The Total Assessment of Rheumatoid Arthritis by Physiotherapists: A Randomized Controlled Trial

Abstract

<p>Are the outcomes of rheumatoid arthritis patients improved when their family physicians are provided with information gathered by specially trained physiotherapists?</p> <p>Two physiotherapists were selected and trained in detailed objective techniques of evaluation and problem identification, leading to a clear and succinct report designed to assist the family physician in treatment decisions. From June 1974 to January 1977, a randomized controlled trial was conducted to assess the effect of these reports on the outcomes of women with rheumatoid arthritis treated in the community by their family physicians.</p> <p>On admission to the trial, patients were randomly allocated to two groups: one experimental group which was assessed according to modern quantitative techniques of evaluation and, following communication of results to family physicians, were treated at home by the trained physiotherapists; and a control group which was assessed according to traditional techniques of evaluation and, following, communication of results to family physicians were treated at home by traditional physiotherapists. All subjects were interviewed initially, at four, and at 12 months by independent assessors who used a standardized prestructured questionnaire designed to measure the level of joint inflammation, functional capacity, compliance and mood.</p> <p>In association with this triaI, a pooled index was developed converting live separate outcome measures into a single prespecified variable, to measure treatment differences.</p> <p>The author's unique contribution to this trial related to: development, formulation and execution of the experimental design, and more specifically, the use of independent assessors in rheumatology, allocation strategies, processing of intakes, supervision and control of data gathering procedures and the introduction of modifications in the design following the protest and during the experiment period that made this trial feasible.</p> <p>This is a "compound" thesis, focussing on the present state of knowledge and rationale for the research, the original design and modifications introduced following the pretest and during the experimental period. The rationale and effects of these modifications will be discussed in detail.</p>