Objective Evaluation of Physical Functioning after TNFi Therapy in Ankylosing Spondylitis Patients; A Selection of Three Feasible Performance-Based Tests

Salima F.E. van Weely¹, Joost Dekker^1,2, Martijn P.M. Steultjens³, Christiaan J. Van Denderen¹, Mike T. Nurmohamed¹, Ben A.C. Dijkmans⁴ and Irene E. van der Horst-Bruinsma⁴, ¹Reade, centre for Rehabilitation and Rheumatology, Amsterdam, Netherlands, ²Rehabilitation Medicine, Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands, ³Institute for Applied Health Research and School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, ⁴Rheumatology, VU University Medical Centre, Amsterdam, Netherlands

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: anti-TNF therapy, Outcome measures, performance, physical function and test

Session Information

Title: Spondyloarthropathies and Psoriatic Arthritis - Clinical Aspects and Treatment I

Session Type: Abstract Submissions (ACR)

Background/Purpose: Physical functioning is considered an important outcome domain for the evaluation of the effectiveness of therapy and the course of the disease. In an effort to find objective outcome measures that assess limitations in physical functioning in Ankylosing Spondylitis (AS) patients, eight performance-based tests based on items of the Bath AS Functional Index (BASFI) were developed. However, in research and clinical practice it is important to eliminate redundant testing in order to safe energy, time and money. Therefore, this study aimed (i) to select a limited number of performance-based tests that are reliable, show improvement in physical functioning after TNFi therapy and generate the equivalent information as the full set of tests and (ii) are feasible for use in daily clinical practice.

Methods: Eight performance-based tests were evaluated ((1) climbing stairs, (2) bending, (3) reaching up, (4) putting on socks, (5) rising up and sitting down on a chair, (6) getting up from the floor, (7) looking over the shoulder and (8) a physically demanding activity). The tests that showed adequate reliability, highest Standardized Response Means (SRM) and the largest proportion of patients with an improved performance-based physical functioning were selected. The selected tests were combined into a new criterion for improvement in physical functioning (AS Performance-based Improvement, ASPI). The number and percentage improved patients identified with the ASPI and identified with the full set of performance tests were compared.

Results: Reliability for all tests was adequate to excellent (Intraclass Correlation Coefficients 0.73-0.96). The tests for bending, putting on socks and getting up from the floor had the highest SRM’s (0.52–0.74) and showed the largest proportion of improved patients after TNFi therapy. The combination of these three tests is feasible in daily clinical practice and showed improved physical functioning after TNFi therapy in 67% of the patients.

Conclusion: The tests for bending, putting on socks and getting up from the floor are recommended for use in daily practice, because they generate comparable information as the full set and are feasible for use in daily clinical practice. A new criterion, the ASPI, using a combination of these three tests showed an improved physical functioning after TNFi therapy in 67% of the patients. By performing only three instead of all performance-based tests, redundant testing is eliminated. In future, evaluations of the effectiveness of TNFi therapy in AS patients might be improved by adding these tests to other outcome measures.

Disclosure:

S. F. E. van Weely,
None;

J. Dekker,
None;

M. P. M. Steultjens,
None;

C. J. Van Denderen,
None;

M. T. Nurmohamed,
None;

B. A. C. Dijkmans,
None;

I. E. van der Horst-Bruinsma,
None.

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