In- and out-patient rehabilitation in rheumatoid arthritis. A controlled, open, longitudinal, cost-effectiveness study.

Twenty-six patients with rheumatoid arthritis (RA) participated either in a 21 day, community sponsored, in-patient multidisciplinary rehabilitation program (N = 20) or; received traditional, out-patient physiotherapy designed by the patient's rheumatologist (N = 6). Clinical assessments were made (prior to, immediately after, and 6 months after rehabilitation) to evaluate the response to these two quite different rehabilitative measures that included: functional classification, joint score index, subjective VAS of pain, HAQ, pain disability index, Comprehensible psychopathological rating scale, hemoglobin, and CRP measurements. Economic assessments included salary, direct and community sponsored costs, for rehabilitation and costs for sick days and production losses. No clear-cut differences between the two rehabilitation modes were detected. Both modes showed improvement in different assessment parameters; patients with higher education and, therefore, with a less joint-disturbing work profile appeared to profit more from an extensive in-patient rehabilitation program. Patients with less education and a more manually-oriented working profile, did worse and had a higher tendency to seek medical pensioning, in spite of rehabilitative measures. As the total costs for out-patient rehabilitation only add up to 15.8% of the total costs for in-patient rehabilitation, this study setting cautiously suggests that out-patient rehabilitation might be an acceptable alternative to individualized patient groups that might not compromise clinical and vocational outcome. Larger patient groups are needed, however, to confirm these findings.