Validity and Reliability of the Thai Version of the 19-Item Compliance-Questionnaire-Rheumatology.

Purpose: To evaluate the psychometric properties and feasibility of the Thai version of Compliance-Questionnaire-Rheumatology (CQR)-19. Patients and Methods: A cross-sectional study was conducted in the Rheumatology clinic of Siriraj hospital from October 2020 to March 2022. Literate patients diagnosed with rheumatoid arthritis and aged ≥ 18 years old were included. Participants completed the Thai CQR-19 at baseline and during a follow-up visit. A pill count at the follow-up visit indicating that ≤ 80% of prescribed pills were taken was defined as poor compliance. Feasibility was assessed by the time to completion and the number of missing questions. Results: 156 participants were enrolled and 88% were in good compliance. The sensitivity of the CQR-19 to detect good compliance was 78.2% and the specificity was 27.8%. The Thai CQR-19 showed moderate agreement (Gwet's AC1= 0.61, p < 0.01) with 72.2% agreement against pill counts. The Thai CQR-19 had good internal consistency (Cronbach's alpha = 0.83) with moderate test-retest reliability (intraclass coefficients = 0.64, 95% CI 0.54-0.73; p < 0.05). There was a weak correlation between the Thai CQR-19 and disease activity (rs = 0.20, p < 0.05), and no correlation with functional disability (rs = 0.09, p = 0.25). The median (IQR) completion time was 4.42 (3.25-6.16) minutes and 114 (73%) completed all 19 questions. Conclusion: The Thai version of CQR-19 is a valid and reliable tool to assess medication compliance in Thai patients with RA. To ensure completeness and accuracy, this questionnaire may be administered by interview.

Efficacy and safety of a simple home-based resistance exercise program for older adults with low muscle mass: a prospective longitudinal clinical trial.

Low muscle mass is a common condition among older adults that adversely affects strength, physical performance and quality of life. This study aimed to investigate the efficacy and safety of a simple home-based resistance exercise program for older adults with low muscle mass, which was defined as appendicular skeletal mass (ASM) measured by bioimpedance analysis lower than 5.7 kg/m2 in females, and lower than 7.0 kg/m2 in males. This home-based resistance exercise program targets 10 muscles with a frequency of 3-5 days/week for 24 weeks. ASM, grip strength, gait speed and functional reach were measured at baseline, 3 and 6 months. The same four outcomes were then remeasured at 9 months to assess long-term effects. A total of 112 participants (average age: 70 years) were recruited. The mean difference between baseline and 6 months was statistically significant for all outcomes, including ASM [0.12 kg/m2: 95% confidence interval (CI), 0.05-0.18; P = 0.001], gait speed (0.19 meter/s: 95% CI, 0.14-0.25; P < 0.001), grip strength (2.06 kg: 95% CI, 1.32-2.80; P < 0.001), and functional reach distance (4.18 cm: 95% CI, 3.18-5.18; P < 0.001). Change over time for all main outcomes from baseline to 9 months also showed statistically significant improvement. The most commonly reported adverse events were muscle pain, joint pain and fatigue. The majority of participants (90-93%) had good exercise compliance, even at the end of the study. In conclusion, this 24-week simple home-based resistance exercise program significantly improved all main outcomes with low adverse events, and most participants continued the program after the end of the intervention.

Rate and causes of noncompliance with disease-modifying antirheumatic drug regimens in patients with rheumatoid arthritis.

INTRODUCTION/OBJECTIVES: To determine the prevalence and factors associated with medication noncompliance by Thai patients with rheumatoid arthritis (RA). METHODS: This prospective cohort study enrolled 443 adult RA patients (≥ 18 years) who were followed up at the outpatient rheumatology clinics of Siriraj Hospital and Phramongkutklao Hospital between May 2018 and December 2019. Medication noncompliance was assessed using the Compliance Questionnaire for Rheumatology-19 (CQR-19). A score of 0 indicated complete noncompliance, whereas a score of 100 indicated a perfect compliance. An unsatisfactory compliance was arbitrarily defined as a taking compliance of ≤ 80%. RESULTS: The prevalence of medication noncompliance was 22.1%. The most common cause was forgetting to take medications due to a busy work schedule. In a univariate analysis, the factors that were significantly related to medication noncompliance were age, income, number of comorbidities, functional status as measured by the Health Assessment Questionnaire (HAQ), number of prescribed pills per day, and number of types of prescribed medications per day. In a subsequent backward stepwise multiple logistic regression analysis, only 2 factors were found to be negatively associated with medication noncompliance: age (risk ratio, 0.98; 95% CI, 0.96-0.99; p, 0.048) and HAQ (risk ratio, 0.62; 95% CI, 0.39-0.98; p, 0.041). CONCLUSIONS: Medication noncompliance is common in patients with RA. As this may lead to unfavorable outcomes, patient education related to drug compliance should be addressed and emphasized in daily practice. Key Points • Medication noncompliance is common in patients with RA. • Forgetting to take pills was the most frequent explanation offered for noncompliance. • All patients should be strongly encouraged to comply with the recommended drug regimens.

Prevalence of and factors associated with depression and anxiety in patients with rheumatoid arthritis: A multicenter prospective cross-sectional study.

AIM: To investigate the prevalence of and factors associated with depression and anxiety in patients with rheumatoid arthritis (RA). METHODS: This prospective cross-sectional study included patients who were consecutively enrolled in the Siriraj Rheumatoid Arthritis Registry or the Thai Army Rheumatoid Arthritis Cohort during the September 2016 to March 2018 study period. Demographic data and clinical variables, including disease activity, functional status, health-related quality of life, and cognitive function, were collected. Depression and anxiety were assessed using the Thai version of the Hospital Anxiety and Depression Scale (Thai HADS). RESULTS: Four hundred and sixty-four patients were included. Mean age was 59 years, median disease duration was 9.9 years, and 85% of patients were female. Based on the Thai HADS cutoff value of 8 or higher, 12.5% and 14.5% of patients had some degree of depression and anxiety, respectively. Multivariate analysis revealed global health score (risk ratio [RR]: 0.98, P = .001) to be the only factor independently negatively associated with depression. Regarding anxiety, functional disability (RR: 2.46, P = .004) and married status (RR: 2.43, P = .009) were significantly associated with increased risk, whereas disease duration of 10 years or more (RR: 0.45, P = .007) and global health score (RR: 0.97, P < .001) were significantly associated with decreased risk of developing anxiety. CONCLUSION: Depression and anxiety are common in patients with RA. Patients' perceptions of their current health are significantly related to mood disorders. Therefore, mental health status, especially mood disturbances, should be addressed in routine practice to improve quality of life in RA.

Factors associated with and cutoff points for Patient Acceptable Symptom State (PASS) in rheumatoid arthritis.

INTRODUCTION/OBJECTIVES: To identify factors associated with and cutoff points for patients' acceptance of symptom state in Thai patients with rheumatoid arthritis (RA). METHOD: Patients aged ≥ 18 years diagnosed with RA who were followed-up at the outpatient rheumatology clinics of Siriraj Hospital and Phramongkutklao Hospital during May 2017 to May 2019 responded to the Patient Acceptable Symptom State (PASS) questionnaire. The PASS questionnaire comprises three questions, including current PASS, future PASS (3 months), and lifelong PASS. Univariate (p < 0.2) and multivariate (p < 0.05) analyses were performed to identify factors significantly associated with PASS. Cutoff points of indices related to disease activity, functional status, and health-related quality of life (HRQoL) in patients with PASS were identified using the 75th percentile and receiver operating characteristic curve analysis based on optimal sensitivity and specificity. RESULTS: From the 443 enrolled patients, 85%, 80%, and 84% considered themselves to be in current, future, and lifelong PASS, respectively. Step-wise backward multivariate analysis revealed disease duration, disease activity, functional status, cardiovascular comorbidities, and HRQoL to be independently associated with PASS. PASS cutoff points were identified, as follows: Disease Activity Score 28, 3.40-3.52; Health Assessment Questionnaire, 0.69-1; Patient Global Assessment of Disease Activity, 2.5-3; Physician Global Assessment of Disease Activity, 1-1.5; and EuroQoL-5 Dimensions, 0.83-0.86. CONCLUSIONS: PASS was high in Thai patients with RA. Patients accepted their disease state at moderate disease activity and mild functional impairment. More shared decision-making and patient education should be incorporated into daily practice to improve patient outcomes.Key Points•Patients with RA accepted their disease state at moderate disease activity and mild functional impairment, while a "treat-to-target" strategy aiming at remission or low disease activity is recommended as a standard goal.•More shared decision-making and patient education should be incorporated into daily practice to improve outcomes.