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Abstract
Background While foot problems in patients with systemic sclerosis (SSc) have been described previously and the association with disability noted, the impact of such problems on the quality of life (QoL) in people living with SSc has yet to be quantified.
Objectives To identify the factors, including those arising from foot pathology, that impact on QoL in SSc.
Methods Structural equation modelling (SEM) was used to explore the multifactorial pathways impacting on QoL in a cross section cohort of people with SSc. Potential candidate factors were identified through: i) a literature review with expert consultation; and ii) a cross-sectional study capturing clinical features. QoL was measured using the disease-specific SScQoL questionnaire.
Results One hundred and twenty one patients with SSc were recruited (106 female; median age 59, ranges 25 to 86 years) with a median disease duration of nine years (IQR:4,13) and a median modified Rodnan Skin Score of 2 (IQR:0, 5). The model that best explained the factors contributing to the SSc impact on QoL showed complex inter-relationships between 11 factors (Figure1) (c2=37.022, df=37, p=0.468, RMSEA=0.002, GFI=0.951, CFI=1.000). Combined, these factors explained 84% of the impact on QoL (R2 =0.84) in patients with SSc. General disease factors, including physical function (standardised total effect 0.64), breathing problems (standardised total effect 0.493), and depression (standardised total effect 0.428) had the greatest impact. Foot problems had a substantial but indirect effect on quality of life (foot function and foot pain standardised total effect 0.343 and 0.327). A summary of the effects of the factors included in the model is provided in the Table 1.
Standardised direct, indirect and total effect of the variables as they relate to QoL, including foot problems
Conclusions The impact of SSc on QoL is substantial and complex. While loss of physical function is the most influential factor on QoL, followed by breathing difficulty and depression, foot problems significantly contribute to this impact.
Disclosure of Interest None declared