Subclinical disability is widespread among individuals with rheumatoid arthritis (RA) and is a strong risk factor for subsequent functional deterioration and disability, show study results. The finding is reported by US researchers, who suggest that subclinical disability is a marker of individuals in a “disability transition phase” who are most likely to benefit from interventions to maintain their functioning. Subclinical disability is defined as the need for behavioral modifications in either task performance or task frequency, but without recognition or acknowledgment of difficulty with the activity. Examples of modifications include limiting the amount or kind of activity performed, needing help from other people, or using special devices or aids. In this study, Patricia Katz (University of California, San Francisco, USA) and colleagues assessed the prevalence and significance of subclinical disability among 1417 patients with RA, using annual structured telephone interviews. At baseline, 72% of participants were considered to have subclinical disability in at least one valued life activity (VLA); the average number of VLAs performed without difficulty but needing modification was 3.25. Subclinical disability was most common in “discretionary” VLAs such as sewing, gardening, visiting friends and family, and leisure activities, and less common, but still highly prevalent, in “committed” activities such as going to appointments, preparing meals, and housework, and “obligatory” activities such as bathing, washing, and getting dressed. Of note, subclinical disability correlated strongly with the duration of RA, supporting the notion that it represents a stage along the disability continuum. Furthermore, individuals with subclinical disability at baseline were at greatest risk of developing further functional limitations and difficulties in VLAs over the 2-year follow-up period. Writing in the journal Arthritis & Rheumatism, Katz et al say that subclinical disability was common in this group of RA patients and was a significant risk factor for development or increase in disability. “For primary prevention, it is important to identify people who are at risk of developing disability,” the authors conclude. “Subclinical disability may be a powerful marker of individuals in a transition phase who are particularly amenable to intervention that would enable them to maintain functioning.”
Lynn, perhaps this should be part of the training that RDs receive. They would recognize the patients who are at risk for subclinical dis. based on patient's meeting a certain criteria set and then be referred for help. If disability could be prolonged or even nipped in the bud it would make huge financial sense to the economy and the individual. Some individuals might be able to return to work or it could possibly be done to keep people in the workplace by modifying their work or environment before they meet the criteria for disability. Once they're disabled it's too late. Lindy
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