Objective To assess the association between self-reported and performance-based physical functioning and to evaluate which performance tests are most frequently impaired in patients with axSpA. Methods Consecutive axSpA patients underwent standardized assessments including patient and disease characteristics, patient-reported outcomes for disease activity, functioning, depression, mobility and physical activity and performance tests. Patients were defined as being impaired if they were not able to perform ≥ 1 of the performance tests. Validated cut-offs were used to define impaired physical performance. Impairment of performance tests as well as discrimination between subgroups were analyzed. Results A total of 200 patients (r-axSpA 65.5%, nr-axSpA 34.5%) was included: 69% males, mean age 44.3 (SD 12.5) years and mean symptom duration 17.9 (12.6) years. The two most frequently impaired performance tests were the repeated chair stand test (n=75, 37.5%) and putting on socks (n=44, 22%). An impairment in ≥ 1 performance test was seen in 91 patients (45.5%). Patients with impairments were older (48.9 vs. 40.8 years), had a higher body mass index (28.7 vs. 26.1 kg/m2), a more active disease (ASDAS 3.0 vs. 2.1), higher BASFI (5.7 vs. 2.8), BASMI (4.3 vs. 2.8) and ASAS HI scores (9.6 vs. 5.0), and higher depression screen values (PHQ 12.1 vs. 6.3), all p<0.01. Conclusion Many patients with axSpA had impairments in physical performance tests. Importantly, this was frequently seen in tasks requiring coordination and muscle power of the lower extremity. Performance tests provide qualitatively different information than BASFI and BASMI assessments in patients with axSpA.

Background:Functioning of patients (pts.) with axial spondyloarthritis (axSpA) is influenced by a variety of factors. In contrast to clinical factors, the influence of contextual factors on functioning has not been well studied. According to the According to the International Classification of Functioning, Disability and Health (ICF), functioning is a complex interaction between health status and contextual factors such as social support, relationships and attitudes.Objectives:The aim of this study is to understand limitations in participation and to investigate barriers and facilitators of contextual factors in pts. with axSpA.Methods:Consecutive axSpA pts. underwent a standardized assessment with collection of patient and disease characteristics, patient-reported outcomes (ASDAS, BASFI, BASMI, PHQ-9, ICF Measure of Participation and ACTivities questionnaire (IMPACT-S (0-100%)), ASAS Health Index (ASAS HI and environment factor item set (EFIS) (1). The EFIS contains 9 dichotomous questions addressing ICF categories of products and technologies (e1), support and relationship (e3), attitudes (e4) and health services (e5). Validated cut-offs of ASAS HI were used to categorize global functioning.Results:A total of 200 axSpA pts. were included: 69% males, 44.3±12.5 years, symptom duration 17.9±12.6 years, ASDAS 2.5±1.1, BASFI 4.0±2.7, BASMI 3.5±1.8, ASAS HI 7.0±4.1. Pts. reported limitations in the IMPACT-S activity and participation domain (82.3% (15.2) and 83.5% (16.8), respectively. The majority of pts. reported as barrier that treatment of axSpA requires time (e4, 58.5%). A minority of pts. but quite a few reported as barrier the need for support by family members (e3, 43.5%), the need to modify home and work environment (e1, 39.5%) and that they cannot rely on family members for help (e3, 22%). Some pts. (< 20%) reported that they have problems to be understood by health care professionals when experiencing a flare (e5, 18.5%), that pts. at home are not adequately taken care of (e4, 18.5%), disliking friends’ behavior toward them (e4, 13.5%), and that friends are too demanding (e4, 13%). The majority of pts. (e4, 75.9%) identified attitudes of friends as the only and major facilitator. All pts. reporting at least one barrier had significantly worse global functioning (ASAS HI, IMPACT-S), and depression (PHQ-9) compared to patients who reported no barriers in the respective ICF categories (p< 0.01). Similarly, pts. with poor functioning are more likely to report barriers in contextual factors compared to pts. with good functioning (Table 1). Pts. having to ask for more support from their families expressed the feeling that they cannot rely on that.Conclusion:Barriers more than facilitators of contextual factors are present in pts. with axSpA. This study shows that barriers in contextual factors are more common in pts. with impairments in self-reported and performed functioning as in those without impairments. This underlines the importance of contextual factors in the management of axSpA pts.References:[1]Kiltz et al. Ann Rheum Dis 2013;72(s3):572Table 1.Presence of contextual factors, stratified for global functioning categoriesICF categoryEFIS ItemGlobal Functioning (ASAS HI 0-17)Good ≤ 5(n= 69)Moderate <5 to <12(n= 106Poor ≥ 12(n= 25)e3EFIS 1: As a result of my rheumatic disease, the children take more responsibility for household tasks.11 (15.9)55 (51.9)21 (84)e3EFIS 2: I don’t like the way my friends acts around me.0 (0)15 (14,2)12 (48,0)e3EFIS 3: I can’t count on my relatives to help me with my problems11 (15,9)24 (22,6)9 (36)e1EFIS 4: I modify my home and work environments.16 (23,2)47 (44,3)9 (36)e5EFIS 5: I have difficulties getting worsening of my disease acknowledged by a health care professional3 (4,3)21 (19,8)16 (64)e5EFIS 6: Treatment of my rheumatic disease is taking up time22 (31,9)73 (68,9)22 (88)e4,EFIS 7: My friends expect too much of1 (1,4)18 (17,0)7 (28)e4EFIS 8: No one pays much attention to me at home10 (14,5)20 (18,9)7 (28)e4EFIS 9: My friends understand me56 (17,4)83 (78,3)12 (48)values given as number (%)Disclosure of Interests:None declared.

BackgroundPhysical function in axial spondyloarthritis (axSpA) usually assessed by the BASFI questionnaire is an established core domain of that disease. There is evidence that self-reported physical function is not equivalent with the actual performance of patients. Physical performance can be assessed as a single task such as grip strength or single stance, or as a generic compound measure such as the short physical performance battery test (SPPB). SPPB comprises a chair rising test, a balance test and gait speed.ObjectivesTo investigate which performance tests are most frequently impaired in patients with axSpA.MethodsConsecutive axSpA patients presenting to our tertiary hospital underwent a standardized assessment including patient and disease characteristics, patient-reported outcomes (ASDAS, BASFI, BASMI, ASAS Health Index (ASAS HI), PHQ-9) and performance tests (SPPB, grip strength and single stance). Structural damage was assessed by mSASSS. Validated cut-offs were used for SPPB, chair rise test, grip strength and gait speed. Impairment of performance tests as well as discrimination between subgroups was analysed.ResultsA total of 200 patients (r-axSpA 65.5%, nr-axSpA 34.5%) were included: 69% males, 44.3±12.5 years of age, mean symptom duration 17.9 years, mean ASDAS 2.5±1.1, BASFI 4.0±2.7, BASMI 3.5±1.8, ASAS HI 7.0±4.1, PHQ-9 8.8±6.2, mSASSS (n=157) 10.2± 18.8. A total of 132 patients were treated with bDMARDs (66.5%). The two most impaired performance tests were repeated chair rising and single stance (Figure 1). An impairment in ≥ 1 performance test was seen in 87 patients (43.5%). Patients with impairments, in comparison to those without, were older (48.9 vs. 40.8 years), more often obese (28.7 vs. 26.1%), more often depressed (PHQ 12.1 vs. 6.3%), had lower BASFI values (5.7 vs. 2.8), a decreased ASAS HI (9.6 vs. 5.0), and higher disease activity (ASDAS 3.0 vs. 2.1), all p<0.01. The documented impairment in performance was irrespective of medication and structural damage on the group and the individual patient level. The correlation between BASFI and the performance test was moderate for SPPB (0.6), gait speed (0.5), chair rise (0.5) and single stance (0.4), while the correlation between BASFI and grip strength (0.2) and mSASSS (0.2) was rather limited.ConclusionIn this consecutively recruited relatively young axSpA patients with limitations in physical function and health as assessed by established measures, we found a high prevalence of patients who didn’t perform well in tests originally developed for older people. Importantly, a lot of impairment was seen when patients were asked to perform complex tasks requiring coordination and muscle strength. Impairment was present even though most patients received bDMARDs. Since such impairment is potentially influenced by physiotherapeutic interventions, we propose to perform studies to address these deficits. Our data strongly suggest to not only collect questionnaires but also do performance tests to better assess the ‘real’ physical capacity of patient...

Background:In patients with axial spondyloarthritis (axSpA) physical functioning is often impaired. The current gold standard to assess physical functioning is self-reported questionnaires (i.e. BASFI), which can be influenced by patients’ subjective feelings. Therefore, a performance-based test-battery was designed to measure physical functioning more objectively: the ankylosing spondylitis (AS) Performance Index (ASPI)) [1]. Based on domains taken from BASFI tasks were designed to imitate activities of daily living (ADL). Although the ASPI has been evaluated a thorough analysis of the deficits of physical functioning and factors which influence the performance of patients with axSpA has not been performed to date.Objectives:The aim of the present study assesses the relation between self-reported assessments of physical functioning and actual performance of patients, and to detect influencing factors.Methods:Consecutive axSpA patients underwent standardized assessments concentrating on the following variables: patient and disease characteristics, patient-reported outcomes (ASDAS, BASFI, BASMI, ASAS Health Index (ASAS HI), PHQ-9, IPAQ), mSASSS and ASPI (ASPI 1: Bending, 2. Putting on socks, 3. Getting up from the floor) [1]. The performance was measured in seconds as time to complete a task based on published instructions. Impairment in physical performance was defined as inability of patients to perform ≥ 1 ASPI test. Spearman Rho correlation was used to compare self-reported functioning and performed physical functioning. Logistic regression analysis was used to identify factors associated with impaired physical performance.Results:A total of 200 patients (AS 66%, nr-axSpA 34%) was included: 69% males, 44.3±12.5 years old, mean symptom duration 17.9 ±12.6 years, BMI 27.2±5.5, mean ASDAS 2.5±1.1, BASFI 4.0±2.7, BASMI 3.5±1.8), ASAS HI 7.0±4.1, PHQ-9 8.8±6.2, and mSASSS (n=157) 10.2±18.8). 133 patients were treated with bDMARDs (66.5%). In total 44 patients (22%) were not able to perform one or more ASPI tests. The mean time for bending was 18.6±9.5 sec (n=179/90%), for putting on socks 12.8±6.4 sec (n=156/78%), and for getting up from floor 6.5±5.0 sec (n=187/94%). A significant correlation was found for all three ASPI-tests with BASFI (0.5-0,7), ASAS HI (0.4-0.6) and spinal mobility as assessed by BASMI (0.4-0.7). Self-reported physical activity (IPAQ) correlated weakly with ASPI (all 0.2) and structural damage correlated only with the task putting on socks (r=0.3), whereas the other tests did not correlate. Logistic regression showed influence of obesity, spinal mobility and global functioning on actual performance but not of disease activity and self-reported physical function, (Figure 1).Conclusion:This study confirms a good correlation of the ASPI with standard questionnaires but it showed a substantial floor effect strongly suggesting that additional information on actual performance is needed. Thus, to obtain a complete picture of function and impairments of patients with axSpA the actual performance needs...