Clinical studies and clinical experience support the impression that rehabilitation can produce modest, but meaningful benefits to the functional and psychosocial status of ambulatory adults with rheumatoid arthritis. However, there is no agreement upon either methods of treatment or indications for treatment. With better information about which rehabilitation strategies are most effective and for whom these interventions are most useful, we will be able to define and justify the role of ambulatory rheumatoid arthritis rehabilitation in managed care health systems which attempt to address the current health care cost crisis. The proposed development and feasibility (D&F) study is designed to develop the methods and measures for a large, nationally representative, prospective, observational study of the treatment effectiveness of ambulatory rehabilitation for persons with rheumatoid arthritis. The D&F effort involves three related activities: 1) Analysis of a longitudinal database consisting of 1,025 patients and 50 physicians for a) rehabilitation therapy effects, with particular emphasis on comparison of patients' disease activity, pain, rehabilitation utilization, and overall change in functional and psychosocial status, and b) physician practice variation in referral to rehabilitation; 2) A regional rheumatologist practice survey to examine the extent of practice variation in referral to rehabilitation services for patients with rheumatoid arthritis, to compare high and low rate referral physician training and practice characteristics, and to identify high and low users of rehabilitation services for subsequent recruitment as project sites; 3) An expert panel process to define and describe rehabilitation treatment processes, including the development of a method to classify and quantify rehabilitation treatment. The D&F project results will allow the investigators to design a credible, prospective, observational study with sufficient power to detect the characteristics of patients and programs that have good rehabilitation outcomes. D&F activities are also expected to generate publishable quality data to describe patient and physician rehabilitation referral rates and patterns, and a method for measuring key dimensions of rehabilitation programs.
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