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Social participation restriction among U.S. adults with arthritis: A population-based study using the International Classification of Functioning, Disability, and Health (ICF)
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  • Alternative Title:
    Arthritis Care Res (Hoboken)
  • Description:

    To examine arthritis impact among U.S. adults with self-reported, doctor-diagnosed arthritis using the International Classification of Functioning, Disability, and Health (ICF) framework (domains=Impairments, Activity Limitations, Environmental, and Personal factors; outcome=social participation restriction (SPR)) 1) overall and among those with SPR, and 2) to identify correlates of SPR.


    Cross-sectional 2009 National Health Interview Survey data were analyzed to examine the distribution of ICF domain components. Unadjusted and multivariable-adjusted prevalence ratios (PR) and 95% confidence intervals (CI) were estimated to identify correlates of SPR. Analyses in SAS v9.2 survey procedures accounted for the complex sample design.


    SPR prevalence was 11% (5.7 million) of adults with arthritis. After initial multivariable adjustment by ICF domain, Serious Psychological Distress (Impairments) (PR=2.5, 95% CI=2.0-3.2, ≥5 medical office visits (Environmental) (PR=3.4, 95% CI=2.5-4.4) , and physical inactivity (Personal) (PR=4.8, 95% CI=3.6=6.4) were most strongly associated with SPR. A combined measure, Key Limitations (walking, standing, or carrying) (PR=31.2 (22.3-43.5) represented the Activity Limitations domain. After final multivariable adjustment incorporating all ICF domains simultaneously, the strongest associations with SPR were Key Limitations (PR= 24.3 (16.8-35.1), ≥9 hours sleep (PR=1.6, 95% CI=1.3-2.0), and income-to-poverty ratio <2.00 and severe joint pain (PR=1.4, 95% CI=1.2-1.6 for both).


    SPR affects 1-in-9 adults with arthritis. This work is the first to use the ICF framework in a population-based sample to identify specific functional activities, pain, sleep, and other areas for priority intervention to reduce negative arthritis impacts, including SPR. Increased use of existing clinical and public health interventions is warranted.

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