Toshihisa Kojima1, Hajime Ishikawa2, Sakae Tanaka3, Nobuhiko Haga4, Keiichiro Nishida5, Masao Yukioka6, Jun Hashimoto7, Hisaaki Miyahara8, Yasuo Niki9, Tomoatsu Kimura10, Hiromi Oda11, Shuji Asai1, Koji Funahashi1, Masayo Kojima12, Naoki Ishiguro1. 1. a Department of Orthopedic Surgery , Nagoya University Hospital , Nagoya , Japan. 2. b Department of Orthopedic Surgery , Niigata Rheumatic Center , Niigata , Japan. 3. c Department of Orthopaedic Surgery, Faculty of Medicine , The University of Tokyo , Tokyo , Japan. 4. d Department of Rehabilitation Medicine , The University of Tokyo Hospital , Tokyo , Japan. 5. e Department of Human Morphology , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan. 6. f Department of Orthopedic Surgery , Yukioka Hospital , Osaka , Japan. 7. g Department of Rheumatology , National Hospital Organization Osaka Minami Medical Centre , Kawachinagano , Japan. 8. h Orthopedic Surgery , National Hospital Organization Kyushu Medical Centre , Fukuoka , Japan. 9. i Department of Orthopedic Surgery , Keio University School of Medicine , Tokyo , Japan. 10. j Department of Orthopedic Surgery, Faculty of Medicine , University of Toyama , Toyama , Japan. 11. k Department of Orthopedic Surgery , Saitama Medical University , Moroyama , Japan. 12. l Department of Medical Education , Nagoya City University Graduate School of Medical Sciences , Nagoya , Japan.
Abstract
OBJECTIVE: To explore the characteristics of functional impairment in patients with established rheumatoid arthritis (RA) based on the range of motion (ROM) of joints in a prospective observational study of RA patients undergoing joint surgery. METHODS: We collected data on demographics, Health Assessment Questionnaire Disability Index (HAQ-DI), and the ROM of large joints including the shoulder, elbow, wrist, hip, knee, and ankle. Associations between the ROM of each joint and disability in the eight HAQ-DI categories were determined using receiver operating characteristic (ROC) and logistic regression analyses. ROM cut-off values of each joint for the absence of disability in each HAQ-DI category were determined using ROC curves. RESULTS: A total of 460 patients were enrolled and analyzed in this study. Based on ROC analysis, the ROM of each joint was significantly associated with disability in each category. After adjusting for disease activity, age, and sex, shoulder abduction had the highest independent impact on disability in activity [cut-off: 139 degrees (OR: 5.26)], elbow flexion-extension in dressing [121 degrees (OR: 2.22)], wrist flexion-extension in reach [86 degrees (OR: 2.71)], hip flexion-extension in walking [126 degrees (OR: 3.42)], and knee flexion-extension in walking [134 degrees (OR: 2.97)]. CONCLUSIONS: Limited ROM of multiple joints was significantly associated with functional impairment in patients with long-standing RA. Motion in daily activity involves multiple joints, and at least two joints were independently involved in disability.
OBJECTIVE: To explore the characteristics of functional impairment in patients with established rheumatoid arthritis (RA) based on the range of motion (ROM) of joints in a prospective observational study of RApatients undergoing joint surgery. METHODS: We collected data on demographics, Health Assessment Questionnaire Disability Index (HAQ-DI), and the ROM of large joints including the shoulder, elbow, wrist, hip, knee, and ankle. Associations between the ROM of each joint and disability in the eight HAQ-DI categories were determined using receiver operating characteristic (ROC) and logistic regression analyses. ROM cut-off values of each joint for the absence of disability in each HAQ-DI category were determined using ROC curves. RESULTS: A total of 460 patients were enrolled and analyzed in this study. Based on ROC analysis, the ROM of each joint was significantly associated with disability in each category. After adjusting for disease activity, age, and sex, shoulder abduction had the highest independent impact on disability in activity [cut-off: 139 degrees (OR: 5.26)], elbow flexion-extension in dressing [121 degrees (OR: 2.22)], wrist flexion-extension in reach [86 degrees (OR: 2.71)], hip flexion-extension in walking [126 degrees (OR: 3.42)], and knee flexion-extension in walking [134 degrees (OR: 2.97)]. CONCLUSIONS: Limited ROM of multiple joints was significantly associated with functional impairment in patients with long-standing RA. Motion in daily activity involves multiple joints, and at least two joints were independently involved in disability.