Pain, function, and RAPID scores: vital signs in chronic diseases, analogous to pulse and temperature in acute diseases and blood pressure and cholesterol in long-term health.
Quantitative clinical assessment measures and indices have been developed for many rheumatic diseases. However, these measures and indices generally are used only in clinical trials and other clinical research, as they are too complex for collection and calculation at a usual clinical visit. The only quantitative measures available in most rheumatology patient care are laboratory tests, which often give false positive and false negative results and may not be available at the time of a patient visit. The most feasible method to collect quantitative data in routine care involves patient self-report questionnaires, completed while waiting to see the physician and reviewed by the clinician at the time of the visit. A multidimensional health assessment questionnaire (MDHAQ) provides a useful one-page questionnaire to assess the three self-report Data Set measures-physical function, pain, patient global estimate, as well as review of systems, recent medical history, fatigue, and demographic data. An index of the three Core Data Set measures, routine assessment of patient index data (RAPID3), can be used to guide "tight control" of inflammation, analogous to a disease activity score (DAS28). RAPID3 can be scored in fewer than 10 seconds and is informative in patients with all rheumatic diseases. It is suggested that the infrastructure of all rheumatology care settings include a patient questionnaire for each patient, with all diagnoses, at each visit to improve quantitative guidance of clinical decisions, documentation of status and improvements, and patient outcomes.
Division of Rheumatology, Department of Medicine, NYU Hospital for Joint Diseases, NYU Medical Center, New York, NY, USA. tedpincus@gmail.com
Theodore
T
Pincus
D000203:Activities of Daily Living; D002908:Chronic Disease; D006305:Health Status Indicators; D006801:Humans; D010147:Pain Measurement; D012216:Rheumatic Diseases / Q000628:therapy; D012219:Rheumatology / Q000379:methods*; D011795:Surveys and Questionnaires