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Patient centred outcomes in osteoarthritis
  1. J W J Bijlsma
  1. UMC Utrecht, Department of Rheumatology, PO Box 85500, 3508 GA Utrecht, The Netherlands; j.w.j.bijlsma@azu.nl
  1. Correspondence to:
    Professor J W J Bijlsma
    j.w.j.bijlsmaazu.nl

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The introduction of minimal clinically important improvement and patient acceptable symptom state is a major advance in outcome research

Osteoarthritis (OA) is the most common joint disorder in the world; it occurs in the majority of people over the age of 65 and is an important cause of (work) disability. The public health impact of OA is immense and will further increase with the growing elderly population. Therefore, the search for, and evaluation of, treatments for OA are relevant research topics, not only for the medical community, including individual patients and doctors, but also for pharmaceutical companies and health economists. Assessment of present and future treatment modalities in OA is important and requires a balanced approach.1

OUTCOME ASSESSMENT

Outcome assessment is the measurement process whereby the consequences of disease and health management interventions are evaluated.2 Outcome measures may be divided into two broad categories: observer dependent (or assessor rated) and observer independent (or self rated). In general, observer independent clinical measures are based on self administered questionnaires, whereas observer dependent clinical measures include questionnaires scored by the interviewer, physical findings, and tests of performance rated on technical instruments, such as walking time.

Many physicians tend to value assessor rated outcome measures higher than self rated outcome measures. However, this interpretation is obsolete and does not allow consideration of the patients’ perspectives. In line with the OMERACT recommendations,3 most studies in OA use clinical outcome measures of pain, function, and patient global assessment (all self rated) and, only for studies over 1 year, imaging (assessor rated). Clinical trials in OA assess short term changes in symptoms and long term changes in structural improvement. As yet, no definite proof of structural improvement has been documented in OA research.

PATIENTS’ PERSPECTIVES

The sequential OMERACT conferences have boosted the science of clinical measurement to generate …

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