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Understanding disability
  1. G Stucki
  1. University Hospital Munich, Department of Physical Medicine and Rehabilitation, Munich, Germany
  1. Correspondence to:
    Professor G Stucki, Department of Physical Medicine and Rehabilitation, Marchioninistr 15, 81377 Munich, Germany;

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Control of disease activity has the greatest effect on physical functional disability so should we bother with multidisciplinary rehabilitation care programmes?

For many years the researchers of the department of rheumatology at the University of Leiden have contributed to our understanding of the effectiveness and cost effectiveness of specific rehabilitation interventions1,2 and the provision of comprehensive care for patients with rheumatoid arthritis.3,4,4a The most recent study by van den Hout et al, published in this issue of the Annals of the Rheumatic Diseases,5 found that compared with inpatient and day patient team care, clinical nurse specialist care provides equivalent quality of life and utility, at lower costs. This result challenges the current but largely unproven assumption that multidisciplinary team care is both necessary and superior. The objective of this editorial is to discuss some conceptual and methodological issues relevant to the interpretation of this result and to draw some conclusions for the design of future studies examining the effectiveness and cost effectiveness of multidisciplinary care.

Basis for the design and interpretation of multidisciplinary care programmes in patients with RA is our understanding of disability

Which mediators determine disability? How large is the relative contribution of these mediators to disability? An understanding of the relative contribution of mediators which have been treated by drugs compared with rehabilitation interventions—for example, multidisciplinary team care, provides us with an understanding of the relative potential of these interventions. When modelling disability the new framework and classification of “functioning, disability, and health” or ICF by the WHO6 can be useful.7 Although in RA there are no comprehensive models explaining disability, as assessed by measures of quality of life, a number of studies have modelled physical functional ability, which is the most important aspect of disability in RA.7–10 These studies consistently found that physical functional disability—for example, measured with the Health Assessment Questionnaire (HAQ) …

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