1	How to measure outcome J. Mieke Hazes Professor of Rheumatology Erasmus university Medical Center Rotterdam, The Netherlands
2	“The Burden of Musculoskeletal Conditions at the Start of the New Millennium”
3	Why should we measure outcome? To show that our interventions make a difference in the health related quality of life of our patients To show that new interventions are better (more cost-effective) than the established interventions Make studies comparable (randomised controlled trials) At least measure “income” In order to measure changes and to compare studies
4	Quality of Life in the Rheumatic Diseases Typical consequences of the disease for the patient: Pain Loss of function Restricted participation in society
5	Structuring process and outcome Are we measuring the right outcomes ? Mix-up with: Process measures Intervening/intermediate measures Disease centered outcomes Patient centered outcomes
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9	ICF- WHO International Classification of Functioning, Disability and Health
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12	Measurement tools: body functions Sensation: Pain Stiffness Fatigue Emotional:depression Muscle strength Condition Mobility/ROM VAS, Likert VAS, time VAS, questionnaire HADS Manual, dynamometer “VO₂ max”, heart rate ROM scores
13	Measurement tools: body structure Swelling Damage Form Structure Joint indexes X-joint scores, fracture scores Ligament damage scores (degrees) Degrees deformity, alignment BMD
14	Measurement tools: activity limitations Essential activities Complex activities Discretional (e.g. gardening) Actual measurement (walking time, grip strength) Questionnaires (HAQ, SF36, AIMS…..) Actual measurement, questionnaire (MACTAR)
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16	Measurement tools: participation restriction At individual level At group level (public health) ? (parts of AIMS, SF36) Work loss, sickness pension Accessibility buildings work loss / work disability
17	SF-36 Comparison Normal vs. RA patients in Europe, US & Mexico
18	Which outcome measures are used in RA Surgery? Harris hip Knee Society Constant Shoulder SFA EFA HSS scores
19	Required properties of measurement tools valid reliable simple available widely used well researched feasible
20	Choice of outcome measurement tools Aim of survey/study Patient relevant measures All domains of ICF Widely used instruments to increase comparability Include generic instrument for policy makers Feasibility & costs
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