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Functioning and Preferences for Improvement of Health Among Patients with Juvenile Idiopathic Arthritis in Early Adulthood Using the WHO ICF Model
MARJA ARKELA-KAUTIAINEN, JARKKO HAAPASAARI, HANNU KAUTIAINEN, LEENA LEPPÄNEN, ILPO VILKKUMAA, ESKO MÄLKIÄ, and MARJATTA LEIRISALO-REPO ABSTRACT. Objective. To evaluate functioning and preferences for health among young adult patients with juvenile idiopathic arthritis (JIA) and controls. The WHO International Classification of Functioning, Disability and Health (ICF) was used as a framework. Methods. The patient files of a rheumatology hospital were screened to identify patients with juvenile arthritis born 1976 to 1980. Functioning was measured by the Finnish version of the Multidimensional Health Assessment Questionnaire (MDHAQ) within the framework of the ICF. Preferences in improvement of health were measured by the Finnish version of the Arthritis Impact Measurement Scales 2. Age and sex matched controls from the community were selected from the Finnish population registry. Results. In all, 123 patients with a mean age of 23 (range 21-26) years participated in the followup study. The mean time from diagnosis to followup was 16.2 years. Among them, 35% (n = 43) were in remission at followup. Lower levels of functioning for 3 ICF components were found in patients with active disease compared to controls. JIA patients with active disease had more pain and lower levels of mobility, self-care, and domestic and social life compared to controls. Patients with active disease differed from those in remission with pain in preferences for improvement of health. Conclusion. Patients with active disease need active treatment and rehabilitation to maintain functioning and decrease pain. The ICF offers a promising model to examine the outcomes of adult patients with JIA. Application of the MDHAQ is supported by our evaluation studies in young adults with JIA. (First Release June 1 2006; J Rheumatol 2006;33:1369–76) Key Indexing Terms:
HEALTH EVALUATION
From the Rheumatism Foundation Hospital, Heinola; Merikoski Rehabilitation and Research Centre, Helsinki; Faculty of Sports and Health Sciences, Department of Health Sciences, University of Jyväskylä, Jyväskylä; and Division of Rheumatology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. Supported by The Social Insurance Institution of Finland and the Rheumatism Foundation Hospital Research Fund. M. Arkela-Kautiainen, MSc; J. Haapasaari, MD, Chief Pediatric Rheumatologist; H. Kautiainen, Statistician; L. Leppänen, PT, Rheumatism Foundation Hospital; I. Vilkkumaa, Lic Soc Sc, Development Chief, Merikoski Rehabilitation and Research Centre; E. Mälkiä, PT, Professor, Department of Health Sciences, University of Jyväskylä; M. Leirisalo-Repo, MD, PhD Professor, Department of Medicine, Helsinki University Central Hospital. Address reprint requests to M. Arkela-Kautiainen, Likolahdenkatu 43, FIN–44150 Äänekoski, Finland. E-mail: marja.arkela-kautiainen@medcare.fi Accepted for publication February 24, 2006.
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