Ab0198 thresholds of presenteeism measurement instruments for unacceptable work participation and future adverse work outcomes in ra

Background Presenteeism is associated with lower work satisfaction and increased risk of future sick leave in rheumatic diseases. Presenteeism is generally measured on a continuous scale; however, despite a lower precision, identifying persons with a meaningful level of presenteeism can improve interpretation in clinical studies and might be useful in routine practice. Recently, thresholds of meaning for presenteeism instruments were established for axial spondyloarthritis (axSpA). Objectives: 1) To identify thresholds for presenteeism instruments that reflect unacceptable work status in patients with RA and whether those thresholds could predict future adverse work outcomes (AWO); 2) To assess in patients with RA the performance of presenteeism thresholds previously established in axSpA for the same instruments. Methods We used data from the 1-year multinational prospective study on Patient-Reported Outcomes in Employment Study in Rheumatoid Arthritis (RA-PROSE). Thresholds to determine when patients consider themselves in ‘unacceptable work status’ were calculated at baseline for 4 presenteeism instruments (Work Productivity and Activity Impairment questionnaire -WPAI-, Quality and Quantity method -QQ-, Workplace Activity Limitations Scale -WALS- and Work Limitations Questionnaire -WLQ 25-) and for a patient global assessment of pain. We created receiver operating characteristic (ROC) using as external criterion a Patient Acceptable Work State question, addressing one’s ability to perform their current job satisfactorily. We used different approaches (75 th percentile, Youden index, Liu method, nearest to 0.1) to determine the optimal cut-off, while balancing over-under diagnosis. Accuracy of thresholds to predict “future adverse work outcome” throughout 12 months (defined as sick leave or long-term disability) was assessed. The recently developed presenteeism thresholds for axSpA were also tested. Results A total of 105 employed patients were included: 77% females, mean age 48 (SD 9), with a mean symptom duration of 9.8 (8.7) years. 15% of the patients considered themselves in an unacceptable work status and 7 (8%) had at least one AWO during 12 months. All instruments (presenteeism and pain) showed good performance vs the external criterion (AUC >0.75) except for the QQ method (AUC 0.62). The Table 1 shows the optimal thresholds for each instrument and their performance to correctly identify an unacceptable work status and AWO during 12 months for the RA-specific threshold (1 st row) and the available axSpA threshold (2 nd row). Interestingly, the axSpA thresholds performed better to classify work status as ‘unacceptable’ and to predict AWO. For adverse work outcome over 12 months, pain and WPAI performed better specially in predicting AWO. Conclusion Thresholds for presenteeism and pain representing unacceptable work status have been established for RA. Previously developed thresholds for axSpA showed an even better performance and are therefore the preferred to be used. WPAI performed the best and can be used to identify patients requiring more tailored care in order to avoid future AWO. Table 1. Optimal thresholds for presenteeism measures and patients correctly classified for unacceptable work status and adverse work outcome during 12 months. Optimal threshold (SE/SP) Correctly classified for unacceptable work status n (%) Correctly classified for AWO during 12 months n (%) WPAI presenteeism (0-100 ) ≥30 (89/70 ) 66 (73) 57 (69) ≥40 (78/82 ) 77 (82) 62 (75) QQ method (0-10 ) ≥2 (67/55 ) 53 (56) 49 (59) ≥3 (56/64 ) 59 (63) 57 (69) WALS (0-3 ) ≥0.61 (89/59 ) 51 (62) 44 (61) ≥0.75 (67/68 ) 56 (68) 49 (68) WLQ 25 (0-100 ) ≥27 (89/77 ) 53 (57) 45 (55) ≥29 (77/80 ) 57 (61) 46 (56) Pain (0-10 ) ≥4 (67/68 ) 64 (68) 61 (73) The final thresholds are colored in green and correspond to the one’s derived from axSpA. For pain measurement there was no axSpA derived threshold. Figure 1. ROC curves for presenteeism (4 different measurement instruments) and for pain according to unacceptable work status Acknowledgements RA-PROSE study was funded by AbbVie. Disclosure of Interests Dafne Capelusnik: None declared, Sofia Ramiro Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, Sanofi, UCB, Grant/research support from: AbbVie, Galapagos, MSD, Novartis, Pfizer, UCB, Elena Nikiphorou Speakers bureau: Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, Lilly, Fresenius, Consultant of: Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, Lilly, Fresenius, Grant/research support from: Pfizer and Lilly, Walter P Maksymowych Consultant of: Abbvie, BMS, Boehringer, Celgene, Eli-Lilly, Galapagos, Janssen, Merck, Novartis, Parexel, Pfizer, UCB, Grant/research support from: Abbvie, Novartis, Pfizer, UCB, Marina Magrey Consultant of: Novartis, Abbvie, UCB, Eli-Lilly, Janssen, Pfizer, Grant/research support from: BMS and Amgen, Helena Marzo-Ortega Speakers bureau: Abbvie, Biogen, Eli-Lilly, Janssen, Moonlake, Novartis, Pfizer and UCB, Consultant of: Abbvie, Biogen, Eli-Lilly, Janssen, Moonlake, Novartis, Pfizer and UCB, Grant/research support from: Janssen, Novartis and UCB, Annelies Boonen Consultant of: AbbVie, Galapagos, Novartis, and Pfizer, Grant/research support from: Abbvie.