Leiden University Medical Center, Leiden, The Netherlands.
Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands, and Zuyderland Medical Center, Heerlen, The Netherlands.
Arthritis Care Res (Hoboken). 2018 Dec;70(12):1829-1839. doi: 10.1002/acr.23566.
To investigate whether illness perceptions and coping influence the relationship between back pain and health outcomes in patients suspected of having axial spondyloarthritis (SpA).
In the SPondyloArthritis Caught Early cohort, regression models were computed at baseline, with back pain intensity (range 0-10) as the determinant and health-related quality of life, the physical component summary score (PCS) and mental component summary (MCS) of the Short Form 36 (SF-36) health survey, or work productivity loss as outcomes. Subsequently, using Leventhal's Common-Sense Model of Self-Regulation, illness perceptions and, thereafter, coping were added to the models. Analyses were repeated for patients diagnosed and classified as having axial SpA according to the Assessment of SpondyloArthritis international Society axial SpA criteria (ASAS axial SpA), patients only diagnosed with axial SpA (axial SpA-diagnosed only), and those with chronic back pain.
A total of 424 patients (145 with ASAS axial SpA, 81 with only a diagnosis of axial SpA, and 198 with chronic back pain); 64% of the total group were female, the mean ± SD age was 30.9 ± 8.1 years, and the mean ± SD symptom duration was 13.3 ± 7.1 months) were studied. In all patients, the strength of the associations between back pain and the PCS, back pain and the MCS score, and back pain and loss of work productivity were decreased by adding illness perceptions to the model, but explained variance improved. Adding coping to these models did not change the results. Comparable results were observed in all subgroups.
Illness perception, but not coping, is important in the relationship between back pain and HRQoL and work productivity loss in patients suspected of having axial SpA, irrespective of subgroup. This finding suggests that targeting illness perceptions could improve health outcomes in patients suspected of having axial SpA.
研究疾病感知和应对方式是否会影响疑似患有中轴型脊柱关节炎（SpA）患者的背痛与健康结局之间的关系。
在 SPondyloArthritis Caught Early 队列中，以背痛强度（范围 0-10）为自变量，以健康相关生活质量、36 项简短健康调查的身体成分综合评分（PCS）和精神成分综合评分（MCS）或工作生产力损失为因变量，在基线时计算回归模型。随后，使用 Leventhal 的自我调节的普通感知模型，将疾病感知添加到模型中，之后添加应对方式。分析重复用于根据评估 SpA 国际协会的中轴型 SpA 标准（ASAS 中轴型 SpA）诊断和分类为中轴型 SpA 的患者、仅诊断为中轴型 SpA 的患者（仅诊断为中轴型 SpA 的患者）和慢性背痛患者。
共纳入 424 例患者（145 例符合 ASAS 中轴型 SpA 标准，81 例仅诊断为中轴型 SpA，198 例为慢性背痛）；总人群中 64%为女性，平均年龄（标准差）为 30.9（8.1）岁，平均症状持续时间（标准差）为 13.3（7.1）个月）。在所有患者中，将疾病感知添加到模型后，背痛与 PCS、背痛与 MCS 评分以及背痛与工作生产力损失之间的关联强度减弱，但解释方差增加。将应对方式添加到这些模型中并没有改变结果。在所有亚组中均观察到类似的结果。
在疑似患有中轴型 SpA 的患者中，疾病感知（而非应对方式）在背痛与 HRQoL 和工作生产力损失之间的关系中很重要，无论亚组如何。这一发现表明，针对疾病感知可能会改善疑似患有中轴型 SpA 的患者的健康结局。
