Impact of disease cyclicity on quality-of-life impairment—A mixed method explanatory study

Background: Disease cyclicity, a composite measure of unpredictable and daily fluctuations of symptoms, strongly predicts quality-of-life (QoL) impairment. Objective: To explore the mechanisms by which cyclicity impacts QoL. Methods: 1:1 semi-structured interviews were conducted and qualitatively analyzed using grounded theory. Common themes were identified and used to derive a theoretical framework. Results: Twenty-three adults, (median age 28.5, range 20-72) with a range of chronic inflammatory diseases including eczema, psoriasis, and inflammatory arthritis were prospectively recruited. Cyclicity, characterized by unpredictability, uncontrollability, and lability, contributed to a varying productivity and inconsistent ability in performing daily activities. Challenges intensified if external expectations of the patient were inconsistent with their fluctuating ability. Coping abilities, shaped by internal and external factors, moderated the relationship between cyclicity and QoL impairment. Limitations: Qualitative interviews assume patients have accurate insights into their own behaviors. The generalizability of findings may be limited in other populations. Conclusion: Disease cyclicity defines many inflammatory diseases. This study provides a theoretical framework for understanding and managing the challenges patients with a cyclical condition face.