BERNER Carolin

Work Ability, Health-Related Quality of Life and Medication Adherence in an Outpatient Population with Rheumatoid Arthritis

In daily clinical practice improving medical outcomes (e.g. disease activity or pain) is the main therapeutic target for most clinicians. Psychosocial (soft) outcomes, such as health-related quality of life (HRQoL) or work ability, have recently gained more attention in research and daily patient care, as they are crucially important for the holistic patient treatment especially in chronic disabling diseases like rheumatoid arthritis (RA). 

This PhD project consists of two parts, both based on a population of RA outpatients at the 2nd medical division, SMZ Süd (Kaiser Franz Josef Spital). First (A), data analysis of an exploratory study on psycho-social factors including HRQoL, illness perception, coping with illness and medication adherence. Second (B), conduct of an exploratory study on work ability and selected physiological needs (sexual functioning and sleep) and associated socio-demographic, clinical and physical fitness parameter.

Project Aims, Part A:
1) Describe HRQoL, illness perception, coping strategies and medication adherence in the RA outpatient population and examine their relation to socio-demographic and clinical parameters.
2) Determine the contribution of coping strategies together with socio-demographic factors and clinical factors to medication adherence in RA.
3) Determine the contribution of illness beliefs together with socio-demographic factors to physical and mental HRQoL in patients with RA.

Project Aims, Part B:
1) Describe work ability in patients with seropositive RA in the working age and the association of work ability with disease activity.
2) Determine the association of muscle strength, lower extremity function, functional ability and frailty with work ability in RA.
3) Determine the association of disease activity with selected physiological needs (sleep quality, sexual functioning) in RA.

The database for project part A is the result of a cross- sectional study conducted in 2015. A questionnaire package comprising socio-demographic and clinical data as well as (amongst others) the SF-36 Questionnaire on HROoL, the Brief Illness Perception Questionnaire, Medication Adherence Report Scale Questionnaire (MARS) and the Freiburg Questionnaire for Coping with Illness was administered to, and completed by, each participant. A total of 120 participants were included in the study.

For project part B a cross- sectional study was set up and conducted on 100 participants in the working age (between 18 and 65 years).  A clinical disease activity index as a measure for rheumatoid disease activity was assessed and blood sampling for the measurements of inflammation marker (serum level of CRP, IL-6, TNF –alpha) was done during the patient’s routine visits at the outpatient clinic. Workability, frailty and functional disability were assessed with (self-reported) questionnaires as well as with physical tests (Workability Index/Score, Health Assessment Questionnaire Disability Index, SHARE Frailty Instrument, Short Physical Performance Battery).  Muscle strength was determined with dynamometer measurements of isometric hand grip strength and quadriceps femoris muscle contraction strength. The physiologic needs sleep (MOS-sleep scale) and sexual functioning were additionally assessed with self-reported questionnaires.

The doctoral thesis will be written in form of a “cumulative” thesis comprising two peer reviewed publication resulting from project part A, one methods paper (publication of study protocol) and one publication of the results of project part B.

Methods and Skills:

clinical studies; elisa; measurement of muscle strength

Publications:

Ernstbrunner M, Kabon B, Zotti O, Zeitlinger M, Berner C, Hinterholzer G, Säemann M, Frommlet F, Fleischmann E, Hecking M. Intravenous fluid challenge decreases intracellular volume: a bioimpedance spectroscopy-based crossover study in healthy volunteers. Sci Rep 7: 9644, 2017

Berner C, Erlacher L, Quittan M, Fenzl KH, Dorner TE. Workability and muscle strength in patients with seropositive rheumatoid arthritis: survey study protocol. JMIR Res Protoc 6: e36, 2017

Berner C, Aumüller E, Gnauck A, Nestelberger M, Just A, Haslberger A. Epigenetic control of estrogen receptor expression and tumor suppressor genes is modulated by bioactive food compounds. Ann Nutr Metab 57: 183-189, 2010