Validation of Index of Activity Speed (Timed Up and Go test) for Outcome Measure of Patients with Long-Standing Rheumatoid Arthritis: Multicenter Prospective Cohort Study for Evaluation of Joint Surgery on Physical Function

Toshihisa Kojima¹, Hajime Ishikawa^2,3, Sakae Tanaka⁴, Nobuhiko Haga⁵, Keiichiro Nishida⁶, Masao Yukioka⁷, Jun Hashimoto⁸, Hisaaki Miyahara⁹, Yasuo Niki¹⁰, Tomoatsu Kimura¹¹, Hiromi Oda¹², Shuji Asai¹³, Koji Funahashi¹, Masayo Kojima¹⁴ and Naoki Ishiguro¹⁵, ¹Department of Orthopedic Surgery, Nagoya University Hospital, Nagoya, Japan, ²Orthopedic Surgery, Niigata Rheumatic Center, Shibata, Japan, ³Orthopedic Surgery, Niigata Rheumatic Center, Shinata, Japan, ⁴Department of Orthopaedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan, ⁵Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan, ⁶Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama city, Japan, ⁷Orthopedic Surgery, Yukioka Hospital, Osaka, Japan, ⁸Dept of Rheumatology, Osaka-Minami Medical Center, Kawachinagano City, Japan, ⁹Department of Rheumatology and Orthopaedic Surgery, Kyushu Medical Center, Fukuoka, Japan, ¹⁰Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan, ¹¹Department of rthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan, ¹²Orthopedic Surgery, Saitama Medical Univeristy, Morohongo Moroyama, Japan, ¹³Nagoya University Hospital, Nagoya, Japan, ¹⁴Medical education, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan, ¹⁵Department of Orthopedic Surgery, Nagoya University, Graduate School & Faculty of Medicine, Nagoya, Japan

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Outcome measures, physical impairment and rheumatoid arthritis, treatment

Session Information

Date: Sunday, November 13, 2016

Title: Rheumatoid Arthritis – Clinical Aspects - Poster I: Clinical Characteristics/Presentation/Prognosis

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

Total management including reconstructive joint surgery and rehabilitation should be needed for further improvements of physical function for long-standing RA patients. It is very important to set treatment goal for those management using index of activity speed [Timed Up and Go test (TUG)] and range of motion (ROM). The purpose of this study is to explore the characteristics of functional impairment and relationship TUG and physical function in RA patients who were needed joint surgery using multicenter prospective cohort.

Methods:

We started the prospective study in September, 2012 (Study registration: UMIN000012649). In this study, we used baseline (preoperation) data as follows; age, sex, disease duration, drug therapies, and disease activity, functional evaluations [TUG, HAQ-DI, DASH (upper limb function), joint ROM (hip, knee, ankle, shoulder, elbow, wrist)], and patient-reported outcome [EQ-5D (QOL) and BDI-II (depression)]. Correlation between TUG and other variables were determined. Association between TUG and no disability of daily activity in each 8 HAQ-DI categories and cut-off values for no disability were determined using ROC curve. TUG by disability in 8 HAQ-DI categories was compared by ANOVA with adjustment of age and sex. This study is supported by grant from the Japanese Ministry of Health, Labour and Welfare.

Results:

435 surgical patients were registered. Mean values for age, disease duration, and sex were 64.2 years, 17.1 years, and 89% female, respectively. Actually, even long-standing RA patients who were needed joint surgery had remission or low disease activity in this baseline data (median values for DAS28 (3.0) and CRP (0.2 mg/dl). 23.0% of the patients were treated with biologics. We confirmed the significant correlation (r>0.3) between TUG and Age, HAQ-DI, DASH, patient-reported outcome (EQ-5D) and range of motion (hip, knee, shoulder). We also found significant relationship between TUG and 5 of 8 categories in HAQ-DI.

The relevant association between TUG and category Walking, Arising, and Activity (AUC>0.7) was found based on ROC analyses. Cut-off value of TUG for HAQ remission (<0.5) was 8.6 seconds (sensitivity 64%, specificity 65%). Cut-off for no disability in category Arising, Walking, and Activity were 8.6s (sensitivity 74%, specificity 63%), 8.4s (sensitivity 76%, specificity 71%) and 8.2s (sensitivity 69%, specificity 66%), respectively. Age, sex-adjusted TUG for no disability in Arising, 9.2s (95%CI: 8.2-10.1), Waling, 8.6s (95%CI: 7.6-9.6), Activity, 8.6s (95%CI: 7.2-10.0).

Conclusion: TUG was significantly associated with other physical function measurements and patient-reported outcome. The cut-off values of TUG (~9 seconds) should be important for assessment of disability in patients with long-standing RA and could provide target of surgical procedure and rehabilitation program.

Disclosure: T. Kojima, None; H. Ishikawa, None; S. Tanaka, None; N. Haga, None; K. Nishida, None; M. Yukioka, None; J. Hashimoto, None; H. Miyahara, None; Y. Niki, None; T. Kimura, None; H. Oda, None; S. Asai, None; K. Funahashi, None; M. Kojima, None; N. Ishiguro, None.

To cite this abstract in AMA style:

Kojima T, Ishikawa H, Tanaka S, Haga N, Nishida K, Yukioka M, Hashimoto J, Miyahara H, Niki Y, Kimura T, Oda H, Asai S, Funahashi K, Kojima M, Ishiguro N. Validation of Index of Activity Speed (Timed Up and Go test) for Outcome Measure of Patients with Long-Standing Rheumatoid Arthritis: Multicenter Prospective Cohort Study for Evaluation of Joint Surgery on Physical Function [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/validation-of-index-of-activity-speed-timed-up-and-go-test-for-outcome-measure-of-patients-with-long-standing-rheumatoid-arthritis-multicenter-prospective-cohort-study-for-evaluation-of-joint-surge/. Accessed .

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