IV|3@Health Related Quality-of-life in Arthritis and Musculoskeletal Disorders: From Theory to Practice.
The importance of function and health quality of life in chronic arthritis and musculoskeletal disease has been recognized since 1949 and since the early 80's many psychometrically superior questionnaires have been developed to measure physical function and health status. Generic and arthritis specific measures have been widely applied in clinical and health services research..
These new questionnaires have excellent psychometric properties, measure patient concerns and are sensitive to change and clinical status, and are proxies for disease severity and activity and predict outcome including mortality and health resource utilization. Their acceptance in the research literature underscores their importance. In patient care, however, they have had limited dissemination and the reason for this give us insights into the role of outcomes measurement in clinical practice.
The outcome paradigm states that if outcomes of medical care are accurately measured, the information can be fed back to improve the efficiency, the quality, and the results of health care. For the model to work in improving health, four things are necessary; 1) one must agree on what outcomes should be targeted; 2) the outcomes must be measurable; 3) they must be modifiable; and 4) the system should have the capacity and the will to change on the basis of the information obtained. In arthritis and musculoskeletal disease, outcomes can be measured and in many instance modifiable.
The other criteria are not met and limit the usefulness of current measures. Although there is little question that such outcome measures have been a major advance, process measures will be more useful in achieving the objectives of outcomes measurement in clinical practice.