Background Total management including reconstructive joint surgery and rehabilitation should be needed for further improvements of physical function for long-standing RA patients. It is very important to set treatment goal for those management using index of activity speed [Time Up and Go (TUG)] and range of motion (ROM).
Objectives The purpose of this study is to explore the characteristics of functional impairment and relationship TUG and physical function in RA patients who were needed joint surgery using multicenter prospective cohort.
Methods We started the prospective study in September, 2012 (Study registration: UMIN000012649). We collected data on age, sex, disease duration, drug therapies, and disease activity. Functional evaluations were made using the TUG, HAQ-DI, DASH (upper limb function), and patient subjective evaluations using the EQ-5D (QOL) and BDI-II (depression). Joint range of motion was also measured as part of this evaluation. This study is supported by grant from the Japanese Ministry of Health, Labour and Welfare.
Results 347 surgical patients were registered. Mean values for age, disease duration, and sex were 65.2 years, 18 years, and 88% female, respectively. Actually, even long-standing RA patients who were needed joint surgery had remission or low disease activity in this baseline data (median values for DAS28 (3.0) and CRP (0.33 mg/dl). 23.8% of the patients were treated with biologics. We confirmed the significant correlation between TUG and disease duration, HAQ-DI, patient-reported outcome (EQ-5D, BDI-II) and range of motion (hip, knee, shoulder ankle). We also found significant relationship between TUG and the level of disability in 18 of 20 components in HAQ-DI [not in Question 5 (cut meat) and 6 (lift a full glass to your mouth)]. The correlation in representative compornent, Question8 (walking) and 11 (bathing) was shown in Fig.A, TUG was significantly associated with high ADL status (total HAQ point <6/60: upper quartile value of study population) based on ROC curve (Fig. B). Cut-off value of TUG for high ADL status was 8.98 seconds (sensitivity 67%, specificity 59%).Cut-off of TUG (9 seconds) was associated with the TUG value of patients without disability of HAQ-DI component (Fig.C).
Conclusions TUG was significantly associated with many kinds of daily activity and patient-reported outcome. The information should be important for assessment of disability in patients with long-standing RA. TUG as shown in this study could be target of surgical procedure and rehabilitation program. Relationship between range of motion of joints and physical function in patients with long-standing rheumatoid arthritis: multicenter prospective cohort study for evaluation of joint surgery on physical function
Disclosure of Interest None declared
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