Aligning Clinical Care: Which Aspects of ASAS Do AxSpA Patients Find Most Concerning?

Findings in this study can help clinicians tailor axial spondyloarthritis clinical care appropriateiy to better address patients' needs.

In an effort to identify which aspects of health were most concerning to patients with axial spondyloarthritis (axSpA), researchers analyzed multinational patient-reported surveys and found that highest relative importance was assigned to pain, sleep, exhaustion, ability to stand, and motivation to perform tasks requiring physical effort.1 

Identifying these concerns can help direct alignment of clinical care to those areas that patients find most debilitating. 

Researchers utilized items included in the Assessment of SpondyloArthritis international Society Health Index (ASAS) to generate a set of 17 “choice tasks”, each including 4 various items.  Patients with axSpA (10 from 20 different countries) were then asked to identify which items from a listed choice task was most, and least, important to them. 

Estimations of the relative importance for each choice task were made using the hierarchical Bayes method, and then subgroups were analyzed using one-way analysis of variance or Mann-Whitney U-tests to identify if any baseline demographic information or SpA disease characteristics could be identified within them. 

A total of 199 patients completed the test, 58.8% men, with a mean age of 42.3±13.6 years and mean disease duration 11.1±11.2 years.  

Researchers identified the following as being ranked by patients of having the highest relative importance, listed in descending order:

  • Pain (14.2; 95% confidence interval [CI]: 13.8, 14.6)
  • Sleep (10.3; 95% CI: 9.6, 11.0)
  • Exhaustion (9.6; 95% CI: 9.0, 10.3)
  • Standing (9.25; 95% CI: 8.5, 10.0) 
  • Motivation to engage in activities requiring physical effort (8.7; 95% CI: 8.1, 9.3)

Of the presented options, sexual relationships, toileting, contact with people, driving, and washing hair were given less relative importance by responders. 

“A clear gradient was seen in the importance of the different aspects of health that impact functioning of patients with axSpA… [whereas] differences between subgroups were small or non-existent,” the authors stated.

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Kiltz U, Essers I, Hiligsmann M, et al. Which aspects of health are most important for patients with spondyloarthritis? A Best Worst Scaling based on the ASAS Health Index. Rheumatology (Oxford). Published online ahead of print June 21, 2016. pii: kew238.