Background The need of team-rehabilitation for patients with chronic arthritis in the era of biologics has been questioned.
Objectives We evaluated the short and long-term patient-oriented effects of rehabilitation program in warm climate in patients with inflammatory joint diseases who had inadequate response to physiotherapy in Sweden. We further questioned if patient-reported responses were influenced by demographic, disease factors and level of physical activity.
Methods In all, 161 patients with peripheral arthritis and spondyloarthritis, mean age 53 years (range 21 to 77), 73% women, 51% with comorbid condition, 49% treated with synthetic DMARDs and 63% with biologics, who experienced activity limitations and reduced quality of life despite physiotherapy in Sweden, received structured team-rehabilitation during 4 weeks in warm climate. The change in outcomes (variables of the International Classification of Functioning, Disability and Health) pre- and post-rehabilitation and after 3 and 12 months was assessed: HAQ (in patients with peripheral arthritis), BASFI (in patients with spondyloarthritis), EQ-5D, VAS of patient reported general health (VAS-GH) and pain (VAS-pain). The International Physical Activity Questionnaire (IPAQ) was used to assess the level of physical activity.
Results At inclusion patients reported activity limitations, HAQ mean (SD) 1.13 (0.55), and reduced quality of life, EQ-5D median (IQR) 0.66 (0.52–0.73). HAQ, VAS-GH and VAS-pain improved significantly from pre-rehabilitation to all follow-up time-points, and BASFI and EQ-5D from pre-rehabilitation up to 3 months. At the 3 and 12 months the proportion of patients reporting improvement from baseline above minimal clinically important difference (MCID) was for HAQ 62% and 35%, BASFI 73% and 61%, EQ-5D 47% and 39%, VAS-GH 68% and 52%, for VAS-pain 68% and 51%, respectively. The improvement in HAQ and VAS scores was not dependent on demographic or disease-related variables, while improvement in BASFI was hampered in older patients and improvement EQ-5D was lower in patients with comorbidity. The gained effect was not affected by changes in treatments as confirmatory analyses on patients without changed medication or unexpected clinical events yielded stable results across all outcomes.
Physical activity increased significantly from pre-rehabilitation to 12 months, p<0.001. Increased IPAQ correlated with improvement in EQ-5D (r=0.20, p=0.040) and trendwise with reduction in VAS-pain and HAQ (r=0.18, p=0.059; r=0.19, p=0.086).
Conclusions Comprehensive team-rehabilitation in warm climate is still important for the patients treated up-to-date, benefits functional ability and quality of life. The benefit of the intervention was evident post-rehabilitation and in many patients sustained for up to one year. The improvements in HAQ, VAS general health and VAS pain 3-month post-rehabilitation were comparable with improvements reported in recent randomized clinical trials of biologicals in RA. The health advantages of the rehabilitation program were combined with increased health-enhancing physical activity.
Disclosure of Interest None declared