Häkkinen Arja, Arkela-Kautiainen Marja, Sokka Tuulikki, Hannonen Pekka, Kautiainen Hannu
Department of Physical Medicine and Rehabilitation, Jyväskylä Central Hospital, 40620 Jyväskylä, Finland.
J Rheumatol. 2009 Feb;36(2):246-53. doi: 10.3899/jrheum.080027.
To assess disability and functioning of elderly patients with rheumatoid arthritis (RA) and population controls by linking the items included in the self-report Multidimensional Health Assessment Questionnaire (MDHAQ) with components of the WHO International Classification of Functioning, Disability and Health (ICF) instrument.
In total, 1439 patients with RA (mean age 66 yrs, men 29%) and 957 population controls (65 yrs, men 27%) completed a mailed questionnaire. Functioning was recorded by the Finnish version of MDHAQ. Data included comorbidity, subjective health, education level, employment, exercise habits, self-report joint pain/tenderness, and, for patients, the disease duration.
Patients had lower levels of functioning compared to controls in all ICF domains, with the exception that male patients functioned comparably to male controls in the "general tasks and demands" domain. In patients, disease activity, education, exercise frequency, and comorbidities were expectedly associated with lower functioning in the body structure and function component, while male sex and subjectively perceived health were associated with more favorable functioning. In the activity and participation components, disease activity, exercise frequency, and comorbidities were associated with impaired functioning, while better health on self-report was associated with better functioning.
There is an extra burden of disability in elderly patients with RA compared to the reference population. With a large patient and control population sample, our study shows that use of the self-report MDHAQ identifies all 3 main components of the ICF framework, thus covering a wide spectrum of functioning. Elderly patients with RA, in comparison to population controls, encounter more difficulties in daily activities and their social life.
通过将自我报告的多维健康评估问卷（MDHAQ）中的项目与世界卫生组织国际功能、残疾和健康分类（ICF）工具的组成部分相联系，评估老年类风湿关节炎（RA）患者和人群对照的残疾情况及功能状况。
总共1439例RA患者（平均年龄66岁，男性占29%）和957例人群对照（65岁，男性占27%）完成了邮寄问卷调查。功能状况通过MDHAQ的芬兰语版本记录。数据包括合并症、主观健康状况、教育水平、就业情况、运动习惯、自我报告的关节疼痛/压痛，对于患者还包括疾病持续时间。
在所有ICF领域中，患者的功能水平均低于对照，但在“一般任务和要求”领域男性患者的功能与男性对照相当。在患者中，疾病活动度、教育程度、运动频率和合并症与身体结构和功能组成部分的功能降低预期相关，而男性性别和主观感知的健康状况与更良好的功能相关。在活动和参与组成部分中，疾病活动度、运动频率和合并症与功能受损相关，而自我报告的更好健康状况与更好的功能相关。
与参考人群相比，老年RA患者存在额外的残疾负担。通过大量的患者和对照人群样本，我们的研究表明，使用自我报告的MDHAQ可识别ICF框架的所有3个主要组成部分，从而涵盖广泛的功能状况。与人群对照相比，老年RA患者在日常活动及其社会生活中遇到更多困难。
