Outcomes and treatment responses, including work productivity, among people with axial spondyloarthritis living in urban and rural areas: A mixed-methods study within a national register
Outcomes and treatment responses, including work productivity, among people with axial spondyloarthritis living in urban and rural areas: A mixed-methods study within a national register
Objective 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 were used to (1) characterise participants with axSpA living in rural and urban areas and (b) assess any differences in outcome after commencement of biologic therapy (phase 1). Semistructured interviews (phase 2) further explored the results from phase 1. Results Patients with axSpA 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 the 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 were important. Support from employers was variable and healthcare professionals were often perceived as unsupportive. Conclusions Patients with axSpA 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 European League Against Rheumatism axSpA recommendations should include support to work as a target to optimise quality of life in patients with axSpA.
epidemiology, outcomes research, qualitative research, spondyloarthritis
1055-1062
Hollick, Rosemary J.
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Stelfox, Kevin
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Dean, Linda E.
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Shim, Joanna
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Walker-Bone, Karen
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Macfarlane, Gary J.
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1 August 2020
Hollick, Rosemary J.
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Stelfox, Kevin
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Dean, Linda E.
bd89ba28-3cfc-41b0-ac80-d0cf3a997ab5
Shim, Joanna
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Walker-Bone, Karen
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Macfarlane, Gary J.
e17bbdb7-9d82-42ac-8a0a-09bf10885e3c
Hollick, Rosemary J., Stelfox, Kevin, Dean, Linda E., Shim, Joanna, Walker-Bone, Karen and Macfarlane, Gary J.
(2020)
Outcomes and treatment responses, including work productivity, among people with axial spondyloarthritis living in urban and rural areas: A mixed-methods study within a national register.
Annals of the Rheumatic Diseases, 79 (8), .
(doi:10.1136/annrheumdis-2020-216988).
Abstract
Objective 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 were used to (1) characterise participants with axSpA living in rural and urban areas and (b) assess any differences in outcome after commencement of biologic therapy (phase 1). Semistructured interviews (phase 2) further explored the results from phase 1. Results Patients with axSpA 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 the 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 were important. Support from employers was variable and healthcare professionals were often perceived as unsupportive. Conclusions Patients with axSpA 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 European League Against Rheumatism axSpA recommendations should include support to work as a target to optimise quality of life in patients with axSpA.
Text
RHollick et al Revised Manuscript (R2) Accepted
- Accepted Manuscript
More information
Accepted/In Press date: 12 May 2020
e-pub ahead of print date: 10 June 2020
Published date: 1 August 2020
Additional Information:
Funding Information:
Funding The BsRBR-as is funded by the British society for Rheumatology, which has received funding, in part, from pfizer, abbVie and UcB. These companies receive advance copies of the results but have no input in determining the topics for analysis or work involved. This work was conducted within the Versus arthritis/medical Research council centre for musculoskeletal Work and Health (grant no: 20665).
Publisher Copyright:
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
Keywords:
epidemiology, outcomes research, qualitative research, spondyloarthritis
Identifiers
Local EPrints ID: 440958
URI: http://eprints.soton.ac.uk/id/eprint/440958
ISSN: 0003-4967
PURE UUID: 7c4d5f3a-4afe-4337-b5fe-9c807ac3be1a
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Date deposited: 26 May 2020 16:30
Last modified: 17 Mar 2024 02:50
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Contributors
Author:
Rosemary J. Hollick
Author:
Kevin Stelfox
Author:
Linda E. Dean
Author:
Joanna Shim
Author:
Gary J. Macfarlane
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