In patients with axial spondyloarthritis (axSpA), driving difficulties are common and have a negative impact on work, according to study results published in Arthritis Care and Research (Hoboken).

Researchers sought to characterize the driving difficulties among patients with axSpA and examine related socioeconomic and clinical features, as well as their impact on work.

The Scotland Registry for Ankylosing Spondylitis (SIRAS) cohort study — a disease register of Scottish patients with a clinical diagnosis of axSpA — was used in this analysis. Researchers enrolled patients with a diagnosis of ankylosing spondylitis who visited secondary care rheumatology departments in Scotland between October 2010 and October 2013. Socioeconomic and lifestyle characteristics were established with a baseline questionnaire, which included clinical and patient-reported measures, as well as work participation measures (Work Productivity and Activity Impairment Questionnaire: Specific Health Problem); clinical data were obtained from patients’ medical records. In addition, patient-related difficulties with 9 driving tasks were evaluated, and the association between driving difficulty and work participation was explored.


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Clinical measures that were obtained from medical records included the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), along with relevant medical history regarding peripheral joint disease and uveitis. All BASDAI scores were categorized to represent either low (<4) or high (≥4) disease activity. The baseline questionnaire included information regarding pain experienced “for at least a day” during the past month. Participants were also asked to indicate the site(s) on a 35-segment manikin, based on which they were classified as having chronic widespread pain, widespread pain (not chronic), or regional pain.

A total of 718 participants (mean age, 52 years; 23% women) had available data, with 642 (89%) experiencing some degree of difficulty with at least 1 driving task and 72 (10%) experiencing some level of difficulty with all 9 driving tasks. For each driving task, the participants were asked to rate their ability to perform that task on a Likert scale from 0 (no difficulty) to 3 (severe difficulty). Overall, 66% of the participants were employed, students, or worked full-time (unpaid) at home.

Three domains of driving difficulty were identified, including dynamic driving scenarios, crossing traffic, and the physical act and comfort of driving. Participants who had retired early or were unemployed because of their health vs those who were employed were more likely to experience difficulties with all 3 driving difficulty domains (dynamic driving scenarios: odds ratio [OR], 1.97; 95% CI, 1.30-3.00; crossing traffic: OR, 2.65; 95% CI, 1.75-4.01; and physical act of driving: OR, 3.81; 95% CI, 2.54-5.71).

Study participants in paid employment with predominantly physical- or labor-intensive jobs vs those with sedentary jobs were more likely to experience driving difficulties, particularly with respect to the physical act of driving (OR, 1.76; 95% CI, 1.11-2.79). Overall, 64% of participants in paid employment reported that their work productivity was affected to some extent by axSpA, with 8% having missed work in the previous 7 days.

Study limitations included the fact that patients were identified for the analysis based on clinical diagnosis, without the use of formal classification criteria; the inability to account for a full range of factors, including joint movement and strength, related to impaired driving; and the cross-sectional design of the study due to which causation could not be inferred.

Researchers concluded that improved understanding and awareness of driving disability among patients with axSpA will help to direct resources, thus enabling this population to remain economically active and independent. They added that future studies should use a standardized approach to evaluate driving difficulties that focuses on the full range of issues and outcomes.

Disclosure: The Scotland Registry for Ankylosing Spondylitis (SIRAS) was supported by AbbVie and Pfizer. Please see the original reference for a full list of authors’ disclosures.

Reference

Morton L, Macfarlane GJ, Jones G, Walker-Bone K, Hollick R. Driving difficulties in patients with axial spondyloarthritis: results from the Scotland Registry for Ankylosing Spondylitis. Arthritis Care Res (Hoboken). Published online March 18, 2021. doi:10.1002/acr.24595