Department of Rheumatology, Leiden University Medical Center, The Netherlands.
Department of Medical Psychology, Leiden University Medical Center, The Netherlands.
Rheumatology (Oxford). 2018 Dec 1;57(12):2190-2199. doi: 10.1093/rheumatology/key231.
To investigate the association between illness perceptions and disability both cross-sectionally and over 2 years in patients with hand OA.
Illness perceptions and self-reported disability were assessed at baseline and after 2 years in 384 patients with primary hand OA (mean age 61 years, 84% women, n = 312 with follow-up) with the Illness Perception Questionnaire - Revised (IPQ-R), Functional Index for Hand OA, Australian/Canadian Hand OA Index and HAQ. Risk ratios for high disability (highest quartile) at both time points were estimated for tertiles of IPQ-R dimensions, using Poisson regression. The mean IPQ dimension change difference between patients with and without disability progression (change Functional Index for Hand OA ⩾ 1, Australian/Canadian Hand OA Index > 1.4, HAQ > 0.22) was estimated with linear regression. Analyses were adjusted for age, Doyle index and baseline score.
At baseline, stronger negative illness perceptions were associated with high disability. Baseline illness perceptions were also associated with high disability after 2 years, although adjustment made apparent that these associations were confounded by baseline disability status. Most illness perceptions changed over 2 years; understanding increased, OA was regarded as more chronic and fewer emotions and consequences and less personal and treatment control were experienced. The 2 year change in disability was different between patients with and without progression for the illness perceptions of more perceived consequences, symptoms, treatment control and emotions.
Illness perceptions seemed to be implicated in disability and its progression. Our results suggest that interventions could focus on improving baseline disability, potentially using illness perceptions to accomplish this goal.
在手部 OA 患者中，从横断面和 2 年随访两个角度研究疾病感知与残疾的相关性。
384 例原发性手部 OA 患者（平均年龄 61 岁，84%为女性，312 例完成随访）分别在基线和 2 年时使用修订后的疾病感知问卷（Illness Perception Questionnaire-Revised，IPQ-R）、手部 OA 功能指数、澳大利亚/加拿大手部 OA 指数和 HAQ 进行疾病感知和自我报告残疾评估。使用泊松回归，对每个时间点的 IPQ-R 维度三分位数，估计高残疾（最高四分位数）的风险比。采用线性回归，估计有和无残疾进展患者之间的平均 IPQ 维度变化差异（手部 OA 功能指数变化 ⩾1，澳大利亚/加拿大手部 OA 指数>1.4，HAQ>0.22）。分析调整了年龄、Doyle 指数和基线评分。
基线时，较强的负面疾病感知与高残疾相关。基线疾病感知也与 2 年后的高残疾相关，尽管调整后明显表明这些相关性是由基线残疾状况造成的混杂因素所致。大多数疾病感知在 2 年内发生变化；对 OA 的理解增加，认为 OA 更具慢性，体验到的情绪和后果、个人和治疗控制更少。有和无进展患者的残疾 2 年变化在感知到更多后果、症状、治疗控制和情绪的疾病感知方面有所不同。
疾病感知似乎与残疾及其进展有关。我们的研究结果表明，干预措施可以侧重于改善基线残疾，可能使用疾病感知来实现这一目标。
