Background/Purpose .  Patient global assessments are components of RA disease activity calculations.  Patient global assessments, however, do not consistently agree with physician assessments.  This discrepancy leads to the question of how patients form global assessments, specifically the role of factors beyond generally recognized RA symptoms and health status.  In this analysis, we evaluate the role of demographic factors, health status, functional limitations, psychological status, and disability in patient global assessments.

Methods .  Data were from the Rheumatoid Arthritis Outcomes Study (n = 438), collected in structured telephone interviews conducted in English or Spanish.  Patient global assessments were obtained with the item:  “Considering all the ways that your arthritis affects you, how well are you doing?”, with responses on a 0 – 100 (very poor – very well) scale.  Demographic (age, sex, language, race/ethnicity, and education), health status (comorbid conditions, ratings of pain and fatigue, and current use of a DMARD, biologic therapy, or prednisone), functional limitations (measured with the Health Assessment Questionnaire, HAQ), depression, disability in valued life activities (VLAs), and self-efficacy were entered into sequential linear regression models to examine the contribution of each variable or group of variables to the overall disease assessment. The VLA scale was scored to provide mean difficulty in obligatory (i.e., necessary for independence and self-sufficiency), committed (associated with major life roles), and discretionary (e.g., socializing and engaging in activities that provide relaxation and pleasure) activities. 

Results . Respondents were 88% female, mean age 60±13 years, 18% Spanish-speaking, and mean RA duration 23±12 years.  Demographic factors alone yielded a model R² of 0.13 (Table 1).  Addition of RA, health status and medications increased R² to 0.20; addition of functional limitations increased R² to 0.23. R²was further increased by adding depression, VLA disability, and self-efficacy. Yet, the final model (Table 2) accounted for only 30% of the variation in patient global assessments, leaving the majority of such variation unexplained.

Conclusion .  Difficulty in participating in discretionary valued life activities and self-efficacy – perhaps representing impact of disease on patients’ daily lives and their evaluations of their ability to cope with RA – play significant roles in RA patients’ global assessments of disease.  The importance of these factors may provide insight into discrepancies between patient and physician assessments of disease. 

 

Table 1.  Summary of results of sequential linear regression models to estimate patient global assessments
	Model 1	Model 2	Model 3	Model 4	Model 5	Model 6
Model R2	0.13	0.20	0.23	0.24	0.27	0.30
F (p-value) for difference in model from previous		4.24 (<0.001)	14.43 (<0.001)	9.26 (<.0001)	4.44 (<.0001)	17.58 (<.0001)
Model 1: age, sex, Spanish-speaking, African American, Asian, education Model 2: Model 1 + comorbid conditions, pain, fatigue, use of DMARD, use of biologic, use of prednisone Model 3: Model 2 + functional limitations (Health Assessment Questionnaire [HAQ]) Model 4: Model 3 + depression (Patient Health Questionnaire [PHQ] ≥ 5) Model 5: Model 4 + VLA difficulty in obligatory, committed, and discretionary activities Model 6: Model 5 + self-efficacy (Self-Efficacy for Managing Chronic Disease Scale)

 

Table 2. Variables in final regression model with p<0.10
	β
Female	-6.9
Spanish-speaking	-11.3	*
Asian	9.3	*
Less than high school education	-10.3	*
Fatigue moderate or greater	-12.5	***
Current use of biologic therapy	-5.1	*
Current use of prednisone	-4.8	*
Depression	-6.2
VLA difficulty, committed activities	6.8	*
VLA difficulty, discretionary activities	-7.9	**
Self-efficacy	3.0	****
Model also included age, African American race, number of comorbid conditions, pain rating, use of DMARDs, and HAQ * p<0.05; ** p<0.01; *** p<0.001; **** p<0.0001

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/disability-in-discretionary-valued-life-activities-and-self-efficacy-explain-a-significant-portion-of-ra-patients-global-assessments/