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In the context of measurement of health status, “impact” is a relatively new term that encompasses the patient's perspective on the disease.1 The importance of patient-reported outcomes has traditionally been recognised within the rheumatology community, as evidenced by their presence in the core set of end points for rheumatoid arthritis (RA) clinical trials formulated at the first Outcome Measures in Rheumatology Initiative (OMERACT) conference in 1992.2 However, patients and researchers present at the OMERACT 6 conference in 2002 noted that the patient perspective was not adequately covered by the three core set measures: pain, physical function and patient global assessment.3 Domains deemed important but not covered included fatigue, sleep quality and well-being.
More recently, researchers from Bristol have suggested that the impact of a disease or its components is dependent on three interdependent concepts: severity, importance and self-management.4 Severity and importance are relatively well-known components that have already been incorporated in so-called “personal preference” tools such as the McMaster-Toronto Arthritis (MACTAR) scale that asks patients to rank their five most important activities and subsequently tracks changes in the ability to perform these activities over time.5 Self-management is a new angle brought in by the patients that is really self evident once named, but rarely mentioned before let alone measured in trials. For example, the impact of a disease flare in RA could be expressed in: the total severity (how bad is it?); the importance (are joints that I really need affected?); and the ability to cope (can I still do what I need to do?).
Therefore, it is a happy occasion that …
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