Low rehabilitation use among Black patients with RA tied to disability, not disease activity
The use of rehabilitation services is low among Black patients with rheumatoid arthritis, with use linked to disability but not disease activity, according to data published in Arthritis Care & Research.
“The advances in drug regimens and biologics have greatly improved disease activity among adults with RA, yet functional limitation and disability remain common,” Louise M. Thoma, PT, DPT, PhD, of the University of North Carolina at Chapel Hill, told Healio Rheumatology. “Rehabilitation, including physical therapy and occupational therapy services, specifically address functional limitation with a goal of preventing or reducing disability, yet it is unclear how and when rehabilitation is used in RA management. Further, we know little about how these services are used among African Americans with RA.”
To analyze the use of rehabilitation services in Black patients with RA, as well as the association with said services and disability or disease activity, Thoma and colleagues studied cross-sectional baseline data from the Consortium for the Longitudinal Evaluation of African Americans with RA (CLEAR) I and CLEAR II registries.
According to the researchers, CLEAR I was a longitudinal cohort of Black patients with early RA — defined as a disease duration of less than 2 years — recruited from 2002 to 2005, while CLEAR II was a cross-sectional group of Black patients with RA and no restriction on duration, from 2006 to 2011. All patients were recruited from five institutions in Alabama, Georgia, South Carolina, North Carolina and Missouri.
For their study, Thoma and colleagues analyzed data from 1,067 participants. Disease activity was assessed using the DAS28 with C-Reactive Protein, while disability was measured based on the Health Assessment Questionnaire. Rehabilitation use was determined by patients’ self-reported recollection of either physical or occupational therapy visits in the 6 months prior to registry enrollment, or ever.
In their analysis, the researchers used separate binary logistic regression models to estimate odds ratios and confidence intervals for the links between disease activity or disability and rehabilitation use, adjusting for potential confounders. They then repeated the analyses with the sample stratified by disease duration — either early or established RA.
According to the researchers, 14% of the included patients reported using rehabilitation services during the 6 months prior to enrollment, while 41% reported ever using rehabilitation. The rate of rehabilitation use was similar between those with early and established RA — 12% and 16%, respectively. However, 50% patients with established RA reported any previous rehabilitation use, compared with 28% of those with early disease.
Worse disability was associated with rehabilitation use in the prior 6 months in those with established RA, but not in those with early disease. Meanwhile, disease activity was not associated with either outcome.
“We learned that rehabilitation utilization is not common among African Americans with RA, which is concerning because adults with RA often report functional limitations and premature disability which may be addressed with rehabilitation,” Thoma said. “More research is needed to understand how to optimize the integration of rehabilitation into routine rheumatology care.”