A survey of outcome measurement procedures in routine rheumatology outpatient practice in Australia

Objective. To assess the extent to which quantitative clinical measurement is performed by rheumatologists in the longitudinal followup of patients with rheumatoid arthritis (RA), osteoarthritis (OA), ankylosing spondylitis (AS), and fibromyalgia (FM) in routine outpatient practice in Australia. Methods. A cross sectional postal survey was conducted using an 18-item self-administered questionnaire sent to Australian Rheumatology Association (ARA) members. Results. Rheumatologists (response rate = 76%, completion rate = 72%) were more likely to longitudinally follow patients with RA and AS than those with OA or FM. There was a high degree of variability in the methods used to monitor patients longitudinally. Many measures used in clinical research were used infrequently in routine clinical practice. In general, the major health status measures surveyed were not used in clinical monitoring. There was a high level of agreement (> 80%) that the characteristics required of an outcome measure for use in clinical practice should include simplicity, brevity, ease of scoring, reliability, validity, and sensitivity to change. Conclusion. The majority of Australian rheumatologists perform outcome measurement during the longitudinal followup of their outpatients with RA, AS, OA, and FM. However, the process lacks standardization. High performance health status measures developed for clinical research have not been widely adopted in rheumatology practices. There is agreement on the characteristics required by Australian rheumatologists for measurement procedures used in routine clinical care. Quantitative measurement in clinical practice using standardized procedures is an attainable, but as yet, unrealized opportunity

Ankylosing spondylitis antirheumatic drug trials: Effects of a standardized instructional videotape on the reliability of observer-dependent outcome measures

Aims: A study was designed to assess the effects of a standardized instructional videotape on reducing interobserver variability for several commonly used observer-dependent outcome measures. Methods: During a single day, six rheumatologists independently examined six patients with ankylosing spondylitis (AS) in a predetermined order using a Latin square design, before and after viewing a standardized videotape demonstrating 14 examination techniques. Reliability coefficients were calculated based on the variance components of the analysis of variance (ANOVA) table. Results: Prestandardization reliability coefficients wer

Approaches to valuation in LCA impact assessment

One of the major problems with the future development of lifecycle assessment is the difficulty in converting lifecycle inventory results into environmental impacts, owing to problems associated with the interpretation and weighting of the data. The four main valuation approaches: distance-to-target, environmental control costs, environmental damage costs and scoring approaches are assessed and the individual methodologies evaluated. In conclusion it is considered that in a country which has clear, up-to-date, politically acceptable emission standards, a distance-to-target valuation system maybe acceptable. However, these circumstances are likely to be rare, and the choice of standards arbitrary and not scientifically based. Therefore a better choice is probably environmental damage costs, provided suitable economic damage figures are available