Assessing health status after inpatient rehabilitation in rheumatoid arthritis

Inpatient rehabilitation in rheumatoid arthritis: one year follow up

Inpatient rehabilitation with medical, psychological, physical and occupational therapy is an expensive approach to rheumatoid arthritis and information about its influence on patients' health status is so far unavailable. Therefore, changes in patients' health status after inpatient rehabilitation were examined in 48 patients with definite or classical rheumatoid arthritis using a multidimensional questionnaire which had been derived from the Arthritis Impact Measurement Scales from Boston University. At discharge, health status was improved in almost all of its physical and all psychological dimensions, whereas in a preliminary study of 20 outpatients we did not find any significant improvement during a four-week period. The improvements achieved decreased during the following year showing the most stable results for decreased pain, anxiety and depression. One year after discharge overall health status was still higher than at admission in 21 of the patients. In a subgroup of patients with shorter duration of the disease improvements were more pronounced. This finding suggests that inpatient rehabilitation is especially useful in the beginning of the disease.

What determines the possession of assistive devices among patients with rheumatic diseases? The influence of the country-related health care system

PURPOSE

To identify the determinants of the possession of assistive devices among patients with various rheumatic conditions. In order to determine the influence of the country-related health care system, patients from two different countries were studied.

METHOD

Patients with rheumatoid arthritis (RA) or psoriatic arthritis (PsA) were selected from rheumatology outpatient clinics in two adjacent regions in The Netherlands and Germany. A total of 142 patients completed a self-administered questionnaire. Information on the possession of assistive devices and data on socio-demographics, clinical status and health status were obtained. Logistic regression analyses were used to identify determinants of the possession of assistive devices.

RESULTS

The majority (78%) of the patients possessed at least one or more assistive devices. Obviously, functional status was the most important determinant, followed by the country where the patient resided. More assistive devices were found in increasingly disabled patients as well as in patients living in The Netherlands.

CONCLUSION

Functional status and the patient's country are the most important determinants of the possession of assistive devices among patients with rheumatic conditions. We hypothesize that the most likely explanation for the differences in possession rates between countries are differences in societal systems for the prescription and reimbursement of assistive devices.

Efficacy of multidisciplinary team care programs in rheumatoid arthritis

OBJECTIVE

To assess the efficacy of multidisciplinary team care programs in rheumatoid arthritis (RA).

METHODS

Data were obtained by a Medline and a manual search of the literature through January 1997. Both the design and analysis aspects of controlled trials were evaluated.

RESULTS

Forty-two papers reporting on 35 clinical trials of multidisciplinary team care were initially identified. Fifteen trials had a controlled design, nine of which were randomized. Patient characteristics, interventions, end point measures, and presentation of the data varied widely among the controlled studies. In 12 trials, inpatient (n = 6) or outpatient (n = 6) multidisciplinary programs were compared with regular outpatient care. Inpatient programs (average duration, 10 to 28 days) had a direct favorable effect on disease activity, lasting up to 1 year. The effect of outpatient programs (average duration, 1 to 2 years) was less marked, with greater improvement of functional status at the end of the treatment program shown in one study. In three trials, inpatient multidisciplinary programs were compared with similar outpatient programs. One study showed that inpatient care was more effective, whereas in two studies similar results were obtained in both groups.

CONCLUSION

Favorable effects on disease activity were seen in most trials comparing short inpatient team care with regular outpatient care. Proof of efficacy of prolonged outpatient team care is scanty. Results of trials comparing inpatient with outpatient team care remain inconclusive.

Evaluating quality-of-life measures for clinical trials in Germany

In spite of an increased discussion of psychosocial outcomes of medical treatments, quality-of-life assessments in clinical trials conducted in Germany are rare. Barriers to the development of quality-of-life-related evaluation research include conceptual, methodologic, practical, and political issues. Each issue is characterized by specific problem areas and by current approaches to problem solving; both are affected by crosscultural considerations. This paper analyzes state-of-the-art in quality-of-life research in Germany with regard to four key issues and presents original work in a biometrical center as an example.