Background/Purpose: Functioning of axSpA patients (pat.) is influenced by many factors, but how contextual factors influence functioning isn’t well studied. According to the International Classification of Functioning, Disability and Health (ICF), functioning is a complex interaction between health status and contextual factors such as social support, relationships and attitudes. Resulting from impaired functioning, pat. reporting barriers might face definite limitations in participation. Thus, limitations in participation as well as barriers and facilitators of contextual factors need to be investigated in axSpA pat.

Methods: axSpA pat. were standardized assessed, thereby collecting pat. and disease characteristics, patient-reported outcomes (ASDAS, BASFI, BASMI, PHQ-9, ICF Measure of Participation and ACTivities questionnaire (IMPACT-S (0-100%)), ASAS Health Index (ASAS HI and environment factor item set (EFIS) (1). The EFIS contains 9 dichotomous questions addressing ICF categories of products and technologies (e1), support and relationship (e3), attitudes (e4) and health services (e5). Prior to the analysis, EFIS 1, 4 and 8 were assumed to act as facilitators. Validated cut-offs of ASAS HI were used to categorize global functioning: good ≤ 5, moderate < 5 to < 12, poor ≥ 12.

Results: A total of 200 axSpA pat. were included: 69% males, 44.3±12.5 years, symptom duration 17.9±12.6 years, ASDAS 2.5±1.1, BASFI 4.0±2.7, BASMI 3.5±1.8, ASAS HI 7.0±4.1. Pat. reported limitations in the IMPACT-S activity and participation domain (82.3% (15.2) and 83.5% (16.8)), respectively. The majority of pat. reported that treatment of axSpA requires time (e4, 58.5%) as a barrier. Some pat. reported needs such as (a) the support by family members (e3, 43.5%), (b) to modify home and work environment (e1, 39.5%) and (c) the inreliability of family members for help (e3, 22%) as barriers. Some pat. (< 20%) reported (a) comprehension problems with health care professionals when experiencing a flare (e5, 18.5%), (b) inadequate care of pat. at home (e4, 18.5%), (c) disliking friends' behavior toward them (e4, 13.5%), and (d) too demanding friends (e4, 13%) as barriers. The majority of pat. (e4, 75.9%) identified attitudes of friends as the only and major facilitator. All pat. reporting at least one barrier, had significantly worse global functioning (ASAS HI, IMPACT-S), and depression (PHQ-9) compared to pat. reporting no barriers in the respective ICF categories (p< 0.01). Similarly, pat. with poor functioning are more likely to report barriers in contextual factors compared to pat. with good functioning (Table 1). Pat., who have to ask for more support from their families, expressed the feeling that they cannot rely on that.

Conclusion: Barriers of contextual factors are more present in axSpA pat. than facilitators. This study shows that barriers of contextual factors are more common in pat. with impairments in self-reported and performed functioning as in those without impairments, underlining the importance of contextual factors in the management of axSpA pat. The controversial response to EF-Items 1, 4 and 8 suggests relevant differences in the individual interpretation of these questions.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/contextual-factors-should-complete-the-assessment-of-functioning-in-patients-with-axial-spondyloarthritis-axspa/