Margaret Holroyd Prize Essay. A patient-centred approach to evaluation and treatment in rheumatoid arthritis: the development of a clinical tool to measure patient-perceived handicap.

Assessment of patient-centered outcomes is of particular importance in a chronic disease such as rheumatoid arthritis (RA), where a major aim of treatment is a reduction of its disabling and handicapping effects. Rheumatology is reasonably well advanced in its deployment of such outcomes. Measurement of the patient's experience of disease has focused on the ability to perform daily living tasks and, latterly, on the more global effect on quality of life. Neither of these approaches is without conceptual and measurement problems. A new measure of patient-centred outcome in RA has been developed (Carr AJ, Br J Rheumatol 1994;33:378-82). This tool, the Disease Repercussion Profile (DRP), attempts to extend the measurement of outcome to incorporate the individual functional, social, psychological, emotional and economic disadvantage resulting from RA, i.e. patient-perceived handicap. It has been designed for use as a clinical tool, to allow patients to specify the problems and needs of most importance to them, and as such represents a new approach. This paper reviews the development of the DRP in the context of existing health status measures and examines its potential role as a routine measure in an out-patient setting.