Discussion

Abstract

There was an extensive discussion of all the papers but the following condensed and edited account summarizes many of the points of view which were expressed. Assessment There are many difficulties and diversities of approach in assessing the number of patients affected, the severity of their disease and the response to treatment. There are so-called objective measures, such as measurement of deformity, radio-logical examination of the joints, measurement of the range of movement and degree of calcification, and improved methods and equipment for measuring the power of movement have recently been developed. At the other extreme the assessment of pain by rating scales is notoriously unsatisfactory although pain is often the most important symptom for the patient. Another possibility is to measure the performance of the patient in daily life, not so much by the rather contrived situation in model rooms, but rather by finding out what patients do in their home environment, by observation or by a questionnaire. Research is in progress to determine whether such measurements can be validated and simplified - a combination of pain, degree of instability, range of movement, ability to walk with or without aids and a standing a. p. film might suffice for the knees.