Session Type: Poster Session (Sunday)
Session Time: 9:00AM-11:00AM
Background/Purpose: In patients with axial spondyloarthritis (axSpA) physical functioning is frequently impaired. The current gold standard to assess physical functioning is self-reported questionnaires (i.e. BASFI), which, however, are of subjective nature. Therefore, a performance-based test-battery was designed to measure physical functioning more objectively: the ankylosing spondylitis (AS) performance index (ASPI)) . To imitate activities of daily living (ADL), tasks based on BASFI domains, were designed. Although the ASPI had previously been evaluated, a thorough analysis of the deficits of physical functioning and factors which influence the performance of patients with axSpA has not been performed to date.
Methods: Consecutive patients diagnosed with axSpA fulfilling the ASAS classification criteria underwent standardized assessments concentrating on the following variables: patient and disease characteristics, patient-reported outcomes (ASDAS, BASFI, BASMI, ASAS Health Index (ASAS HI), PHQ-9, IPAQ), mSASSSand ASPI (ASPI 1: Bending, 2. Putting on socks, 3. Getting up from the floor) . Performance was measured in seconds as time to complete a task based on published instructions given to the patients. Impairment in physical performance was defined as the inability of patients to perform ≥ 1 ASPI test. Spearman Rho correlation was used to compare self-reported functioning and performed physical functioning. Logistic regression analysis was used to identify factors associated with impaired physical performance.
Results: A total of 200 patients (AS 66%, nr-axSpA 34%) was included: 69% males, 44.3±12.5 years old, mean symptom duration 17.9±12.6 years, BMI 27.2±5.5, mean ASDAS 2.5±1.1, BASFI 4.0±2.7, BASMI 3.5±1.8, ASAS HI 7.0±4.1, PHQ-9 8.8±6.2, and mSASSS(n=157) 10.2±18.8. 133 patients were treated with bDMARDs (66.5%). In total 44 patients (22%) were not able to perform one or more ASPI tests. The mean time for bending was 18.6±9.5 sec (n=179/90%), for putting on socks 12.8±6.4 sec (n=156/78%), and for getting up from floor 6.5±5.0 sec (n=187/94%). A significant correlation was found for all three ASPI-tests with BASFI (0.5-0.7), ASAS HI (0.4-0.6). Self-reported physical activity (IPAQ) correlated weakly with ASPI (all 0.2) and structural damage correlated only with the task putting on socks (r=0.3), whereas the other tests did not correlate. Logistic regression showed an influence of obesity, spinal mobility and global functioning on actual performance but not of disease activity and self-reported physical function (Table 1)
Conclusion: This study confirms a good correlation of the ASPI with standard questionnaires of physical functioning and disease activity. However, the ASPI showed a substantial floor effect, since 22% of patients were unable to perform the tests. This striking finding strongly suggests that more information on the actual performance of patients with axSpA is needed. Our data confirm that self-reported physical activity cannot be used as a substitute for the actual performance of axSpA patients. Moreover, obesity as a potential modifying factor that definitely contributes to limitations in actual performance should also be more carefully addressed in patients with axSpA.
To cite this abstract in AMA style:Ahomaa E, Kiltz U, Bühring B, Baraliakos X, van weely S, Braun J. Analysing Impairments in Physical Performance as Assessed by the as Performance Index (ASPI) in Patients with Axial Spondyloarthritis (axSpA) [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/analysing-impairments-in-physical-performance-as-assessed-by-the-as-performance-index-aspi-in-patients-with-axial-spondyloarthritis-axspa/. Accessed November 18, 2019.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/analysing-impairments-in-physical-performance-as-assessed-by-the-as-performance-index-aspi-in-patients-with-axial-spondyloarthritis-axspa/