ABSTRACT
Background: Worldwide the detrimental consequences of the COVID-19 pandemic on physical and psychological health have been recognised. Social distancing and isolation measures have negatively impacted physical functioning (PF) and mental health (MH), and are known to have reduced physical activity (PA) generally within the population. A significant proportion of patients with autoimmune rheumatic disease (ARD) are considered 'clinically extremely vulnerable' (CEV), at high risk from COVID19 and been advised to follow stricter social distancing precautions than the general population. Evidence in ARD patients highlights the importance of PA in maintaining physical and psychological wellbeing. Prior to the pandemic limitations in both PF and MH in patients with ARD were recognised and early in the pandemic MH was noted to be impacted by distancing measures in this population. Objectives: This is an interim report of a research study (clinicaltrials.gov NCT04542031) exploring the impact of the COVID19 pandemic on the physical and psychological wellbeing of patients with rheumatic disease, to inform guidelines and target service provision as the pandemic continues. Methods: We distributed two web-based surveys, eight months apart during the first (April-2020) and second wave (December-2020) of the pandemic. Surveys were communicated via a linked mobile-phone SMS message, to all rheumatology patients with a validated mobile number under follow-up at the Royal Wolverhampton Trust. We assessed patients using the Short Form-12 version 2 made up of mental (MCS) and physical component scores (PCS). For each survey, data were collected 4-weeks following distribution;comparative analysis was conducted using SPSS version-27. Results: Initial surveys were sent to 7911 active follow up patients;1694/7911 (21.4%) responded and consented for further follow up, of which 1636 were linked to a validated mobile number. 899/1636 (55.0%) responded to the second survey and 824/899 (91.7%) responses were linked across both surveys. These 824 patients were predominately female (69.5%), aged 61 years and 76.3% had an ARD;388/824 patients were CEV, 436 were in the comparator group. For the CEV group, scores remained significantly lower than the comparator for PCS (survey 1: 36.40 vs 39.61 [P<0.001], survey 2: 36.11 vs 38.66 [P<0.001]) and MCS (41.61 vs 43.44 P<0.001;41.19 vs 43.60 [P<0.001]);there was no deterioration in CEV scores. In the comparator group, while MCS did not differ in patients with ARD, PCS significantly decreased (1.39;95% CI: 0.69, 2.08;P<0.001);PCS in the non-inflammatory group did not significantly change (-0.23, P=0.65). Conclusion: These preliminary data suggest that while the physical and mental health of CEV patients is significantly lower in this cohort, surprisingly, neither aspects of health have been worsened by the impacts of the pandemic over an 8-month period. However, the physical functioning of patients with ARD significantly decreased in this time, which may reflect the reduction in PA faced by society, and reduced contact with secondary care services. These data suggest services need to adapt to provide additional support to patients with ARD to maintain physical functioning during the pandemic. Further work exploring the evolving pattern of the physical and psychological responses to the pandemic is ongoing.
ABSTRACT
Background/AimsThe COVID-19 pandemic is associated with significant levels ofpsychological distress, affecting both those with and without theCOVID infection. In the general population, COVID-19 has mostnotably affected those who are female, in younger age groups, blackAsian and ethnic minority groups (BAME). A significant proportion ofrheumatology patients are 'clinically extremely vulnerable', classed ashigh-risk of COVID under current national guidance. While it isrecognised that extra precautionary measures in this group, such asstringent social distancing (shielding), adversely impacts thesepatients mental health, other risk factors, for patients with rheumaticdisease whose health related quality of life (HRQoL) scores are mostimpacted, have not being explored. In our large cohort of rheumatology patients under secondary care follow up at the RoyalWolverhampton Trust we assessed HRQoL scores at the 4-weekpoint following the introduction of lockdown measures.MethodsWe distributed a web-based survey via a linked mobile-phone SMSmessage, to all rheumatology patients, with a validated mobilenumber, under follow-up at the Royal Wolverhampton Trust. Weassessed patient's HRQoL by Short Form-12 version 2 (SF12);datawere analysed using SPSS version 26.ResultsThere were 7, 911 active follow up patients with linked mobile numbers.Survey responses were received from 1, 828/7, 911 (23%) and of these1, 727 completed all aspects of the SF12. Responders were mostlywhite British 1, 711/1828 (94%) and female 1, 276 (70%);inflammatoryarthritis was the predominant diagnosis (1, 275, 70%). 858 (47%) wereat high-risk of COVID (advised to follow shielding guidance) and 72(4%) reported having suffered COVID-19 infection. Mental SF-12(MCS) component scores were significantly lower in: COVID vs nonCOVID patients (mean differences: -3.8, P < 0.001);BAME vsCaucasian patients (-1.5, P = 0.04);Females vs Males (-1.3, P = 0.001). Importantly, there were no differences in physical component scores (PCS) in these groups. Patients considered at high risk ofCOVID had lower MCS (-2.1) and PCS (-3.1) (both P < 0.001). Olderpatients had lower PCS (-2.7, P < 0.001) but not MCS.ConclusionWe found significantly worse mental health scores in female patients, BAME patients and those patients that had suffered the COVIDinfection. Clinically extremely vulnerable patients had worse mentaland physical health scores. There was no significant difference inmental health scores between patients in different ages groups, while, as might be expected, physical health scores were significantly worsein the older age groups. These data indicate a focus on adversepsychological consequences in specific patient groups may berequired for future increases in COVID infection rates. Further workon the evolving pattern of psychological responses to the pandemic inrheumatic disease is required.
ABSTRACT
OBJECTIVES: We sought to gain insight into the prevalence of COVID-19 and the impact stringent social distancing (shielding) has had on a large cohort of rheumatology (RD) follow-up patients from a single large UK centre. METHODS: We linked COVID-19-related deaths, screening and infection rates to our RD population (1.2.20-1.5.20) and audited active rheumatology follow-up patients through survey data communicated via a linked mobile phone SMS message. We assessed epidemiology, effect of stringent social distancing (shielding) and quality of life (HRQoL) by Short Form 12 (SF12). RESULTS: There were 10,387 active follow-up patients, 7911 had linked mobile numbers. 12/10,387 RD patients died from COVID-19 (0.12%); local population 4131/7,415,149 (0.12%). For patients with mobile phones, 1693/7911 (21%) responded and of these, 1605 completed the SF12. Inflammatory arthritis predominated 1174/1693 (69%); 792/1693 (47%) were shielding. Advice on shielding/distancing was followed by 1372/1693(81%). 61/1693 (4%) reported COVID-19 (24/61 shielding); medication distribution was similar in COVID and non-COVID patients. Mental SF12 (MCS) but not physical (PCS) component scores were lower in COVID (60) vs. non-COVID (1545), mean differences: MCS, - 3.3; 95% CI - 5.2 to - 1.4, P < 0.001; PCS, - 0.4; 95% CI, - 2.1 to 1.3). In 1545 COVID-negative patients, those shielding had lower MCS (- 2.1; 95% CI - 2.8 to - 1.4) and PCS (- 3.1, 95% CI - 3.7 to - 2.5), both P < 0.001. CONCLUSIONS: Our full RD cohort had no excess of COVID deaths compared to the general local population. Our survey data suggest that shielding adversely affects both mental and physical health in RD. These data broaden our understanding of shielding, indicating need for further study.