Examining Rehabilitation Dose in Adults With Rheumatoid Arthritis: Association With Baseline Factors and Change in Clinical Outcomes

Abstract

Objective. To evaluate the association of baseline factors with rehabilitation dose and the association of rehabilitation dose with meaningful change in physical function, pain, and fatigue over 6 months among adults with rheumatoid arthritis (RA).Methods. Using data from the National Databank for Rheumatic Diseases registry, we extracted baseline characteristics and self-reported physical function (Health Assessment Questionnaire), pain (visual analog scale [VAS]), fatigue (VAS), rehabilitation dose (low: 1-2 visits, medium: 3-8 visits, high: >8 visits), and follow-up outcomes 6 months later. Changes in clinical outcomes were categorized as improved, no change, or worsened. We calculated odds ratios (ORs) and 95% confidence intervals (95% CIs) using proportional odds logistic regression models to examine the association of the baseline factors with rehabilitation dose and the association of rehabilitation dose with changes in clinical outcomes, adjusting for potential confounders.Results. The sample included 1,381 adults with a new episode of rehabilitation (dose: low 27%, medium 42%, high 31%). Worse baseline physical function (adjusted OR 1.29 [95% CI 1.04-1.60]), but not pain (adjusted OR 1.04 [95% CI 0.99-1.10]) or fatigue (adjusted OR 0.98 [95% CI 0.93-1.03]), were associated with a higher rehabilitation dose. A high rehabilitation dose was associated with a favorable change in physical function ), pain ), and fatigue (OR 1.45 [95% CI 1.06-1.99]) compared to a low dose; only the association with physical function change persisted in adjusted models (adjusted OR 1.41 [95% CI 1.03-1.92]).Conclusion. Using real-world data, this study supports a higher rehabilitation dose to improve physical function in adults with RA.

Unequal Treatment: Physical Therapy Utilization in Rheumatoid Arthritis

“…2,3 In this issue of The Journal of Rheumatology, Lane et al present their findings of a cross-sectional study of Medicare data showing disparities in PT utilization by SES and race and ethnicity among persons with RA. 4 Improvement in function with exercise and PT has been reported in RA, and a greater number of PT visits is also associated with greater functional improvement 5 ; however, as the authors point out, uptake of PT among persons with RA is low. 4 Non-Hispanic Black individuals with self-reported arthritis of any type had lower odds of a rehabilitation visit compared with White individuals, 6 but no large study of PT utilization among persons with RA has been reported.…”