate activities in HAQ in both genders. SOFI index was similar in women and men, median (IQR) 0 (3.0) versus 0 (2.0), p = 0.277, with a moderate correlation to HAQ.ConclusionsThe results indicate that in well-treated patients with RA the correlations between reported and observed HAQ scores were strong, similarly in women and men. We found no evidence that the patient’s opinion was dependent on unawareness of her/his own ability.

Unacceptable pain in the BARFOT inception cohort of patients with rheumatoid arthritis: a long-term study

Objectives: Pain is the most common and troublesome complaint in rheumatoid arthritis (RA). This study aimed to assess the prevalence and clinical implications of unacceptable pain in an inception cohort of patients with RA. Method: This study followed 477 patients from the BARFOT (Better Anti-Rheumatic FarmacOTherapy) early RA cohort for 15 years. Unacceptable pain was defined as ≥ 40 mm on a visual analogue scale for pain, while tolerable pain denoted no pain or pain below this cut-off, according to the patient acceptable symptom state concept. Results: Unacceptable pain was frequent. At the 15 year follow-up visit, 34% had unacceptable pain. Patients with unacceptable pain had, compared with patients with tolerable pain, significantly more disease activity, worse patient global assessment, and worse function on the Health Assessment Questionnaire and Signals of Functional Impairment, but the degree of joint destruction was similar. Disease-modifying anti-rheumatic drug treatment was similar, but patients with unacceptable pain were more often treated with corticosteroids. At 15 years, patients with unacceptable pain who were in remission (33%) had less inflammation and better function than those not in remission, suggesting the presence of non-inflammatory causes of pain. Conclusions: In this cohort of patients with RA, pain was frequent and severe, with negative effects on experienced health and function. Unacceptable pain was frequent and occurred also in patients in remission, indicating that pain in RA is multifactorial and should always be regarded as an important concern in itself. The cause of pain should be recognized and treated appropriately.

Importance of Measuring Hand and Foot Function Over the Disease Course in Rheumatoid Arthritis: An Eight‐Year Follow‐Up Study

To assess function using the Signals of Functional Impairment (SOFI) instrument over 8 years, to study clinical variables associated with the change, and to study change over time of the SOFI items. In total, 1,223 patients with early rheumatoid arthritis (RA) from the Better Anti-Rheumatic Farmacotherapy (BARFOT) cohort (mean ± SD age 56.9 ± 15.4 years, 67% women) were included in the analysis. Data from baseline and from 1 and 8 years were studied. The SOFI instrument includes measures of range of motion in the hand, shoulder/arm, and lower extremity (range 0-44, best to worst). The effects of baseline variables (sociodemographic, disease activity, joint destruction, and function) on change in SOFI scores were studied by linear regression analysis. During the first year, the improvement in mean ± SD SOFI scores was 2.7 ± 5.7 (P < 0.001). Worse scores in the Disease Activity Score in 28 joints and Health Assessment Questionnaire score at baseline were associated with this improvement (r2 ≤ 0.11). During the next 7 years, the deterioration in SOFI scores was mean ± SD 1.5 ± 4.9 (P < 0.001). Based on change scores, we found that finger flexion, pincer grip, and toe-standing were the most important items to measure, explaining 58-61% of the total SOFI score, and these items were also associated with radiographic changes at the 8-year follow-up. Function as assessed with SOFI scores improved during the first year in patients with early RA, but it deteriorated slowly thereafter. Impaired hand and foot function was associated with joint destruction at the 8-year follow-up. Measures of hand and foot function will complement self-reported and medical data, both in clinical work and in long-term research studies.

Improved Hand Function, Self-Rated Health, and Decreased Activity Limitations: Results After a Two-Month Hand Osteoarthritis Group Intervention.

To evaluate the effects on hand function, activity limitations, and self-rated health of a primary care hand osteoarthritis (OA) group intervention. Hand OA causes pain, impaired mobility, and reduced grip force, which cause activity limitations. OA group interventions in primary care settings are sparsely reported. Sixty-four individuals with hand OA agreed to participate; 15 were excluded due to not fulfilling the inclusion criteria. The 49 remaining (90% female) participated in an OA group intervention at a primary care unit with education, paraffin wax bath, and hand exercise over a 6-week period. Data were collected at baseline, end of intervention, and after 1 year. Instruments used were the Grip Ability Test (GAT), the Signals of Functional Impairment (SOFI), dynamometry (grip force), hand pain at rest using a visual analog scale (VAS), the Patient-Specific Functional Scale (PSFS), the Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH), and the EuroQol VAS (EQ VAS). Data were analyzed using nonparametric statistics. Hand function, activity limitation, and self-rated health significantly improved from baseline to end of intervention, grip force (right hand: P < 0.001; left hand: P = 0.008), SOFI (P = 0.011), GAT (P < 0.001), hand pain at rest (P < 0.001), PSFS (1: P = 0.008, 2: P < 0.001, and 3: P = 0.004), Quick-DASH (P = 0.001), and EQ VAS (P = 0.039), and the effects were sustained after 1 year. The hand OA group intervention in primary care improves hand function, activity limitation, and self-rated health. The benefits are sustained 1 year after completion of the intervention.

The effect of resistance training on the rehabilitation of hand in rheumatoid arthritis patients

Objective To investigate the effect of resistance training on the rehabilitation of hand joint in patients with rheumatoid arthritis. Methods Selecting 66 cases of the stable phase of rheumatoid arthritis (ra) patients in a rheumatoid immunology outpatient of a general hospital in Beijing during October 2016 to March 2017, 33 patients were randomly divided into control group and 33 patients into intervention group by using random number. Exercise instruction of routine finger operation in control group; The intervention group was guided by trained nurses with finger exercises and resistance training. Two groups of patients were tested before and after 3 months of exercise, and both hands were tested and the patients were recorded with their hands. The patients were evaluated by the Signals of Functional Impairment(SOFI). Results Before exercise, the grip strength, morning stiffness time, SOFI score in the control group were:60.0(43.0,100.5) mmHg(1 mmHg=0.133 kPa), 45.0(30.0,60.0)min,2.0(1.0,3.0),and in the intervention group they were:85.0(49.3,108.7) mmHg,45.0(30.0,60.0) min,2.0(1.0,3.0),the differences between two groups of had no statistical significance (Z=-1.488, -0.609, -0.118, P>0.05). After three months of exercise, the grip strength, morning stiffness time, SOFI score in the control group were:60.0(40.5,102.7) mmHg,30.0(10.0,45.0) min,1.0(1.0,2.0),and in the intervention group they were:89.5(56.0,119.0) mmHg,10.0(5.0,15.0) min,1.0(0.0,1.0),the differences between two groupshad statistical significance (Z=-2.412, -3.668, -2.998, P 0.05), but in the intervention group, the grip strength was significantly higher three months later, and the morning stiffness and SOFI were significantly reduced in the group, and the differences were statistically significant (Z=-4.865, -5.508, -4.711, P<0.05). Conclusions The effect of anti-resistance training on the function of hand joint in rheumatoid arthritis patients is better than that of conventional finger operation, especially in improving the grip strength. Key words: Arthritis, rheumatoid; Hand function; Resistance training

Persistently active disease is common in patients with rheumatoid arthritis, particularly in women: a long-term inception cohort study

Objectives: Despite improved treatment strategies for rheumatoid arthritis (RA), some patients do not respond satisfactorily. The aim of this study was to investigate the course and outcome of early RA diagnosed during the 1990s and followed for 8 years with a focus on those who did not respond well to treatment.Method: This study included 640 patients (66% women) who were enrolled in the BARFOT (Better Anti-Rheumatic PharmacOTherapy) RA inception cohort between the years 1993 and 1999. The 28-joint count Disease Activity Score (DAS28) < 2.6 criteria were used to assess remission. Persistent disease (PD) was defined as absence of remission at all predefined follow-up visits at 1, 2, 5, and 8 years. Function was assessed by Health Assessment Questionnaire (HAQ) and Signals of Functional Impairment (SOFI) scores and radiological joint damage by the Sharp/van der Heijde score (SHS).Results: Of the 640 patients, 214 (37%) had PD (43% of the women and 25% of the men). Over the 8 years of follow-up, patients with PD had significantly worse mean values for patient’s global health measured on a visual analogue scale (VAS patGH), VAS pain, HAQ, SOFI, and SHS compared with those in the non-PD group. Multivariate logistic regression analyses revealed that female gender, current smoking, disease activity at baseline, and absence of remission at 6 months independently predicted PD.Conclusions: Of the patients who entered the early RA inception cohort, 37% suffered a PD course over 8 years. The consequences of PD with regard to general health, pain, function, and joint damage were considerable. Of note, PD was more common in women than in men.

Development of functional impairment and disability in rheumatoid arthritis patients followed for 20 years: relation to disease activity, joint damage, and comorbidity.

To study the course of impairment measured by Signals of Functional Impairment (SOFI) and disability measured by the Health Assessment Questionnaire (HAQ) over 20 years in rheumatoid arthritis (RA) patients followed from the time of diagnosis, and to explore the contribution of disease activity, joint damage, and comorbidity to variation of SOFI and HAQ over time. Patients diagnosed with RA from 1985-1989 were prospectively monitored. There were 183 patients, 63% women, mean ± SD age 52 ± 12 years. Disease activity was measured by the 44-joint Disease Activity Score (DAS), joint damage by Larsen score, and comorbidity by the Charlson Comorbidity Index. The contribution of comorbidity, DAS, and joint damage on development of SOFI and HAQ was studied at 0, 5, 10, 15, and 20 years followup (hierarchical regression model) and over the total study period using a longitudinal regression model. SOFI progressed over 20 years while progression of HAQ levelled off after 10 years. For SOFI, DAS and joint damage contributed the most (2-28% and 3-31%, respectively). Over 20 years, SOFI was explained by DAS (20%), joint damage (20%), age (7%), and comorbidity (4%). For HAQ, DAS contributed the most (4-24%). Over 20 years, HAQ was explained by DAS (20%), joint damage (2%), sex (7%), comorbidity (6%), and age (4%). Over 20 years, 51% of the variation of SOFI and 39% of the variation of HAQ could be explained by age, sex, variations in comorbidity, disease activity, and joint damage. Over time, disease activity contributed significantly to both SOFI and HAQ. Joint damage contributed predominantly to SOFI.

SAT0099 Contribution of disease activity, joint damage and comorbidity to impairment and disability in rheumatoid arthritis patients during 20 years

ObjectivesTo study the contribution of disease activity, joint damage and co-morbidity on development of impairment measured by signals of functional impairment (SOFI) and disability measured by health assessment questionnaire (HAQ)...

FRI0082 Development of impairment, disability, radiological damage, comorbidity and mortality over 20 years in rheumatoid arthritis patients

ObjectivesTo study the development of impairment, disability, radiological damage, comorbidity and mortality over 20 years in a cohort followed prospectively from diagnosis.Methods183 RA patients diagnosed between 1985 and 1989 were...

FRI0478-HPR Worse physical function at disease onset predicts a worse outcome in physical function, but not in meeting who physical activity recommendations, nine years later

BackgroundLong term disease impact on physical functioning in the most affected patients with RA is not well described. Impaired function and inability to be physically active are associated features and...

Disease activity and disability in women and men with early rheumatoid arthritis (RA): An 8‐year followup of a Swedish early RA project

To compare women and men regarding the course of disease activity and disability over 8 years from diagnosis of recent-onset rheumatoid arthritis (RA). A total of 149 patients were followed in the Swedish TIRA study (Early Intervention in RA) for 8 years from RA diagnosis (1996-1998) regarding 28-joint count Disease Activity Score (DAS28), pain (visual analog scale), grip force, Grip Ability Test (GAT), Signals of Functional Impairment (SOFI; hand, upper/lower extremity), walking speed, activity limitation (Health Assessment Questionnaire [HAQ]), and prescribed disease-modifying antirheumatic drugs (DMARDs). Disease activity pattern over time was similar in women and men, showing improvement during the first year and a stable situation during 6 years thereafter. However, at the 7- and 8-year followup times, deterioration was seen with a less favorable course in women. HAQ score did not differ between sexes at diagnosis, but at all followup times women had significantly higher scores than men. Women also had lower grip force and lower walking speed, but higher upper extremity mobility. DMARD prescription was similar for both sexes. Over 8 years, disease duration, sex, biologic agents, grip force, SOFI hand, and pain intensity together explained 43% of the variation in DAS28, whereas grip force, SOFI lower extremity, GAT, and pain intensity could together explain 55% of variations in HAQ score. Disease activity was fairly well managed, but disability gradually worsened. Despite similar medication, women had more disability than men. The discrepancy between disease activity and disability indicates unmet needs for multiprofessional interventions to prevent progressing disability, and patients at risk for disability need to be identified early in the process.

Hand deformities are important signs of disease severity in patients with early rheumatoid arthritis

The aim of this study was to investigate the occurrence and significance of hand deformities during the first 10 years of RA. One hundred and eighty-three early RA patients were included in the study during 1985-89. Mean +/- S.D. of age at onset was 51.4 +/- 12.4 years, and mean duration of symptoms before inclusion 12 +/- 7 months; 64% were women. The patients were followed annually. Assessment of hand deformities was standardized. Hand mobility was measured by signals of functional impairment (SOFI), disability by HAQ and hand HAQ, disease activity by ESR and radiographic changes by the Larsen method. One hundred and eight (59%) patients developed at least one hand deformity during the study time. The majority occurred during the first years. After 10 years, the rate of ulnar deviation, button hole deformity and swan neck deformity was 44, 24 and 23.5%, respectively. The deformity group showed significantly higher disease activity during the first 5 years, and significantly more hand impairment, more disability and more severe radiographic changes throughout the study. Presence of a deformity after 1 year increased the risk of developing a Larsen score above median after 5 years. Odds ratio (95% CI) was 2.1 (1.023, 4.385). More than half of the patients in this early RA cohort had developed hand deformities after 10 years. Most deformities occurred during the first year of the disease. Presence of hand deformities had an impact on daily life function and added useful prognostic information, being an early sign of a more severe disease.

Measures and time points relevant for post-surgical follow-up in patients with inflammatory arthritis: a pilot study

BackgroundRheumatic diseases commonly affect joints and other structures in the hand. Surgery is a traditional way to treat hand problems in inflammatory rheumatic diseases with the purposes of pain relief, restore function and prevent progression. There are numerous measures to choose from, and a combination of outcome measures is recommended. This study evaluated if instruments commonly used in rheumatologic clinical practice are suitable to measure outcome of hand surgery and to identify time points relevant for follow-up.MethodsThirty-one patients (median age 56 years, median disease duration 15 years) with inflammatory rheumatic disease and need for post-surgical occupational therapy intervention formed this pilot study group.Hand function was assessed regarding grip strength (Grippit), pain (VAS), range of motion (ROM) (Signals of Functional Impairment (SOFI)) and grip ability (Grip Ability Test (GAT)). Activities of daily life (ADL) were assessed by means of Disabilities of the Arm, Shoulder and Hand Outcome (DASH) and Canadian Occupational Performance Measure (COPM). The instruments were evaluated by responsiveness and feasibility; follow-up points were 0, 3, 6 and 12 months.ResultsAll instruments showed significant change at one or more follow-up points. Satisfaction with activities (COPM) showed the best responsiveness (SMR>0.8), while ROM measured with SOFI had low responsiveness at most follow-up time points. The responsiveness of the instruments was stable between 6 and 12 month follow-up which imply that 6 month is an appropriate time for evaluating short-term effect of hand surgery in rheumatic diseases.ConclusionWe suggest a core set of instruments measuring pain, grip strength, grip ability, perceived symptoms and self-defined daily activities. This study has shown that VAS pain, the Grippit instrument, GAT, DASH symptom scale and COPM are suitable outcome instruments for hand surgery, while SOFI may be a more insensitive test. However, the feasibility of this protocol in clinical practice awaits prospective studies.

Influence of gender on assessments of disease activity and function in early rheumatoid arthritis in relation to radiographic joint damage

Objective:To evaluate gender differences in score on 28-joint Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ) and Signals Of Functional Impairment (SOFI) and to relate these scores to radiographic joint...

Hand function tests are important and sensitive tools for assessment of treatment response in patients with rheumatoid arthritis

Objectives: To assess the usefulness of hand function measurements in a study of treatment effects of tumour necrosis factor (TNF) blockers and to define the relationship between different hand function tests and also relate hand function to general disability and disease activity.Methods: The study group consisted of 49 patients with established rheumatoid arthritis (RA) who were followed for 1 year while on TNF inhibitors. Evaluation of hand function included Signals of Functional Impairment (SOFI), grip and pinch grip force, and the Grip Ability Test (GAT). General disability was assessed by the Health Assessment Questionnaire (HAQ) and disease activity by the 28‐joint Disease Activity Score (DAS28). The standardized mean response (SMR) method was used to evaluate sensitivity to change for all hand tests using DAS28 and HAQ as external indicators of change.Results: HAQ, DAS28, grip and pinch grip force, and GAT showed a highly significant improvement over time (p<0.001). The improvement in SOFI was also significant (p<0.01). The correlations between the different hand tests varied between 0.45 and 0.72. All hand function tests were significantly related to HAQ but showed only weak correlations to DAS28. SOFI, grip force, and pinch grip force showed large sensitivity for improvement in DAS28 and HAQ (SMR = 0.8–0.9). GAT showed modest sensitivity (SMR = 0.6–0.7).Conclusions: Patients with advanced RA attained considerable improvement in hand function that was only partly reflected by measures of general disability and disease activity. Focused assessment of hand function is therefore important for optimal evaluation of treatment response.

Multivariate relationships between pain intensity and other aspects of health in rheumatoid arthritis–cross sectional and five year longitudinal analyses (the Swedish TIRA project)

Objectives. This study analyses the relationships between pain intensity and other aspects of health commonly used to assess disease activity and disability in early rheumatoid arthritis and examines whether such relationships were different between women and men.Subjects and methods. This study included the 189 patients (69% women) with early RA (symptoms <12 months at diagnosis) still remaining in the Swedish TIRA cohort 5 years after inclusion. Disease activity and disability was assessed 3, 6, 12, 18, 24, 36, 48, and 60 months (M0-M60) after inclusion by erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), number of swollen and tender joints, physicians global assessment of disease activity (PGA), grip force average over 10 seconds (Grippit), Grip Ability Test (GAT), Signals of Functional Impairment (SOFI) in hand, lower limb and upper limb, Health Assessment Questionnaire (HAQ), and pain intensity measured with a visual analogue scale (VAS). The variables were divided into meaningful blocks according to the correlation structure in a principal component analysis (PCA) at M60. Using hierarchical partial least squares (PLS) analyses, this study investigated the blocks cross-sectionally to test for correlations with pain intensity at M0 and M60. The blocks at M0 were also used as predictors of pain intensity at M60 in a hierarchical PLS.Results. The strongest relationship was found between pain intensity and the second block, consisting of HAQ and SOFI-lower limb at the cross-sectional analyses in both women and men. The block representing disease activity (i.e., ESR, CRP, PGA, and swollen and tender joints) had the weakest relation to pain intensity. According to the longitudinal analyses, the disease activity variables (block 1) at M0 had the strongest relationship to pain intensity at M60 in men. In contrast, HAQ and SOFI-lower limb (block 2) at M0 had a strong relation to pain intensity in women.

Hand function in women and men with early rheumatoid arthritis. A prospective study over three years (the Swedish TIRA project)

Objective: To describe the course of hand function in women and men during the first 3 years after diagnosis of recent‐onset rheumatoid arthritis (RA), to investigate sex differences in hand function, and to study correlations between and within hand function assessments.Methods: A total of 276 patients (69% women) with RA of a maximal duration of 12 months were recruited to the study. Hand function was assessed by the Grip Ability Test (GAT) and Signals of Functional Impairment (SOFI). Peak and average grip force over 10 s in the right and left hand was measured by an electronic device.Results: Hand function was affected at diagnosis, but had improved significantly at the 3‐months' follow‐up and then remained stable (but still affected) in both women and men. As assessed by SOFI, hand function was worse in men than in women, whereas women had significantly lower grip force. GAT, grip force, and SOFI correlated weakly. The average and peak values of grip force correlated strongly, as did the grip force in the right and the left hand.Conclusion: Hand function was profoundly affected at diagnosis of RA, but improved significantly within 3 months and remained stable (but still affected) over 3 years. As expected, women on average had significantly lower grip force than men.

Change in and predictors of leisure activities among patients with rheumatoid arthritis: a prospective study

Objective: To describe factors associated with leisure activities, changes in leisure activities over time, and predictors of such changes among persons with rheumatoid arthritis (RA).Methods: A prospective study was conducted of 80 consecutive persons with RA, recruited while participating in a 3‐week, rehabilitation day‐care programme. The number of leisure activities was assessed through a structured interview. Sociodemographic variables, measures of disease activity [pain, patient's global assessment, C‐reactive protein (CRP)], disability [Health Assessment Questionnaire (HAQ), Signals of Functional Impairment (SOFI), grip strength], quality of life at baseline, as well as disease activity [mean erythrocyte sedimentation rate (ESR)] and treatment (proportion of follow‐up time on anti‐rheumatic drugs during follow‐up) were evaluated as possible predictors of change in leisure activities.Results: Active leisure activities increased, while ‘not obviously active or passive’ leisure activities were unchanged during the follow‐up period. The change in active leisure activities did not correlate with the predictors evaluated.Conclusion: The increase in active leisure activities was not predicted to a substantial degree by disease activity, disability, or medication. The results suggest that factors other than those evaluated influence changes in leisure activities.

Learned helplessness and its correlation to impairment, pain, anxiety and depression in rheumatoid arthritis.

A Swedish version of the self-report instrument Arthritis Helplessness Index (AHI) is presented. Validity and reliability of the translation has been analyzed. 100 consecutive patients with rheumatoid arthritis (RA) were studied, 78 of which completed 2 self-administered questionnaires with AHI, impairment, pain, anxiety and depression. Furthermore 20 of the patients were interviewed with regard to AHI. Forty-two other patients with RA were analyzed for correlation between AHI and biochemical activity and Signals of Functional Impairment (SOFI). We conclude that the Swedish version of AHI has satisfactory validity and reliability. It correlates with age, physical impairment, pain, anxiety and depression but not with sex or disease activity. Five of the original 15 items could for various reasons be omitted, leaving a 10 statement instrument. AHI is promising as a variable in future outcome studies of RA.

Functional assessment of early rheumatoid arthritis.

A new performance index, SOFI (Signals of Functional Impairment), is described. This aims to detect functional impairment of different joints as early as possible. It comprises assessments of hand, arm and leg function. The assessment time is short and reliability is satisfactory. The index correlates significantly with range of motion, Ritchie index, grip strength, and the Stanford Health Assessment Questionnaire (HAQ) disability index. The last mentioned was used in parallel with the new index to study 50 early RA patients. These were followed every 3-6 months for 1 year. Both indices seemed to fluctuate with changes in the patient's state.