Which patients improve the most after arthritis rehabilitation? A study of predictors in patients with inflammatory arthritis in Northern Europe, the STAR-ETIC collaboration.
OBJECTIVE
To study health-related quality of life (HRQoL) in arthritis rehabilitation performed by multidisciplinary teams in patients with chronic inflammatory arthritis. Predictors of change in health-related quality of life and the proportion of patients with clinical improvement were investigated.


METHODS
Multicentre prospective observational study in 4 European countries.


METHODS
HRQoL was measured with the European Quality 5 Dimensions (EQ-5D) and the Short Form 36 Health Survey (SF-36) in 731 patients who underwent multidisciplinary rehabilitation. Potential predictors were physical functioning (Health Assessment Questionnaire (HAQ)), self-efficacy (Arthritis Self Efficacy Scale (ASES)), psychological health (Hopkins Symptom Check List (HSCL-25)), pain/fatigue (numeric rating scales (NRS)), age, sex, diagnosis, comorbidity, education, clinical setting and change of medication during rehabilitation. Analysis of covariance (ANCOVA) was used to assess for potential predictors and interactions. The minimal important differences for HRQoL were analysed.


RESULTS
Reporting worse function (b 0.05, p = 0.01), less psychological well-being (b 0.09, p = 0.000), and experiencing more pain (b 0.03, p = 0.000) or fatigue (b 0.02, p = 0.000) at admission predicted improved HRQoL. Change in medication during rehabilitation (b 0.08, p = 0.013) was associated with greater improvement in HRQoL. These EQ-5D findings were supported by SF-36 findings. Positive minimal important differences were noted in 46% (EQ-5D) and 23-47% (SF-36 subscales) of the patients.


CONCLUSIONS
Patients with more severe symptoms experienced the largest gain in HRQoL post-intervention. The results of this study are of value for selecting the right patients for rheumatological team rehabilitation.
Department of Clinical Sciences Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Lund , Sweden. sofia.hagel@med.lu.se.
Sofia
S
Hagel
Elisabet
E
Lindqvist
Ingemar F
IF
Petersson
Jorit J L
JJ
Meesters
Mari
M
Klokkerud
Gerd J
GJ
Aanerud
Inger H
IH
Stovgaard
Kim
K
Hørslev-Petersen
Britta
B
Strömbeck
Thea P M
TP
Vliet Vlieland
Ann
A
Bremander
D000328:Adult; D000704:Analysis of Variance; D001172:Arthritis, Rheumatoid / Q000453:epidemiology* / Q000534:rehabilitation*; D015897:Comorbidity; D005060:Europe / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology; D010147:Pain Measurement; D011446:Prospective Studies; D011788:Quality of Life; D020377:Self Efficacy; D013167:Spondylitis, Ankylosing / Q000453:epidemiology / Q000534:rehabilitation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome