A quality indicator set for use in rehabilitation team care of people with rheumatic and musculoskeletal diseases; development and pilot testing.

BACKGROUND: Systems for monitoring effectiveness and quality of rehabilitation services across health care levels are needed. The purpose of this study was to develop and pilot test a quality indicator set for rehabilitation of rheumatic and musculoskeletal diseases. METHODS: The set was developed according to the Rand/UCLA Appropriateness Method, which integrates evidence review, in-person multidisciplinary expert panel meetings and repeated anonymous ratings for consensus building. The quality indicators were pilot-tested for overall face validity and feasibility in 15 specialist and 14 primary care rehabilitation units. Pass rates (percentages of "yes") of the indicators were recorded in telephone interviews with 29 unit managers (structure indicators), and 164 patients (process and outcome indicators). Time use and participants' numeric rating of face validity (0-10, 10 = high validity) were recorded. RESULTS: Nineteen structure, 12 process and five outcome indicators were developed and piloted. Mean (range) sum pass rates for the structure, process and outcome indicators were 59%(84%), 66%(100%) and 84%(100%), respectively. Mean (range) face validity score for managers/patients was 8.3 (8)/7.9 (9), and mean answering time was 6.0/5.5 min. The final indicator set consists of 19 structure, 11 process and three outcome indicators. CONCLUSION: To our knowledge this is the first quality indicator set developed for rehabilitation of rheumatic and musculoskeletal diseases. Good overall face validity and a feasible format indicate a set suitable for monitoring quality in rehabilitation. The variation in pass rates between centers indicates a potential for quality improvement in rheumatic and musculoskeletal rehabilitation in Norway.

Prevalence and burden of osteoarthritis: results from a population survey in Norway.

OBJECTIVE: To investigate the prevalence of osteoarthritis (OA) in knee, hip, and hand in a general population in Norway and the burden of disease in terms of associations between the report of OA and health-related variables. METHODS: In 2004, postal questionnaires were sent to all people in a local community born in 1928-30, 1938-40, 1948-50, 1958-60, 1968-70, and 1978-80. A total of 3266 (56.7%) responded. The prevalence of hip, knee, and/or hand OA was obtained by the item "Have you ever been diagnosed with osteoarthritis in hip/knee/hand by a medical doctor or by x-ray?". RESULTS: The overall prevalence of OA was 12.8% (95% CI 11.7-14.0), being significantly higher among women [14.7% (95% CI 13.1-16.4)] than men [10.5% (95% CI 9.0-12.1)]. The prevalence for hip OA was 5.5% (95% CI 4.7-6.3), knee OA 7.1% (95% CI 6.3-8.0), and for hand OA 4.3% (95% CI 3.6-5.0). OA was significantly (all p < 0.001) associated with higher age, less than 12 years of education, being out of work, pain duration > 1 year, pain in several body sites, sick leave for more than 8 weeks, emotional distress, poor sleeping quality, fatigue, and with frequent use of healthcare providers in primary health care. A significant (p = 0.001) dose-response relationship between increasing body mass index and OA was found. CONCLUSION: The overall prevalence of OA was 12.8% and higher prevalence was found among women and older people, people with less than 12 years of education, those out of work, and those overweight. OA was associated with pain, disability, and poor health status, and frequent use of healthcare providers.

Despite technical problems personal digital assistants outperform pen and paper when collecting patient diary data.

OBJECTIVES: To assess how personal digital assistants (PDAs) perform as collection tools of patient-reported outcomes in clinical research compared to pen and paper (P&P) diaries in terms of feasibility, protocol compliance, data accuracy, and subject acceptability. STUDY DESIGN AND SETTING: A systematic review of randomized and quasi-randomized controlled trials comparing the PDA and P&P methods in a health diary context involving repeated measures in persons with chronic health problems. RESULTS: Nine studies were included. Their methodological quality was variable. Five studies reported on feasibility, and all reported technical difficulties with the PDA technology. Two studies reported that electronic collection leads to a substantial reduction in time used for data handling. Five studies reported that the PDA method results in better compliance, whereas one study reported the opposite. All three articles reporting on data accuracy indicated that there are fewer errors in the PDA records. Four articles scrutinized subject preference, and the PDA method came out favorably in all four. CONCLUSION: The PDA method seems to perform better than P&P in most of the selected outcomes. Technical malfunction is the chief disadvantage with the PDA method. Further research comparing PDA with paper data collection using more stringent methodology is needed.