Rheumatology Advance Access originally published online on February 28, 2007
Rheumatology 2007 46(5):891-892; doi:10.1093/rheumatology/kel439
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Rehabilitation, an old useful tool in the midst of a new therapeutic era for rheumatoid arthritis
Department of Medicine, Division of Medicine I & Rheumatology, University of Florence, Italy
Correspondence to: M. Matucci Cerinic, Department of Medicine, Division of Rheumatology, Villa Monna Tessa, viale Pieraccini 18, 50139 Firenze, Italy. E-mail: cerinic{at}unifi.it
SIR, Dr J.G. Jones raises an important issue about rehabilitation that was neglected in our editorial. The rheumatologist should look at the triad pathology–disability–handicap not only from the point of view of the outcome measures, but also as a ‘world’ where, after the diagnosis is made and the treatment started, an active rehabilitation procedure should be seen as an imperative part of the therapeutic strategy, and started as soon as possible. This attitude may eventually lead the rheumatologist to add another valuable weapon in the fight against disease-related disability. In fact, drugs can switch off joint inflammation, but only a correct rehabilitation programme can promote an optimal recovery of joint functionality and range of motion.
On the other hand, some doubt on the real efficacy of rehabilitation in the early phase of rheumatoid arthritis (RA), where treatments usually guarantee the better response, have been recently addressed [1]: the necessity for controlled clinical trials to determine the exact efficacy of different rehabilitation programmes in rheumatic diseases has been stressed. Thus, the rehabilitative approach is currently under scrutiny because of lack of standardization of disease status [2], as indicated by the lack of unanimous acceptance of the Patient Generated Index (PGI) [3]. Moreover, only few recent studies have considered the proposed bio-psycho-social approach as potentially valuable but still not conclusive [4, 5].
Finally, International Classification of Functioning, Disability and Health (ICF) is considered by the WHO as a powerful tool to study health and health-related states, outcomes and determinants. ICF permits also the comparison of the data obtained from different countries, because it supplies a coded information for health status. ICF was mainly created to improve communication between different users (health care workers, researchers, policy-makers and the public).
In order to correctly evaluate the contribution of rehabilitation to the therapeutic strategy, two problems should be considered: the first that still today the rheumatologists have scarce experience with the ICF, and the second, that likely only tertiary centres are adequately provided with dedicated personnel (physicians and HPs) that can permit the assessment, during a normal 20-min evaluation of the patients status, of all the variables of the bio-psycho-social approach suggested by ICF. In addition, some authors recognize that the ICF is a time-consuming evaluating tool with scarce feasibility and requiring a high skilfulness [6].
In conclusion, the contribution of rehabilitation to the treatment remains a fundamental tool for the recovery of the RA patient. However, specific outcome measures are still awaited to allow the validation of rehabilitative techniques proposed to fight disability and handicaps of a disease such as RA.
The authors have declared no conflicts of interest.
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- Hammond A. (2004) Rehabilitation in rheumatoid arthritis: a critical review. Musculoskeletal Care 2:135–51.[CrossRef][Medline]
- Cieza A and Stucki G. (2005) Understanding functioning, disability, and health in rheumatoid arthritis: the basis for rehabilitation care. Curr Opin Rheumatol 17:183–9.[CrossRef][Web of Science][Medline]
- Patel KK, Veenstra DL, Patrick DL. (2003) A review of selected patient-generated outcome measures and their application in clinical trials. Value Health 6:595–603.[CrossRef][Web of Science][Medline]
- Stamm TA, Cieza A, Coenen M, et al. (2005) Validating the International Classification of Functioning, Disability and Health Comprehensive Core Set for Rheumatoid Arthritis from the patient perspective: a qualitative study. Arthritis Rheum 53:431–9.[CrossRef][Web of Science][Medline]
- Coenen M, Cieza A, Stamm TA, Amann E, Kollerits B, Stucki G. (2006) Validation of the International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis from the patient perspective using focus groups. Arthritis Res Ther 8:R84.[CrossRef][Medline]
- Schuntermann MF. (2005) The implementation of the International Classification of Functioning, Disability and Health in Germany: experiences and problems. Int J Rehabil Res 28:93–102.[CrossRef][Web of Science][Medline]
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