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Skovsgaard CV, Kruse M, Hjollund N, Maribo T, de Thurah A. Cost-effectiveness of a telehealth intervention in rheumatoid arthritis: economic evaluation of the Telehealth in RA (TeRA) randomized controlled trial. Scand J Rheumatol 2023; 52:118-128. [PMID: 35048793 DOI: 10.1080/03009742.2021.2008604] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Telehealth is rapidly gaining ground from usual treatment, not least because of coronavirus disease 2019 (COVID-19) measures. Within rheumatology, telehealth has been used for, inter alia, follow-up for patients with rheumatoid arthritis (RA) with low disease activity or in remission. This study aims to assess the cost-effectiveness of such a telehealth intervention. METHOD In a randomized controlled trial, 294 patients were randomized into patient-reported outcome-based telehealth follow-up by either a nurse (PRO-TN) or a rheumatologist (PRO-TR) or to conventional outpatient follow-up (control). Cost-effectiveness was evaluated using costs per quality-adjusted life-year (QALY) gained. Individual-level healthcare and productivity costs were retrieved from national Danish registers. Incremental cost-effectiveness ratios were calculated for the intervention groups compared to the control group. Bootstrapping with 10 000 replications was used to obtain confidence intervals. Furthermore, cost-effectiveness acceptability curves were generated. RESULTS The cost comparison showed that PRO-TR was significantly less costly than the control group, whereas the relative reduction in costs for PRO-TN was not significant. The telehealth groups experienced minor, non-significant declines in QALYs, whereas the control group experienced a slight, non-significant increase. The cost-effectiveness analysis showed that for PRO-TR, the willingness to accept a QALY loss was 89 328 EUR. A similar but smaller and non-significant result was seen for PRO-TN. CONCLUSION PRO-TR and PRO-TN seem to cost less but provide broadly similar health outcomes compared with conventional follow-up. Between the intervention groups, PRO-TR was significantly less costly. More studies are needed to conclude whether rheumatologist- or nurse-led telehealth is more cost-effective than conventional follow-up.
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Affiliation(s)
- C V Skovsgaard
- Department of Public Health, Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - M Kruse
- Department of Public Health, Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Nhi Hjollund
- AmbuFlex, Center for Patient-reported Outcomes, Hospital Unit West Jutland, Herning, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - T Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Public Health and Rehabilitation Research, DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - A de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
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Ahmad Ainuddin H, Romli MH, S F Salim M, Hamid TA, Mackenzie L. A validity study to consult on a protocol of a home hazard management program for falls prevention among community dwelling stroke survivors. PLoS One 2023; 18:e0279657. [PMID: 36630460 PMCID: PMC9833545 DOI: 10.1371/journal.pone.0279657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/11/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE A fall after a stroke is common but the consequences can be devastating not only for the stroke survivors, but also for caregivers, healthcare, and the society. However, research on falls prevention among the stroke population are limited, particularly on home hazards assessment and home modifications, demanding for a study to be conducted. The aim of the study is to validate the protocol and content of a home hazard management program guided by the Person-Environment-Occupation (PEO) Model for falls prevention among community dwelling stroke survivors. METHOD Researchers developed their own questionnaire for content validation which consist of 23 items that covers two domains, namely justification for telehealth home hazard management practice and the protocol's overall methodology. Occupational therapists with at least one year of experience in conducting a home hazard assessment were consulted for the content validation of a two-group clinical controlled trial protocol utilizing a home hazard assessment, home modifications and education over the usual care. Written consent was obtained prior to the study. The occupational therapists were given a Google Form link to review the protocol and intervention based on the questionnaire and rated each item using a four-point Likert scale for relevance and feasibility. Open-ended feedback was also recorded on the google form. Content Validity Index (CVI), Modified Kappa Index and Cronbach's Alpha was calculated for the content validity and reliability analysis. RESULTS A total of sixteen occupational therapists participated in the study. 43.7% of participants had a master's degree, 93.7% worked in the government sector and 56.2% had six years and more experience on conducting home hazard assessments. Content validity of the protocol is satisfactory for relevancy and feasibility (CVI = 0.84, ranging from 0.5 to 1.00), and for the reliability (α = 0.94 (relevance) and α = 0.97 (feasibility), respectively. The Modified Kappa ranged from 0.38 to 1.00 for all items. Feedback was also received regarding the design and procedure of the study protocol which included participant's selection criteria, sample size, equipment provided, cost, location, and care for the participants during the intervention. CONCLUSIONS Introducing a home hazard management program to prevent falls among the stroke population is viewed relevant and feasible. Practical suggestions from the consultation panel were adopted, and minor adjustments were required to strengthen the protocol's overall methodology. This study established a rigorous and robust experimental protocol for future undertaking.
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Affiliation(s)
- Husna Ahmad Ainuddin
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Centre of Occupational Therapy Studies, Faculty of Medicine and Health Sciences, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
| | - Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Mazatulfazura S F Salim
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Tengku Aizan Hamid
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
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Knudsen LR, Lomborg K, de Thurah A. Design and development of an e-learning patient education program for self-management support in patients with rheumatoid arthritis. PEC INNOVATION 2022; 1:100004. [PMID: 37364010 PMCID: PMC10194095 DOI: 10.1016/j.pecinn.2021.100004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 06/28/2023]
Abstract
Objective To develop an e-learning education program targeting patients with rheumatoid arthritis. Methods The development process involved content specification and creative design. It was theoretically framed within theories of multimedia learning and entertainment-education and empirically based on evidence of patient education in rheumatoid arthritis and focus group discussions with stakeholders. We conducted a feasibility test among ten patients to assess the acceptability and usability of the program, and to identify areas to be adjusted. Results The following themes for educational needs were found in focus group discussions: "Knowledge of rheumatoid arthritis," he disease course and prognosis," "Medical treatment," "A new life situation" and "Daily life with rheumatoid arthritis." Based on this, an e-learning program covering the disease course, examinations, treatment, and daily life, was created. It combines animations, videos, podcasts, text, speech, and tests. Test persons found the program feasible-that is, clear in content and easy to understand with a suitable pace and coherence between graphics, speech, and text. Conclusion This e-learning program is based on solid theoretical knowledge that meets users' needs and is easy to use. Innovation This study contributes to the innovation of health care by the development of a new digital tool for patient education.
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Affiliation(s)
- Line Raunsbæk Knudsen
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 59, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Kirsten Lomborg
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 2, 2820 Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 København N, Denmark
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 59, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
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Riaz MM, Mahmood SBZ, Nasir N. Telemedicine for Rheumatology Patients in Covid-19 Pandemic: Perspectives of Patients. J Patient Exp 2022; 9:23743735221092635. [PMID: 35441090 PMCID: PMC9008472 DOI: 10.1177/23743735221092635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Telemedicine use for patients with autoimmune rheumatic conditions during the
pandemic mandates better characterization. We conducted a telephonic survey on
patients who consulted rheumatologists remotely to determine their attitudes
toward telemedicine. The study was conducted at Aga Khan University Hospital, a
tertiary care hospital in Pakistan which is a lower-middle-income country.
Descriptive analyses were performed. Fifty patients visited tele-rheumatology
clinic, 35 (70.0%) were female with a mean (SD) age of 47.6 (18.1) years.
Majority (27, 54.0%) learned about telemedicine from hospital website and
outpatient clinic desk or helpline. Lack of examination was the biggest concern
with teleconsultation (18, 22.2%). Most patients (38, 76.0%) agreed to continue
teleconsultation beyond the pandemic. Telemedicine is preferable for providing
rheumatology outpatient service during and after the pandemic.
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Affiliation(s)
| | | | - Noreen Nasir
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Momsen AMH, Fox JC, Nielsen CV, Thuesen J, Maribo T. Rehabilitation Research in Denmark Between 2001 and 2020: A Scoping Review. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:849216. [PMID: 36188956 PMCID: PMC9397721 DOI: 10.3389/fresc.2022.849216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
The demand for rehabilitation has increased, and evidence is rapidly growing; however, a rehabilitative health strategy receives less attention than treatment. Knowledge of what is being researched, who are the target groups and who contributes to rehabilitation research is deficient. We did not find any reviews mapping rehabilitation research regarding the research questions. The objective was to identify and synthesize existing scientific evidence on rehabilitation research published by Danish institutions between 2001 and 2021. The research questions to be explored were: Among which study groups has rehabilitation research been published?. Which types of studies on rehabilitation have been published?. Which institutions have been involved in rehabilitation research? Methods The process was guided according to the Joanna Briggs Institute's (JBI's) scoping review methodology. Four databases were searched. All types of peer-reviewed studies on any target group and rehabilitation setting, with any affiliation to a Danish institution, were eligible to be included. Studies referring to population and the type of design were categorized. Institutions were counted as Danish first authorship. Results The search revealed 3,100 studies, and following screening 1,779 were included. A total of 24 broad study groups were identified, mostly diagnosis-based health conditions. Musculoskeletal, cancer, and cardiac had 342, 228, and 174 studies, respectively. A total of 1,545 had a Danish first authorship, most of the Danish publications came from hospitals (56.6%) and universities (28.4%). The publication trend showed an almost linear development, with a 10-15% increase during the period. Conclusion Following screening 1,779 studies were included involving 24 broad study groups. Most categories were diagnosis-based; musculoskeletal, cancer, and cardiac health conditions encompassed most studies. All study designs were represented, and 1/10 were secondary studies. The majority (87%) of studies had a Danish first authorship. The majority of first affiliations were among hospitals followed by universities. A few municipalities were presented although they are yet to have research responsibility. Publication trends showed an increase primarily from 2013. Systematic Review Registration https://osf.io/, identifier [10.17605/OSF.IO/2AENX].
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Affiliation(s)
- Anne-Mette Hedeager Momsen
- DEFACTUM-Social and Health Services and Labour Market, Corporate Quality, Central Denmark Region, Aarhus, Denmark
| | - Jasmine Charlotte Fox
- DEFACTUM-Social and Health Services and Labour Market, Corporate Quality, Central Denmark Region, Aarhus, Denmark
| | - Claus Vinther Nielsen
- DEFACTUM-Social and Health Services and Labour Market, Corporate Quality, Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Gødstrup Hospital, Herning, Denmark
| | - Jette Thuesen
- Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital, Odense, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Denmark
- Centre for Nutrition and Rehabilitation, Absalon University College, Sorø, Denmark
| | - Thomas Maribo
- DEFACTUM-Social and Health Services and Labour Market, Corporate Quality, Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Song Y, Bernard L, Jorgensen C, Dusfour G, Pers YM. The Challenges of Telemedicine in Rheumatology. Front Med (Lausanne) 2021; 8:746219. [PMID: 34722584 PMCID: PMC8548429 DOI: 10.3389/fmed.2021.746219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/20/2021] [Indexed: 12/14/2022] Open
Abstract
During the past 20 years, the development of telemedicine has accelerated due to the rapid advancement and implementation of more sophisticated connected technologies. In rheumatology, e-health interventions in the diagnosis, monitoring and mentoring of rheumatic diseases are applied in different forms: teleconsultation and telecommunications, mobile applications, mobile devices, digital therapy, and artificial intelligence or machine learning. Telemedicine offers several advantages, in particular by facilitating access to healthcare and providing personalized and continuous patient monitoring. However, some limitations remain to be solved, such as data security, legal problems, reimbursement method, accessibility, as well as the application of recommendations in the development of the tools.
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Affiliation(s)
- Yujie Song
- IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
| | - Laurène Bernard
- Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Department of Rheumatology, Lapeyronie University Hospital, Montpellier, France
| | - Christian Jorgensen
- IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France.,Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Department of Rheumatology, Lapeyronie University Hospital, Montpellier, France
| | - Gilles Dusfour
- IRMB, University of Montpellier, CARTIGEN, CHU de Montpellier, Montpellier, France
| | - Yves-Marie Pers
- IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France.,Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Department of Rheumatology, Lapeyronie University Hospital, Montpellier, France
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MacIver A, Hollinger H, Carolan C. Tele-health interventions to support self-management in adults with rheumatoid arthritis: a systematic review. Rheumatol Int 2021; 41:1399-1418. [PMID: 34132890 PMCID: PMC8245362 DOI: 10.1007/s00296-021-04907-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/29/2021] [Indexed: 11/26/2022]
Abstract
Rheumatoid arthritis (RA), a long-term auto-immune condition is a challenging condition for patients to manage. Goals of treatment include reducing pain, decreasing inflammation, and improving an individual's overall function. Increasingly technology is being utilised to support patients to self-manage their condition. The aim of this systematic narrative review was to synthesise and critically appraise published evidence concerning the effectiveness of tele-health interventions to support self-management in RA. Bibliographic databases searched from 2014 to March 2020 included MedLINE, Embase, Cochrane Library. Search strategy combined the following concepts: (1) rheumatoid arthritis, (2) tele-health interventions, and (3) self-management. Only randomised controlled trials (RCTs) involving adults with RA were included. Titles, abstracts, full-text articles were screened, any discrepancies were checked by a second reviewer. Risk of bias was assessed using Cochrane risk of bias tool and data were extracted utilising the Cochrane data collection form for RCT interventions along with the TiDier checklist. Due to high heterogeneity, results were not meta-analysed and instead data were synthesised narratively. The search identified 98 articles, seven were included. The completed RCTs varied in the nature of the interventions, duration/severity of RA, outcomes measured and effectiveness of the interventions. The completed RCTs included a total of 791 participants Disease duration was largely between 4 and 10 years and disease severity on average was moderate. There was extensive variation in intervention components, theories underpinning theories and outcomes measured. Five RCTs reported a positive effect on factors such as disease activity, medication adherence, physical activity and self-efficacy levels. This study suggests that tele-health interventions that are well-designed, tailored and multi-faceted can help to achieve positive self-management outcomes in RA. None of the studies showed evidence of harm.
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Affiliation(s)
- Alison MacIver
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
- NHS Western Isles, Stornoway, Scotland UK
| | - Hannah Hollinger
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
| | - Clare Carolan
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
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Stamm T, Moe RH. How to manage rheumatic and musculoskeletal diseases - Preface. Best Pract Res Clin Rheumatol 2020; 34:101568. [PMID: 32762938 DOI: 10.1016/j.berh.2020.101568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria.
| | - Rikke Helene Moe
- Diakonhjemmet Hospital, Division of Rheumatology and Research, Norway
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