Impact of functional impairment in ankylosing spondylitis: impairment, activity limitation, and participation restrictions

Abstract

Objective: To describe difficulties in everyday activities related to impaired function in patients with ankylosing spondylitis (AS), and to examine possible sex differences in the impact of the disease. In addition, to examine the relationships between measures of personal characteristics, impairment, and activity/participation levels within the framework of the International Classification of Functioning (ICF).

Methods: A total of 152 patients with AS took part in a clinical examination including anthropometric measures, blood samples, and self-reported disease related measures. The Canadian Occupational Performance Measure (COPM) interviews were performed to describe and measure activity limitations and participation restrictions perceived by the patient during the last year. The study variables were categorized and analyzed according to the levels of the ICF model using bivariate and multivariate statistical approaches.

Results: The mean age of patients was 47 (SD 13) years, 58% were men, and the mean disease duration was 15 (SD 12) years. The problems most frequently reported in COPM interviews were "interrupted sleeping," "turn head when driving," "carry groceries," and ""having energy for social activities." Women reported higher level of disease activity and more physical limitations than men. Disease activity and reduced mobility (impairment variables) seemed to result in more activity/participation restrictions in female than in male patients. The impairment variables explained only one-third of the activity and participation restrictions perceived by patients.

Conclusion: Activity limitations and participation restrictions reported by patients were only partly explained by the impairment variables. Further research should identify social, structural, and attitudinal barriers influencing activity and participation in patients with AS.