The impact of the COVID-19 pandemic on physical functioning and mental wellbeing in 824 patients with rheumatic disease over 8 months: Physical functioning declines

Cleaton, N.; Raizada, S.; Sheeran, T.; Bateman, J.

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.