Examining rehabilitation dose in adults with rheumatoid arthritis: Association with baseline factors and change in clinical outcomes

Objective: Evaluate the association of baseline factors with rehabilitation dose and the association of rehabilitation dose with meaningful change in physical function, pain, and fatigue over 6 months among adults with rheumatoid arthritis (RA). Methods: Using data from the FORWARD registry, we extracted baseline characteristics and self-reported physical function (Health Activity Questionnaire [HAQ]), pain (Visual Analog Scale [VAS]), fatigue (VAS), rehabilitation dose (low: 1-2 visits, medium: 3-8 visits, high: >8 visits) and follow-up outcomes 6 months later. Change in clinical outcomes were categorized as improved, no change, or worsened. We calculated odds ratios (OR) and 95% confidence intervals (CI) using proportional odds logistic regression models to examine the association of the baseline factors with rehabilitation dose and the association of rehabilitation dose with change in clinical outcomes, adjusting for potential confounders (adjusted OR – aOR). Results: The sample included 1,381 adults with a new episode of rehabilitation (Dose: low 27%, medium 42%, high 31%). Worse baseline physical function (aOR 1.29 [CI 1.04, 1.60]), but not pain (aOR 1.04 [CI 0.99, 1.10]) or fatigue (aOR 0.98 [CI 0.93, 1.03]), were associated with higher rehabilitation dose. High rehabilitation dose was associated with favorable change in physical function (OR 1.51 [CI 1.14, 1.98]), pain (OR 1.44 [CI 1.06, 1.96]), and fatigue (OR 1.45 [CI 1.06, 1.99]) compared to low dose; only the association with physical function change persisted in adjusted models (aOR 1.41 [1.03, 1.92]). Conclusion: Using real-world data, this study supports higher rehabilitation dose to improve physical function in adults with RA.