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Illness Perception Influences Back Pain Severity, QoL in Suspected Spondyloarthritis
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Among patients with suspected axial spondyloarthritis, the perception of their illness — rather than the use of a coping strategy — significantly impacted the relationship between back pain and health-related quality of life and loss of work productivity, according to findings published in Arthritis Care and Research.
“Back pain is a patient-reported and subjective symptom, which is prevalent in [axial spondyloarthritis (axSpA)],” Miranda van Lunteren, MSc, of the Leiden University Medical Center, the Netherlands, and colleagues wrote. “Therefore, it would be interesting to additionally investigate the prior mentioned associations with an objective sign typical for axSpA.”
To test whether illness perceptions and coping strategies influence the relationship between back pain and health outcomes among patients with suspected axSpA, the researchers drew baseline data from the Spondyloarthritis Caught Early (SPACE) cohort from between January 2009 and February 2017. According to the researchers, the SPACE cohort is a prospective inception group of patients with chronic back pain recruited from Dutch, Norwegian and Italian outpatient clinics.
van Lunteren and colleagues included 424 patients in their study, including 145 who were diagnosed and classified with axSpA, 81 who were only diagnosed with axSpA and 198 who were diagnosed with chronic back pain. Researchers performed regression models at baseline of patient-reported back pain as a determinant, and health-related quality of life (QoL), including physical and mental component summary of the 36-item ShortForm Health Survey, and work productivity loss as outcomes. The researchers also added the Leventhal's Common-Sense Model of self-regulation, illness perceptions and coping to the models.
According to the researchers, high-intensity back pain among patients with suspected axSpA was associated with worsening of physical health-related QoL and increasing loss of work productivity. Associations between back pain and physical component summary, back pain and mental component summary, and back pain and work productivity loss were all diminished when illness perceptions were added to the model. However, explained variance improved. The results were unchanged when researchers added coping strategies to the models. These results were comparable among all study subgroups, the researchers wrote.
“Rheumatologists and health care professionals should be aware that illness perceptions play an important role in determining medical outcomes in these patients. Illness perceptions should, therefore, be actively explored and taken into consideration in the management plan,” van Lunteren and colleagues wrote. “To maximally improve health outcomes in patients with axSpA, psychological support could be given in addition to targeting back pain by drug treatment and physiotherapy.” – by Jason Laday
Disclosure: van Lunteren reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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