ANKİLOZAN SPONDİLİTLİ HASTALARDA HASTALIĞA İLİŞKİN BİLGİ DÜZEYİ İLE HASTALIK AKTİVİTESİ, FONKSİYON, YAŞAM KALİTESİ, KORKU, DUYGUSAL DURUM VE ÖZ-YETERLİLİK ARASINDAKİ İLİŞKİ: KESİTSEL BİR ÇALIŞMA

Öz

Giriş: Hastalığa ilişkin bilgi, kronik inflamatuar romatizmal hastalıklarda öz-yönetimi destekleyebilir. Amaç: Bu çalışma, ankilozan spondilitli (AS) hastalarda hastalığa ilişkin bilgi ile klinik ve psikososyal sonuçlar arasındaki ilişkileri incelemiştir. Yöntem: Bu tek merkezli kesitsel çalışmaya 139 AS hastası dahil edildi. Hastalığa ilişkin bilgi AS Bilgi Anketi ile değerlendirildi. Hastalık aktivitesi, fonksiyon, hastalığa özgü yaşam kalitesi, hastalıkla ilişkili korku, anksiyete, depresyon ve öz-yeterlilik ile ilişkiler; eğitim düzeyi, yaş, cinsiyet, hastalık süresi, düzenli ilaç kullanımı, düzenli egzersiz ve hastalık aktivitesi kontrol edilerek Pearson ve düzeltilmiş kısmi korelasyonlarla incelendi. Bonferroni düzeltmesi, her iki analizde önceden belirlenen yedi ilişkiye ayrı ayrı uygulandı. Bulgular: Yaş ortalaması 43,1 ± 12,1 yıl olup katılımcıların %54.0'ı erkekti; hastalığa ilişkin bilgi puanı ortalaması 16,2 ± 4,5 idi. Düzeltme sonrasında hastalığa ilişkin bilgi; hastalık aktivitesi ile zayıf negatif (kısmi r = -0,34), fonksiyonel kısıtlılık (kısmi r = 0,40), daha kötü hastalığa özgü yaşam kalitesi (kısmi r = 0,42) ve öz-yeterlilik (kısmi r = 0,53) ile orta düzeyde pozitif, depresyon ile orta düzeyde negatif (kısmi r = -0,50) korelasyon gösterdi; tümü p < 0.007 düzeyinde anlamlı kaldı. Hastalıkla ilişkili korku ve anksiyete ile ilişkiler düzeltme sonrasında anlamlı değildi. Sonuç: Daha yüksek hastalığa ilişkin bilgi; daha düşük hastalık aktivitesi, daha az depresif belirti ve daha yüksek öz-yeterlilik ile, ancak aynı zamanda daha fazla fonksiyonel kısıtlılık ve daha kötü hastalığa özgü yaşam kalitesi ile ilişkiliydi.

Anahtar Kelimeler

• Ankilozan spondilit
• Hastalığa ilişkin bilgi
• Yaşam kalitesi
• Öz-yeterlilik
• Depresyon

Etik Beyan

Çalışma, Helsinki Deklarasyonu ilkelerine uygun olarak yürütülmüş ve Gazi Üniversitesi Araştırma Etik Kurulu tarafından onaylanmıştır (tarih: 21.02.2023, sayı: 2023-392). Çalışmaya katılım öncesinde tüm katılımcılardan yazılı bilgilendirilmiş onam formu alınmıştır.

THE RELATIONSHIP BETWEEN DISEASE-RELATED KNOWLEDGE AND DISEASE ACTIVITY, FUNCTION, QUALITY OF LIFE, FEAR, EMOTIONAL STATUS, AND SELF-EFFICACY IN PATIENTS WITH ANKYLOSING SPONDYLITIS: A CROSS-SECTIONAL STUDY

Öz

Background: Disease-related knowledge may support self-management in chronic inflammatory rheumatic diseases. Aim: This study examined associations between disease-related knowledge and clinical and psychosocial outcomes in patients with ankylosing spondylitis (AS). Method: This single-center cross-sectional study included 139 patients with AS. Disease-related knowledge was assessed using the AS Knowledge Questionnaire. Associations were examined using Pearson correlations and adjusted partial correlations. Partial correlations controlled for educational level, age, sex, disease duration, regular medication use, regular exercise, and disease activity, except when disease activity was the outcome. Bonferroni correction was applied separately to seven prespecified associations in both analyses. Results: Mean age was 43.1 ± 12.1 years; 54.0% were male, and the mean disease-related knowledge score was 16.2 ± 4.5. After adjustment, disease-related knowledge was weakly and negatively correlated with disease activity (partial r = -0.34), moderately and positively correlated with functional impairment (partial r = 0.40), poorer disease-specific quality of life (partial r = 0.42), and self-efficacy (partial r = 0.53), and moderately and negatively correlated with depression (partial r = -0.50); all remained significant at p < 0.007. Associations with disease-related fear and anxiety were not significant after correction. Conclusion: Greater disease-related knowledge was associated with lower disease activity, fewer depressive symptoms, and higher self-efficacy, but also with greater functional impairment and poorer disease-specific quality of life.

Anahtar Kelimeler

• Ankylosing spondylitis
• disease-related knowledge
• quality of life
• self-efficacy
• depression

Etik Beyan

The study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Research Ethics Committee of Gazi University (date: 21.02.2023, number: 2023-392). Written informed consent was obtained from all participants prior to enrolment.

Kaynakça

1. 1. Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet. 2017;390(10089):73-84. doi: 10.1016/S0140-6736(16)31591-4
2. 2. Braun J, Sieper J. Ankylosing spondylitis. Lancet. 2007;369(9570):1379-90. doi: 10.1016/S0140-6736(07)60635-7
3. 3. Ward MM. Quality of life in patients with ankylosing spondylitis. Rheum Dis Clin North Am. 1998;24(4):815-27. doi: 10.1016/S0889-857X(05)70043-0
4. 4. Bostan EE, Borman P, Bodur H, Barça N. Functional disability and quality of life in patients with ankylosing spondylitis. Rheumatol Int. 2003;23(3):121-6. doi: 10.1007/s00296-002-0261-4
5. 5. Hakkou J, Rostom S, Mengat M, Aissaoui N, Bahiri R, Hajjaj-Hassouni N. Sleep disturbance in Moroccan patients with ankylosing spondylitis: prevalence and relationships with disease-specific variables, psychological status and quality of life. Rheumatol Int. 2013;33(2):285-90. doi: 10.1007/s00296-012-2376-6
6. 6. Martindale J, Smith J, Sutton CJ, Grennan D, Goodacre L, Goodacre JA. Disease and psychological status in ankylosing spondylitis. Rheumatology (Oxford). 2006;45(10):1288-93. doi: 10.1093/rheumatology/kel115
7. 7. Gossec L, Chauvin P, Saraux A, Hudry C, Cukierman G, de Chalus T, et al. Development and psychometric validation of a patient-reported outcome measure to assess fears in rheumatoid arthritis and axial spondyloarthritis: the Fear Assessment in Inflammatory Rheumatic diseases (FAIR) questionnaire. Ann Rheum Dis. 2018;77(2):258-63. doi: 10.1136/annrheumdis-2017-212000
8. 8. Keleşoğlu Dinçer AB, Sezer S. Association of Fear Assessment in Inflammatory Rheumatic diseases (FAIR) questionnaire with ankylosing spondylitis quality of life and disease activity in patients with ankylosing spondylitis. J Surg Med. 2022;6(7):679-83. doi: 10.28982/josam.1119839

9. 9. Zangi HA, Ndosi M, Adams J, Andersen L, Bode C, Boström C, et al. EULAR recommendations for patient education for people with inflammatory arthritis. Ann Rheum Dis. 2015;74(6):954-62. doi: 10.1136/annrheumdis-2014-206807
10. 10. Ramos-Remus C, Salcedo-Rocha AL, Prieto-Parra RE, Galvan-Villegas F. How important is patient education? Baillieres Best Pract Res Clin Rheumatol. 2000;14(4):689-703. doi: 10.1053/berh.2000.0107
11. 11. Lubrano E, Helliwell P, Moreno P, Griffiths B, Emery P, Veale D. The assessment of knowledge in ankylosing spondylitis patients by a self-administered questionnaire. Br J Rheumatol. 1998;37(4):437-41. doi: 10.1093/rheumatology/37.4.437
12. 12. da Rocha Lopes SM, Duarte JA, Mesquita CT. Cross-cultural adaptation and validation of the Portuguese version of "The assessment of knowledge in ankylosing spondylitis patients by a self-administered questionnaire". Rheumatol Int. 2016;36(4):515-9. doi: 10.1007/s00296-016-3434-2
13. 13. Claudepierre P, Flipo RM, Sibilia J, Berthelot JM, Goupille P, Cortinovis S, et al. Patient knowledge of their disease: a French multicenter study in ankylosing spondylitis. Joint Bone Spine. 2004;71(6):550-6. doi: 10.1016/j.jbspin.2004.09.001
14. 14. Jassim N, Majeed S. The assessment of knowledge in sample of Iraqi patients with ankylosing spondylitis. Rheumatology (Bulgaria). 2020;28(1):31-40. doi: 10.35465/28.1.2020.pp31-40
15. 15. Alkan G, Akkoç Y, Zengin B, Keser G, Kabasakal Y, Akkoç N. The adaptation of the Turkish version of the Assessment of Knowledge in Ankylosing Spondylitis Patients by a Self-Administered Questionnaire. Turk J Phys Med Rehabil. 2020;66(3):299-306. doi: 10.5606/tftrd.2020.4013
16. 16. van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthritis Rheum. 1984;27(4):361-8. doi: 10.1002/art.1780270401
17. 17. Akkoç Y, Karatepe AG, Akar S, Kirazlı Y, Akkoç N. A Turkish version of the Bath Ankylosing Spondylitis Disease Activity Index: reliability and validity. Rheumatol Int. 2005;25(4):280-4. doi: 10.1007/s00296-003-0432-y
18. 18. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994;21(12):2286-91.
19. 19. Karatepe AG, Akkoç Y, Akar S, Kirazlı Y, Akkoç N. The Turkish versions of the Bath Ankylosing Spondylitis and Dougados Functional Indices: reliability and validity. Rheumatol Int. 2005;25(8):612-8. doi: 10.1007/s00296-004-0481-x
20. 20. Calin A, Garrett S, Whitelock H, Kennedy LG, O'Hea J, Mallorie P, et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol. 1994;21(12):2281-5.
21. 21. Duruöz MT, Doward L, Turan Y, Cerrahoglu L, Yurtkuran M, Calis M, et al. Translation and validation of the Turkish version of the Ankylosing Spondylitis Quality of Life (ASQOL) questionnaire. Rheumatol Int. 2013;33(11):2717-22. doi: 10.1007/s00296-013-2796-y
22. 22. Doward LC, Spoorenberg A, Cook SA, Whalley D, Helliwell PS, Kay LJ, et al. Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis. Ann Rheum Dis. 2003;62(1):20-6. doi: 10.1136/ard.62.1.20
23. 23. Küçükakkaş O, Rezvani A, Yurdakul OV, Tolu S, Kılıçoğlu MS, Aydın T. Fear Assessment in Inflammatory Rheumatic diseases (FAIR) questionnaire: a cross-cultural adaptation and validation to the Turkish language. Clin Rheumatol. 2018;37(12):3247-54. doi: 10.1007/s10067-018-4239-3
24. 24. Aydemir Ö, Güvenir T, Küey L, Kültür S. Hastane Anksiyete ve Depresyon Ölçeği Türkçe formunun geçerlilik ve güvenilirlik çalışması. Turk Psikiyatri Derg. 1997;8(4):280-7.
25. 25. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361-70. doi: 10.1111/j.1600-0447.1983.tb09716.x
26. 26. Sandhu J, Packham JC, Healey EL, Jordan KP, Garratt AM, Haywood KL. Evaluation of a modified Arthritis Self-Efficacy Scale for an ankylosing spondylitis UK population. Clin Exp Rheumatol. 2011;29(2):223-30.
27. 27. Lorig K, Chastain RL, Ung E, Shoor S, Holman HR. Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheum. 1989;32(1):37-44. doi: 10.1002/anr.1780320107