Abstract
Objective To examine the association of patient resilience with health-related quality of life (HRQOL) in systemic lupus erythematosus (SLE).
Methods We used data from a prospective cohort study of patients with SLE enrolled across 15 rheumatology clinics across the US who viewed a patient decision aid for SLE management during a regular clinic visit. We examined the association of high resilience with HRQOL on 29-item Patient Reported Outcomes Measurement Information System (PROMIS-29) domains using multivariable linear mixed-effects model analysis, adjusted for demographics, social determinants of health (SDOH), flare, site, time, and comorbid rheumatic diseases.
Results Out of 945 patients with SLE, 27% had high resilience, with a 2-item Connor-Davidson Resilience Scale (CD-RISC2) score of 8. Compared to patients who had low resilience, those with high resilience were more likely to report excellent or very good health (46% vs 17.7%); lower SLE activity (3.94 vs 5.18 on a 0-10 scale), and higher SLE wellness (7.54 vs 6.15 on a 0-10 scale). We noted that high resilience was associated with a positive moderate effect size (Cohen d > 0.5) for physical functioning, social participation, emotional anxiety, emotional distress, fatigue, pain interference, and pain intensity, as well as a favorable small effect size (Cohen d 0.2-0.49) for sleep disturbance, in unadjusted analyses. In a multivariable-adjusted mixed linear regression analysis, high resilience was associated with all 8 HRQOL scale scores.
Conclusion High patient resilience was independently associated with better HRQOL outcomes in SLE after adjusting for demographics, SDOH, SLE flare, site, time, and comorbid rheumatic diseases. Interventions to promote resilience have the potential to improve HRQOL outcomes in SLE. (ClinicalTrials.gov: NCT03735238)
