Fatores associados às limitações nas atividades e restrições na participação em indivíduos com artrite reumatoide conforme a Classificação Internacional de Funcionalidade, Incapacidade e Saúde

Abstract

Background: Rheumatoid Arthritis (RA) is a systemic disease, chronic inflammatory disease, which results in pain and swelling in the joints and periarticular structures, which can result in limitations of everyday activities. The application of the International Classification of Functioning, Disability and Health model (ICF) in RA patients is of highest importance for the systematization and understanding of the complexity of the different functional components associated to it which result in severe incapacitations for these subjects. Objectives: 1 - To evaluate the impact of different variables of the components proposed by the ICF model in activity limitation and restriction of social participation of the individuals with rheumatoid arthritis, considering personal and environmental factors. 2 - Investigate the main difficulties in the areas of performance of patients, and verify the relation of these activities with clinical and functional classification of RA and work situation. Methods: In this cross-sectional study, we have included 81 patients treated at Bias Fortes Rheumatology Health Center service at the Hospital of the Federal University of Minas Gerais. The variables included manual dexterity, intensity of fatigue and rigidity, pinch strength and palm grip of dominant hand, insufficiency in the range of motion (ROM), deformity of dominant hand, mental health, vitality, pain, time since diagnosis, functional classification function, general health condition, work status, work activities, age and gender. Multiple regression was used to construct the model for analysis of variables related to, activity limitation and restriction of social participation. In addition, we performed the characterization of the major limitations in performing the activities analyzed using the Canadian Occupational Performance Measure (COPM) through frequencies and percentages and chi-square. Results: We constructed seven regression models, being five models for limitation of activities, for which 18-24 variables were included, using a significance level of 0.05. For Model I (Activities in RA), the variables which reached statistical significance were: grip strength, ROM deficit, and dominant hand deformities, and mental health. In Model II (MMSS Activities), the significant variables were time to diagnosis, dexterity, palm grip strength of dominant hand and ROM deficit of dominant hand. In Model III (Timed Activities), dexterity and work activities were significant. In Model IV (Activities for the Quality of Life in RA), ROM deficit of the dominant hand, ROM total deficit of dominant hand, vitality, pain, and functional classification were significant. In Model V (Quality of Life Activities), functional classification and vitality were significant. For restrictions in participation, reproducibility results were satisfactory, since the ICC between, within observers and retest test ranged from good to excellent. The last two regression models were constructed for the participation component: Model I (Social Activities) 24 variables were evaluated which were then analyzed in the regression model. The final model was composed of mental health, activities for quality of life, and activities in RA. Model II (Social and Family Activities for Quality of Life) 24 variables were analyzed which were included in the regression model. The only variable that remained in the model was mental health. In the final result, it was observed that between the two instruments of participation presented, the one which showed a better explanation for the variables studied was the Social Activities (R² = 0.62), the Family and Social Activities for Quality of Life (R² = 0.201). The common predictor variable among the models was mental health. Regarding the COPM, the activities which had more complaints of difficulty related to instrumental everyday activities and mobility, which then related to the functional classification of the disease. Conclusions: The limitations in activities encountered by the subjects with RA are related to the strength measurements in manual grip and deficit in ROM of fingers. Beyond these factors, the statistical analysis showed other explanatory variables demonstrating the great complexity of incapacities in this population. In relation to restrictions of social participation, the factor mental health has shown great influence. The areas with the highest complaint of difficulty in occupational performance were functional mobility and housework. These results refer to the social context of the population studied and the planning for promoting occupational health of the individual with RA.