Background There is a lack of knowledge about the nature and frequency of the main limitations in activities and participation experienced by a subgroup of people with rheumatoid arthritis (RA) and severe limitations in physical functioning. More insight is essential to optimize treatment for this subgroup and can be obtained by linking the treatment goals perceived by the patient to the International Classification of Functioning, Disability and Health (ICF) as a frame of reference. Goal setting is widely recognized for tailoring and optimizing treatment, and for this purpose the Patient Specific Complaint (PSC) instrument is recommended in physiotherapy practices in the Netherlands [1]

Objectives To describe the nature and frequency of limitations in activities and participation of people with RA and severe limitations. Limitations will be derived from the PSC [1] and linked to the ICF and the comprehensive and brief ICF Core Sets for RA.

Methods Baseline data from a randomized controlled trial on the effect of long-term exercise therapy in people with RA and severe limitations in functioning were used. For each participant, the three most limited activities were identified and prioritized using the PSC. Two researchers independently identified meaningful concepts within each PSC activity and linked them to the most specific ICF category within the “Activities and Participation” component, following standardized ICF linking rules [2]. In case of disagreement, this was discussed with a third researcher until consensus was reached. The frequencies of ICF categories were calculated overall and for PCS activities ranked 1, 2 and 3. Finally, the uniquely identified ICF categories were compared to the content of the comprehensive and brief RA ICF core sets for the component “Activities and Participation”.

Results From 206 RA patients (90.8% female, 58.7 (12.9) years of age, 1.5 (0.5) HAQ-DI score), 618 PSC activities were recorded, including 911 meaningful concepts. These concepts were subsequently linked to 909 ICF categories, with 72 unique ICF codes. Overall, the most prevalent ICF categories were: 1) d4501 walking long distances (n=121; 59%); 2) d4502 walking on different surfaces (n=79; 38%); 3), d451 stairclimbing (n=62; 30%) 4) d4103 changing body position from sitting (n=60; 29%) and 5) d4401 grasping (n=51, 25%). The categories for the ranked PSC activities differed slightly, and manipulating, d4502, often proved limited too (see Table 1). The uniquely identified ICF codes covered 21 of 32 items (66%) of the comprehensive and 4 of 6 items (67%) of the brief ICF core set for RA patients. Performing daily routine, d230 and rewarding work, d850, were limitations included in both core sets that were not identified in this subpopulation. However, stair climbing limitations were prevalent in this population, but are not part of the RA core sets.

Conclusion The most prevalent limited activities involved walking (long distances, on different surfaces and climbing stairs), changing body position from sitting and hand use (grasping and manipulating). To optimize treatment for this specific subgroup, clinicians should be aware that not all RA core set items are prevalent in practice and that some frequent problems are not included in the core sets.

References [1]Stevens et al. Musculoskelet Sci Pract 2017;27:23-31.

[2]Cieza et al. Disabil Rehabil 2019; 41(5):574-583.

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Acknowledgements This project is financially supported by Netherlands Organization for Health Research and Development (ZonMw; 852004018), Ministry of Health, Welfare and Sport (VWS), the Royal Dutch Society for Physical Therapy (KNGF) and the Dutch Arthritis Society (ReumaNederland).

Disclosure of Interests None Declared.