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.

Hollick, Rosemary J.; Stelfox, Kevin; Dean, Linda E.; Shim, Joanna; Walker-Bone, Karen; Macfarlane, Gary J.

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.

Citation

HOLLICK, R.J., STELFOX, K., DEAN, L.E., SHIM, J., WALKER-BONE, K. and MACFARLANE, G.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 [online], 79(8), pages 1055-1062. Available from: https://doi.org/10.1136/annrheumdis-2020-216988

• Journal Article Type: Article
• Acceptance Date: May 12, 2020
• Online Publication Date: Jun 10, 2020
• Publication Date: Aug 31, 2020
• Deposit Date: Sep 14, 2021
• Publicly Available Date: Sep 14, 2021
• Journal: Annals of the rheumatic diseases
• Print ISSN: 0003-4967
• Electronic ISSN: 1468-2060
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 79
• Issue: 8
• Pages: 1055-1062
• DOI: https://doi.org/10.1136/annrheumdis-2020-216988
• Keywords: Biologics; Work outcomes; Rheumatology; Spondyloarthritis; Health impact
• Public URL: https://rgu-repository.worktribe.com/output/1447209
• Additional Information: The file accompanying this output contains the supplementary material of a lay summary at the end of the main text.