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Association between helplessness, disability, and disease activity with health-related quality of life among rheumatoid arthritis patients in a multiethnic Asian population

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Abstract

To investigate the association between helplessness, disability, and disease activity with health-related quality of life (HRQoL) in a multiethnic cohort of rheumatoid arthritis (RA) patients in Singapore. This cross-sectional study was conducted at Tan Tock Seng Hospital, Department of Rheumatology, Allergy and Immunology, from October 2010 to October 2011. All patients fulfilled the American College of Rheumatology 1987 criteria for RA. Socio-demographics, clinical, and patient-reported outcome (PRO) variables were collected. HRQoL outcomes were Short Form 36 (SF-36) physical and mental component summary (PCS and MCS) scores and Short Form 6 Dimensions (SF-6D) utilities. Stepwise multiple linear regression analyses were performed using HRQoL outcomes as dependent variables in separate models and with adjustment for helplessness (Rheumatology Attitudes Index, RAI), disability (Health Assessment Questionnaire, HAQ), and disease activity (Disease Activity in 28 joints) followed by socio-demographic, clinical, and PRO variables. Complete data were provided by 473 consenting subjects [mean (SD) age: 60.02 (11.04) years, 85 % female, 77 % Chinese]. After adjustment for all measured covariates, only RAI and HAQ scores remained significantly associated with SF-36 MCS (β: −0.9, p < 0.001; β: −7.0, p < 0.001) and SF-6D utilities (β: −0.005, p < 0.001; β: −0.081, p < 0.001), respectively, while only HAQ scores were significantly associated with SF-36 PCS (β: −7.7, p < 0.001). Interventions to address the sense of helplessness and to prevent or reduce disability could improve HRQoL of RA patients.

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References

  1. Shapira Y, Agmon-Levin N, Shoenfeld Y (2010) Geoepidemiology of autoimmune rheumatic diseases. Nat Rev Rheumatol 6(8):468–476. doi:10.1038/nrrheum.2010.86

    Article  CAS  PubMed  Google Scholar 

  2. Cella DF (1994) Quality of life: concepts and definition. J Pain Symptom Manag 9(3):186–192

    Article  CAS  Google Scholar 

  3. Cadena J, Vinaccia S, Pérez A, Rico MI, Hinojosa R, Anaya J-M (2003) The impact of disease activity on the quality of life, mental health status, and family dysfunction in Colombian patients with rheumatoid arthritis. J Clin Rheumatol 9(3):142–150

    Article  PubMed  Google Scholar 

  4. Guillemin F (2000) Functional disability and quality-of-life assessment in clinical practice. Rheumatology 39(suppl 1):17–23

    Article  PubMed  Google Scholar 

  5. Eichler HG, Mavros P, Geling O, Hunsche E, Kong S (2005) Association between health-related quality of life and clinical efficacy endpoints in rheumatoid arthritis patients after four weeks treatment with anti-inflammatory agents. Int J Clin Pharmacol Ther 43(5):209–216

    Article  CAS  PubMed  Google Scholar 

  6. Marra CA, Lynd LD, Esdaile JM, Kopec J, Anis AH (2004) The impact of low family income on self-reported health outcomes in patients with rheumatoid arthritis within a publicly funded health-care environment. Rheumatology 43(11):1390–1397. doi:10.1093/rheumatology/keh334

    Article  CAS  PubMed  Google Scholar 

  7. Langley PC, Mu R, Wu M, Dong P, Tang B (2011) The impact of rheumatoid arthritis on the burden of disease in urban China. J Med Econ 14(6):709–719. doi:10.3111/13696998.2011.611201

    Article  PubMed  Google Scholar 

  8. Cho S-K, Kim D, Jun J-B, Bae S-C, Sung Y-K (2012) Factors influencing quality of life (QOL) for Korean patients with rheumatoid arthritis (RA). Rheumatol Int 1–10. doi:10.1007/s00296-011-2352-6

  9. Rupp I, Boshuizen HC, Roorda LD, Dinant HJ, Jacobi CE, van den Bos G (2006) Poor and good health outcomes in rheumatoid arthritis: the role of comorbidity. J Rheumatol 33(8):1488–1495

    PubMed  Google Scholar 

  10. Linde L, Sorensen J, Ostergaard M, Horslev-Petersen K, Rasmussen C, Jensen DV, Hetland ML (2009) What factors influence the health status of patients with rheumatoid arthritis measured by the SF-12v2 health survey and the Health Assessment Questionnaire? J Rheumatol 36(10):2183–2189. doi:10.3899/jrheum.090134

    Article  PubMed  Google Scholar 

  11. Sadamoto K, Fukuya H, Saito E (2001) What is the factor that most influences QOL among rheumatoid arthritis patients? Mod Rheumatol 11(1):52–55. doi:10.1007/s101650170044

    Article  CAS  PubMed  Google Scholar 

  12. Standfield L, Norris S, Harvey C, Elliot L, Riordan J, Hall S, Day R, Nash P, Thirunavukkarasu K, Robertson J, Palmer T (2010) Relationship between rheumatoid arthritis disease severity, health-related utility, and resource use in Australian patients: a cross-sectional, multicenter study. Clin Ther 32(7):1329–1342. doi:10.1016/j.clinthera.2010.07.006

    Article  PubMed  Google Scholar 

  13. Kojima M, Kojima T, Ishiguro N, Oguchi T, Oba M, Tsuchiya H, Sugiura F, Furukawa TA, Suzuki S, Tokudome S (2009) Psychosocial factors, disease status, and quality of life in patients with rheumatoid arthritis. J Psychosom Res 67(5):425–431. doi:10.1016/j.jpsychores.2009.01.001

    Article  PubMed  Google Scholar 

  14. Kagawa-Singer M (2011) Impact of culture on health outcomes. J Pediatr Hematol Oncol 33:S90–S95. doi:10.1097/MPH.1090b1013e318230dadb

    Article  PubMed  Google Scholar 

  15. Fry PS, Grover SC (1982) Cognitive appraisals of life stress and depression in the elderly: a Cross-Cultural comparison of Asians and Caucasians. Intl J Psychol 17(1–4):437–454. doi:10.1080/00207598208247455

    Article  Google Scholar 

  16. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, Medsger TA, Mitchell DM, Neustadt DH, Pinals RS, Schaller JG, Sharp JT, Wilder RL, Hunder GG (1988) The American rheumatism association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31(3):315–324. doi:10.1002/art.1780310302

    Article  CAS  PubMed  Google Scholar 

  17. Fransen J, van Riel PLCM (2009) The disease activity score and the EULAR response criteria. Rheum Dis Clin North Am 35(4):745–757. doi:10.1016/j.rdc.2009.10.001

    Article  PubMed  Google Scholar 

  18. Koh ET, Seow A, Pong LY, Koh WH, Chan L, Howe HS, Lim TH, Low CK (1998) Cross cultural adaptation and validation of the Chinese Health Assessment Questionnaire for use in rheumatoid arthritis. J Rheumatol 25(9):1705–1708

    CAS  PubMed  Google Scholar 

  19. Bruce B, Fries J (2003) The Stanford Health Assessment Questionnaire: dimensions and practical applications. Health Qual Life Outcomes 1(1):20

    Article  PubMed Central  PubMed  Google Scholar 

  20. Callahan LF, Brooks RH, Pincus T (1988) Further analysis of learned helplessness in rheumatoid arthritis using a “Rheumatology Attitudes Index”. J Rheumatol 15(3):418–426

    CAS  PubMed  Google Scholar 

  21. Ware JE (1993) Manual and interpretation guide. Nimrod Press, Boston

    Google Scholar 

  22. Hays RD, Morales LS (2001) The RAND-36 measure of health-related quality of life. Ann Med 33(5):350–357. doi:10.3109/07853890109002089

    Article  CAS  PubMed  Google Scholar 

  23. Brazier J, Roberts J, Deverill M (2002) The estimation of a preference-based measure of health from the SF-36. J Health Econ 21(2):271–292. doi:10.1016/s0167-6296(01)00130-8

    Article  PubMed  Google Scholar 

  24. Walters SJ, Brazier JE (2005) Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res 14(6):1523–1532. doi:10.1007/s11136-004-7713-0

    Article  PubMed  Google Scholar 

  25. Thumboo J, Feng P-H, Chan S-P, Boey M-L, Thio S-T, Fong K-Y (2002) A Chinese version of the Rheumatology Attitudes Index is a valid and reliable measure of learned helplessness in patients with SLE. Lupus 11(2):88–94. doi:10.1191/0961203302lu156oa

    Article  CAS  PubMed  Google Scholar 

  26. Koh ET, Leong KP, Tsou IYY, Lim VH, Pong LY, Chong SY, Seow A, Group ftTTSHRAS (2006) The reliability, validity and sensitivity to change of the Chinese version of SF-36 in oriental patients with rheumatoid arthritis. Rheumatology 45(8):1023–1028. doi:10.1093/rheumatology/kel051

    Article  CAS  PubMed  Google Scholar 

  27. O’brien R (2007) A caution regarding rules of thumb for variance inflation factors. Qual Quant 41(5):673–690. doi:10.1007/s11135-006-9018-6

    Article  Google Scholar 

  28. Brady TJ (2003) Measures of self-efficacy, helplessness, mastery, and control: the Arthritis Helplessness Index (AHI)/Rheumatology Attitudes Index (RAI), Arthritis Self-Efficacy Scale (ASES), Children’s Arthritis Self-Efficacy Scale (CASE), Generalized Self-Efficacy Scale (GSES), Mastery Scale, Multi-Dimensional Health Locus of Control Scale (MHLC), Parent’s Arthritis Self-Efficacy Scale (PASE), Rheumatoid Arthritis Self-Efficacy Scale (RASE), and Self-Efficacy Scale (SES). Arthritis Care Res 49(S5):S147–S164. doi:10.1002/art.11413

    Article  Google Scholar 

  29. Chui DYY, Lau JSK, Yau ITY (2004) An outcome evaluation study of the rheumatoid arthritis self-management programme in Hong Kong. Psychol Health Med 9(3):286–292. doi:10.1080/13548500410001721855

    Article  Google Scholar 

  30. Jakobsson ULF, Hallberg IR (2002) Pain and quality of life among older people with rheumatoid arthritis and/or osteoarthritis: a literature review. J Clin Nurs 11(4):430–443. doi:10.1046/j.1365-2702.2002.00624.x

    Article  PubMed  Google Scholar 

  31. Rupp I, Boshuizen HC, Dinant HJ, Jacobi CE, van den Bos GA (2006) Disability and health-related quality of life among patients with rheumatoid arthritis: association with radiographic joint damage, disease activity, pain, and depressive symptoms. Scand J Rheum 35(3):175–181. doi:10.1080/03009740500343260

    Article  CAS  PubMed  Google Scholar 

  32. Mikuls T, Saag K, Criswell L, Merlino L, Cerhan JR (2003) Health related quality of life in women with elderly onset rheumatoid arthritis. J Rheumatol 30(5):952–957

    PubMed  Google Scholar 

  33. Rupp I, Boshuizen HC, Jacobi CE, Dinant HJ, van den Bos G (2004) Comorbidity in patients with rheumatoid arthritis: effect on health-related quality of life. J Rheumatol 31(1):58–65

    PubMed  Google Scholar 

  34. Thumboo J, Fong KY, Machin D, Chan SP, Soh CH, Leong KH, Feng PH, Thio S, Boey ML (2003) Quality of life in an urban Asian population: the impact of ethnicity and socio-economic status. Soc Sci Med 56(8):1761–1772

    Article  PubMed  Google Scholar 

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Acknowledgments

This study is supported by a Grant from the National Healthcare Group (NHG)-SIG/PTD/06044.

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Correspondence to Hwee-Lin Wee.

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Kwan, Y.H., Koh, E.T., Leong, K.P. et al. Association between helplessness, disability, and disease activity with health-related quality of life among rheumatoid arthritis patients in a multiethnic Asian population. Rheumatol Int 34, 1085–1093 (2014). https://doi.org/10.1007/s00296-013-2938-2

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