Abstract
Objectives: To examine differences in clinical and patient reported outcomes, including work, in individuals with axial spondyloarthritis (AxSpA) living in rural and urban settings.
Methods: Using a sequential, explanatory mixed-method design, data from The British Society for Rheumatology Biologics Register for Ankylosing Spondylitis (BSRBR-AS) was used to a) characterise axSpA participants living in rural and urban areas and b) to assess any differences in outcome after commencement of biologic therapy (phase 1). Semi-structured interviews further explored results from phase 1.
Results: axSpA patients living in rural areas were older and more likely to work in a physical job. Among patients prescribed biologics, there were no differences in response to biologics, but, after adjustment for age, sex and local-area deprivation, rural-dwellers reported more presenteeism and overall work impairment. Work effects could be explained by accounting for individual differences in: disease activity; fatigue; physical function and job type. Interviews highlighted complex relationship between clinical factors, contextual factors (work environment, job demands) and work disability. The ability to work and flexibility in terms of what, when and how tasks are undertaken was important. Support from employers was variable and healthcare professionals often perceived as unsupportive.
Conclusions: axSpA patients living in rural areas report a greater impact of their disease on work productivity. New measures are needed to capture important contextual factors and comprehensively determine the impact of long-term conditions on work. Future EULAR axSpA recommendations should include support to work as a target to optimise quality of life in patients with axSpA.
Methods: Using a sequential, explanatory mixed-method design, data from The British Society for Rheumatology Biologics Register for Ankylosing Spondylitis (BSRBR-AS) was used to a) characterise axSpA participants living in rural and urban areas and b) to assess any differences in outcome after commencement of biologic therapy (phase 1). Semi-structured interviews further explored results from phase 1.
Results: axSpA patients living in rural areas were older and more likely to work in a physical job. Among patients prescribed biologics, there were no differences in response to biologics, but, after adjustment for age, sex and local-area deprivation, rural-dwellers reported more presenteeism and overall work impairment. Work effects could be explained by accounting for individual differences in: disease activity; fatigue; physical function and job type. Interviews highlighted complex relationship between clinical factors, contextual factors (work environment, job demands) and work disability. The ability to work and flexibility in terms of what, when and how tasks are undertaken was important. Support from employers was variable and healthcare professionals often perceived as unsupportive.
Conclusions: axSpA patients living in rural areas report a greater impact of their disease on work productivity. New measures are needed to capture important contextual factors and comprehensively determine the impact of long-term conditions on work. Future EULAR axSpA recommendations should include support to work as a target to optimise quality of life in patients with axSpA.
Original language | English |
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Pages (from-to) | 1055-1062 |
Number of pages | 8 |
Journal | Annals of the Rheumatic Diseases |
Volume | 79 |
Issue number | 8 |
Early online date | 10 Jun 2020 |
DOIs | |
Publication status | Published - Aug 2020 |
Bibliographical note
ACKNOWLEDGEMENTSWe are grateful to the staff of the British Society for Rheumatology Biologics Register in Axial Spondyloarthritis register who at the time of the study were Elizabeth Ferguson-Jones, Maureen Heddle, Nafeesa Nazlee and Barry Morris, and to the recruiting staff at the clinical centres, details of which are available at: https://www.abdn.ac.uk/iahs/research/epidemiology/spondyloarthritis.php#panel1011.
FUNDING
The BSRBR-AS is funded by the British Society of Rheumatology who have received funding for this, in part, from Pfizer, Abbvie and UCB. These companies receive advance copies of results but have no input in determining the topics for analysis or work involved in undertaking it. This work was conducted within the Versus Arthritis/Medical Research Council Centre for Musculoskeletal Work and Health (Grant No: 20665).
Keywords
- axial spondyloarthritis
- qualitative research
- rural
- work disability
- BSRBR-AS
- epidemiology
- spondyloarthritis
- outcomes research
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Rosemary Hollick
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Senior Clinical Lecturer
- School of Medicine, Medical Sciences & Nutrition, MRC/Versus Arthritis Centre for Musculoskeletal Health and Work
- School of Medicine, Medical Sciences & Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health (ACAMH)
Person: Clinical Academic