1
|
Watson K, Sheldon H, Pallari E, Arumalla N, Olive RR, Boiko O, Aznar C, Adams EJ, Bosworth A, Demetriou L, Martin M, Palmer MA, Sinclair P, Smith EJ, Sevdalis N, Walker A, Garrood T. Remote monitoring of patients with rheumatoid arthritis in a low disease activity state: a mixed methods evaluation across six hospitals in London, UK. Rheumatology (Oxford) 2024; 63:2721-2733. [PMID: 38402509 PMCID: PMC11443016 DOI: 10.1093/rheumatology/keae112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 12/22/2023] [Accepted: 01/21/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVES This study evaluated the scale-up of a remote monitoring service, capturing monthly Rheumatoid Arthritis Impact of Disease scores and patient-generated text messages, for patients with rheumatoid arthritis (RA; in remission or with low disease activity) attending routine outpatient clinics across six hospitals. We explored patients and staff experiences and implementation outcomes. METHODS A pragmatic, mixed methods approach was used, with active patient involvement throughout. We undertook a rapid review, analysed service-level data, and conducted a patient survey and patient and staff interviews, informed by the Capability, Opportunity, Motivation, Behaviour (COM-B) and Exploration, Preparation, Implementation, Sustainment (EPIS) theoretical frameworks. RESULTS The review included 37 articles, covering themes of patient and clinician acceptability, engagement, feasibility and clinical impact. Service-level data (n = 202) showed high levels of patient engagement with the service. The patient survey (n = 155) showed patients felt the service was easy to use, had confidence in it and felt it improved access to care. Patient interview (n = 22) findings mirrored those of the survey. Motivating factors included increased responsiveness and ease of contact with clinical teams. Views from staff interviews (n = 16) were more mixed. Some implementation barriers were specific to roll-out sites. Prioritization of staff needs was emphasized. CONCLUSION Patients were positive about the service and engagement was high. Staff views and engagement were more mixed. Results suggest that equal levels of patient and staff engagement are required for sustainability. These findings further our understanding of the implementation challenges to scaling remote monitoring interventions for patients with rheumatoid arthritis in routine care settings.
Collapse
Affiliation(s)
- Kathryn Watson
- Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Helen Sheldon
- Insights Team, Health Innovation Network, London, UK
| | - Elena Pallari
- Insights Team, Health Innovation Network, London, UK
| | - Nikita Arumalla
- Rheumatology Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Rachel R Olive
- Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Olga Boiko
- Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Camille Aznar
- Insights Team, Health Innovation Network, London, UK
| | | | | | - Len Demetriou
- Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Melanie Martin
- Rheumatology Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Mary-Ann Palmer
- Patient Author from Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | | | - Emily J Smith
- Rheumatology Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Andrew Walker
- Insights Team, Health Innovation Network, London, UK
| | - Toby Garrood
- Rheumatology Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| |
Collapse
|
2
|
Xu Z, Han T, Cheng L, Fan J, Jiang Y, Yan S. The real experience of reporting electronic patient-reported outcomes in patients with inflammatory arthritis and factors influencing participation: a scoping review. Rheumatol Int 2024:10.1007/s00296-024-05716-z. [PMID: 39313678 DOI: 10.1007/s00296-024-05716-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/30/2024] [Indexed: 09/25/2024]
Abstract
Inflammatory arthritis can result in pain, stiffness, fatigue, and reduce quality of life. Frequent monitoring of disease activity is necessary for patients with inflammatory arthritis, and electronic patient-reported outcomes (ePROs) play a crucial role in this process. This study aimed to investigate the real experience of reporting ePROs in patients with inflammatory arthritis, as well as to identify factors influencing participation. The ultimate goal was to inform targeted strategies and develop interventions to enhance the utilization of ePROs in clinical settings. A scoping review was performed using PubMed, Web of science, Embase, and the Cochrane library from 2000 to the present and the literature search focused on the experience of reporting ePROs in inflammatory arthritis and the factors that influence participation. Screening articles based on inclusion and exclusion criteria. A total of 1478 studies were identified, out of which 26 were included in the review. The top experience of applications/platforms in patients was that they were easy to use and that the applications were clear, logical and intuitive. A summary of 18 potential influencing factors were identified and there was inconsistent evidence for five of these factors. The participation of reporting ePROs is influenced by various factors, and the experience is a crucial aspect in patients with inflammatory arthritis. Analyzing patients' experience and influencing factors provides a theoretical basis for future interventions to facilitate the clinical application of ePRO. However, further research is needed to fully understand the association between influencing factors and intervention outcomes.
Collapse
Affiliation(s)
- Zixin Xu
- School of Nursing and Rehabilitation, Nantong University, Nantong, 226007, Jiangsu, China
| | - Tianyi Han
- Department of Computer Technology, Affiliated Hospital of Nantong University, Nantong, 226007, Jiangsu, China
| | - Lin Cheng
- School of Nursing and Rehabilitation, Nantong University, Nantong, 226007, Jiangsu, China
| | - Jiaxin Fan
- School of Nursing and Rehabilitation, Nantong University, Nantong, 226007, Jiangsu, China
| | - Yujie Jiang
- School of Nursing and Rehabilitation, Nantong University, Nantong, 226007, Jiangsu, China
| | - Sang Yan
- Department of Computer Technology, Affiliated Hospital of Nantong University, Nantong, 226007, Jiangsu, China.
| |
Collapse
|
3
|
Gladman T, Li H, McCullough O, Grainger R. Rapid Design of a Student-Centred App for Musculoskeletal Clinical Skills: An Example of a Theoretically Informed Approach to Developing Apps for Learning. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:368-379. [PMID: 38948401 PMCID: PMC11212788 DOI: 10.5334/pme.1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 06/05/2024] [Indexed: 07/02/2024]
Abstract
Background and need for innovation The process to design mobile apps for learning are infrequently reported and focus more on evaluation than process. This lack of clear process for health professional education mobile apps may explain the lack of quality mobile apps to support medical student learning. Goal of innovation The goal of this project was to develop a student informed ready for production wireframe model of a minimally viable mobile app to support learning of musculoskeletal (MSK) clinical skills. Steps taken for development and implementation of innovation The Information Systems Research (ISR) framework and Design Thinking were combined for the mobile app design. The process followed the cycles and modes of the combined framework to; systematically review available apps, use a focus group to identify attributes of the app valued by students, define the initial plan for the mobile app, develop an app prototype, and test and refine it with students. Outcomes of innovation The student focus group data had five themes: 1) interactive usability, 2) environment, 3) clear and concise layout, 4) anatomy and pathology, 5) cultural safety and 'red flags'. The prototyping of the app went through three cycles of student review and improvement to produce a final design ready for app development. Critical reflection on our process We used a student-centred approach guided by design frameworks to design a minimally viable product mobile app to support learning of MSK clinical skills in ten weeks with a small team. The framework supported nonlinear, iterative, rapid prototyping. Student data converged and diverged with the MSK teaching methods literature. Of note our students requested cultural safety learning in the app design, suggesting mobile apps could support cultural safety learning.
Collapse
Affiliation(s)
| | - Henry Li
- University of Otago Wellington, New Zealand
| | | | | |
Collapse
|
4
|
Giebel GD, Speckemeier C, Schrader NF, Abels C, Plescher F, Hillerich V, Wiedemann D, Börchers K, Wasem J, Blase N, Neusser S. Quality assessment of mHealth apps: a scoping review. FRONTIERS IN HEALTH SERVICES 2024; 4:1372871. [PMID: 38751854 PMCID: PMC11094264 DOI: 10.3389/frhs.2024.1372871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
Introduction The number of mHealth apps has increased rapidly during recent years. Literature suggests a number of problems and barriers to the adoption of mHealth apps, including issues such as validity, usability, as well as data privacy and security. Continuous quality assessment and assurance systems might help to overcome these barriers. Aim of this scoping review was to collate literature on quality assessment tools and quality assurance systems for mHealth apps, compile the components of the tools, and derive overarching quality dimensions, which are potentially relevant for the continuous quality assessment of mHealth apps. Methods Literature searches were performed in Medline, EMBASE and PsycInfo. Articles in English or German language were included if they contained information on development, application, or validation of generic concepts of quality assessment or quality assurance of mHealth apps. Screening and extraction were carried out by two researchers independently. Identified quality criteria and aspects were extracted and clustered into quality dimensions. Results A total of 70 publications met inclusion criteria. Included publications contain information on five quality assurance systems and further 24 quality assessment tools for mHealth apps. Of these 29 systems/tools, 8 were developed for the assessment of mHealth apps for specific diseases, 16 for assessing mHealth apps for all fields of health and another five are not restricted to health apps. Identified quality criteria and aspects were extracted and grouped into a total of 14 quality dimensions, namely "information and transparency", "validity and (added) value", "(medical) safety", "interoperability and compatibility", "actuality", "engagement", "data privacy and data security", "usability and design", "technology", "organizational aspects", "social aspects", "legal aspects", "equity and equality", and "cost(-effectiveness)". Discussion This scoping review provides a broad overview of existing quality assessment and assurance systems. Many of the tools included cover only a few dimensions and aspects and therefore do not allow for a comprehensive quality assessment or quality assurance. Our findings can contribute to the development of continuous quality assessment and assurance systems for mHealth apps. Systematic Review Registration https://www.researchprotocols.org/2022/7/e36974/, International Registered Report Identifier, IRRID (DERR1-10.2196/36974).
Collapse
Affiliation(s)
- Godwin Denk Giebel
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Christian Speckemeier
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Nils Frederik Schrader
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Carina Abels
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Felix Plescher
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Vivienne Hillerich
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Desiree Wiedemann
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | | | - Jürgen Wasem
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Nikola Blase
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Silke Neusser
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
5
|
MacBrayne A, Curzon P, Soyel H, Marsh W, Fenton N, Pitzalis C, Humby F. Attitudes towards technology supported rheumatoid arthritis care: investigating patient- and clinician-perceived opportunities and barriers. Rheumatol Adv Pract 2023; 7:rkad089. [PMID: 38033364 PMCID: PMC10684358 DOI: 10.1093/rap/rkad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/09/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives Globally, demand outstrips capacity in rheumatology services, making Mobile Health (mHealth) attractive, with the potential to improve access, empower patient self-management and save costs. Existing mHealth interventions have poor uptake by end users. This study was designed to understand existing challenges, opportunities and barriers for computer technology in the RA care pathway. Methods People with RA were recruited from Barts Health NHS Trust rheumatology clinics to complete paper questionnaires and clinicians were recruited from a variety of centres in the UK to complete an online questionnaire. Data collected included demographics, current technology use, challenges managing RA, RA medications and monitoring, clinic appointments, opportunities for technology and barriers to technology. Results A total of 109 patient and 41 clinician questionnaires were completed. A total of 83.5% of patients and 93.5% of clinicians use smartphones daily. However, only 25% had ever used an arthritis app and only 5% had persisted with one. Both groups identified managing pain, flares and RA medications as areas of existing need. Access to care, medication support and disease education were mutually agreeable opportunities; however, discrepancies existed between groups with clinicians prioritizing education over access, likely due to concerns of data overwhelm (80.6% considered this a barrier). Conclusions In spite of high technology use and willingness from both sides, our cohort did not utilize technology to support care, suggesting inadequacies in the existing software. The lack of an objective biomarker for RA disease activity, existing challenges in the healthcare system and the need for integration with existing technical systems were identified as the greatest barriers. Trial registration Registered on the Clinical Research Network registry (IRAS ID: 264690).
Collapse
Affiliation(s)
- Amy MacBrayne
- Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Paul Curzon
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Hamit Soyel
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK
| | - William Marsh
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Norman Fenton
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Costantino Pitzalis
- Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Frances Humby
- Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
| |
Collapse
|
6
|
Seppen BF, Wiegel J, Nurmohamed MT, Bos WH, ter Wee MM. Facilitators and barriers to adhere to monitoring disease activity with ePROs: a focus group study in patients with inflammatory arthritis. Rheumatol Int 2023; 43:677-685. [PMID: 36627396 PMCID: PMC9995401 DOI: 10.1007/s00296-022-05263-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/25/2022] [Indexed: 01/11/2023]
Abstract
Telemonitoring disease activity with electronic patient-reported outcomes (ePROs) may reduce the workload of rheumatic care by decreasing outpatient clinic visits. However, low adherence to reporting ePROs is frequently observed. Our objective was to identify facilitators and barriers to weekly monitoring of disease activity with ePROs. Patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) who recently participated in one of the two telemonitoring studies with ePROs completed in a smartphone app, were invited to participate in focus group discussions (FGD). Thematic analysis was used to identify themes that play a role in the decision to continue or stop reporting weekly ePROs. A total of 22 patients participated in three FGDs. Five themes were identified that were of importance to adhere to telemonitoring: (1) questionnaire frequency, (2) discussing results of completed ePROs, (3) physical consultations, (4) patient insight into disease activity and (5) user experience of the app. All themes contained both barrier and facilitator elements. The results suggest that to improve adherence to telemonitoring of disease activity with ePROs, the perceived benefits of completing ePROs should be maximized. This can be done by providing patients the ability to skip (unneeded) physical consultations in case of low disease activity, and training clinicians to always discuss the completed ePROs. In addition, it is essential to reduce the effort to report ePROs, by tailoring the frequency of ePROs based on the patients' disease activity or preference, aiming for optimal app functionality as well as by sending notifications when new ePROs are available.
Collapse
Affiliation(s)
- Bart F. Seppen
- grid.16872.3a0000 0004 0435 165XAmsterdam Rheumatology and Immunology Center, Reade, Admiraal Helfrichstraat 1, 1056 AA Amsterdam, The Netherlands
- grid.16872.3a0000 0004 0435 165XAmsterdam Rheumatology and Immunology Center, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Societal Participation in Health, Amsterdam, The Netherlands
| | - Jimmy Wiegel
- grid.16872.3a0000 0004 0435 165XAmsterdam Rheumatology and Immunology Center, Reade, Admiraal Helfrichstraat 1, 1056 AA Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Societal Participation in Health, Amsterdam, The Netherlands
| | - Michael T. Nurmohamed
- grid.16872.3a0000 0004 0435 165XAmsterdam Rheumatology and Immunology Center, Reade, Admiraal Helfrichstraat 1, 1056 AA Amsterdam, The Netherlands
- grid.16872.3a0000 0004 0435 165XAmsterdam Rheumatology and Immunology Center, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- grid.509540.d0000 0004 6880 3010Department of Rheumatology and Immunology, Amsterdam UMC Location Vrije Universiteit, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, Amsterdam, The Netherlands
| | - Wouter H. Bos
- grid.16872.3a0000 0004 0435 165XAmsterdam Rheumatology and Immunology Center, Reade, Admiraal Helfrichstraat 1, 1056 AA Amsterdam, The Netherlands
| | - Marieke M. ter Wee
- grid.509540.d0000 0004 6880 3010Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Societal Participation in Health, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Ngan Kee R, Milne V, Dalbeth N, Grainger R. Patient participation in defining best-practice rheumatology service provision in Aotearoa New Zealand: a qualitative study with service consumers. BMC Rheumatol 2023; 7:1. [PMID: 36694263 PMCID: PMC9872402 DOI: 10.1186/s41927-022-00319-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/02/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Aotearoa New Zealand (AoNZ) has no agreed models for rheumatology service provision in government-funded health care. We aimed to describe what people with inflammatory rheumatic diseases who have used rheumatology services view as being important in those services, and map these views to previously collated statements describing best practice components of rheumatology services from international recommendations. If these statements did not capture all service aspects that people with inflammatory rheumatic diseases considered important, we aimed to co-create new statements with our patient-participants. METHODS We conducted one focus group and an interview with people with inflammatory rheumatic disease who had used a government-funded rheumatology service in the previous 5 years (patient-participants) and analysed data using thematic analysis. The research team mapped subthemes to previously collated best practice recommendations that had been included in a Delphi consensus exercise with rheumatologists in AoNZ and proposed new statements, based on patient-participant data. Patient-participant feedback on thematic analysis and the new statements led to a refining of statements. A patient-partner in the research team informed research design and data analysis. RESULTS Patient-participants viewed it as highly valuable for rheumatology services to respect and value their experiences as people and patients, and those of their whānau (Māori word for family). They expected rheumatology services to provide the right care, at the right time. Many of the subthemes mapped to the best-practice statements. However, three new principles and three new statements were developed and refined by patient-participants. The three principles addressed valuing individuals, and their whānau (family) and their experiences, and providing a patient-focused health system that supports patient participation in decision-making and self-management, and patient education. New statements related to having a specific rheumatologist and other staff for comprehensive care, having adequate nurse staffing, and active provision of outside services and support. CONCLUSION It was important to patients that rheumatology services demonstrated that patients and their whānau (family) were valued. The inclusion of people with rheumatic diseases who are users of rheumatology services in service development can provide valuable insights to inform how services should be delivered.
Collapse
Affiliation(s)
- Rachel Ngan Kee
- grid.29980.3a0000 0004 1936 7830Department of Medicine, University of Otago Wellington, 23a Mein St, PO Box 7343, Newtown, Wellington South 6242 New Zealand
| | | | - Nicola Dalbeth
- grid.9654.e0000 0004 0372 3343Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand ,grid.414057.30000 0001 0042 379XDepartment of Rheumatology, Auckland District Health Board, Auckland, New Zealand
| | - Rebecca Grainger
- grid.29980.3a0000 0004 1936 7830Department of Medicine, University of Otago Wellington, 23a Mein St, PO Box 7343, Newtown, Wellington South 6242 New Zealand ,grid.413663.50000 0001 0842 2548Wellington Regional Rheumatology Unit, Hutt Valley District Health Board, Lower Hutt, New Zealand
| |
Collapse
|
8
|
Guaracha-Basáñez GA, Contreras-Yáñez I, Estrada-González VA, Estrada-González VA, Valverde-Hernández SS, Hernández-Molina G, Pascual-Ramos V. Comparison of Teleconsultations and In-Person Consultations from Outpatients with Rheumatoid Arthritis, During the COVID-19 Pandemic: An Internal Audit of Medical Notes. Telemed J E Health 2022; 28:1835-1842. [PMID: 35506921 DOI: 10.1089/tmj.2022.0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction: The objectives of this study were to compare the quality-of-care and compliance with medical record regulations between in-person consultations (QIP and CIP) and telephone consultations (QTP and CTP), from rheumatoid arthritis (RA) outpatients, during the COVID-19 pandemic, and to explore the impact of the consultation modality on the treatment. Methods: Data from 324 medical notes corresponding to rheumatic consultations between July and December 2020 were abstracted. Notes were selected considering a stratified (in-person and telephone consultations) random sampling strategy. QIP, CIP, QTP, and CTP were scored based on prespecified criteria as percentages, where higher numbers translated into better standards. Logistic regression analysis investigated the association between the consultation modality and the treatment recommendation (dependent variable). Results: There were 208 (64.2%) medical notes related to in-person consultations and 114 (35.2%) to telephone consultations. Overall, medical notes corresponded to middle-aged women with long-standing disease. QIP was superior to QTP (median, interquartile range): 60% (60-75%) versus 50% (25-60%), p ≤ 0.001, and differences were related to disease activity and prognosis documentation (81.3% vs. 34.5% and 55.8% vs. 33.6%, respectively, p ≤ 0.001) and the prolonged prescription of glucocorticoids with a documented management plan (58.5% vs. 30.4%, p = 0.045). Meanwhile, CIP and CTP were similar. Telephone consultation was a significant risk factor for no changes in the treatment recommendation (odds ratio: 2.113, 95% confidence interval: 1.284-3.479, p = 0.003), and results were consistent in the 142 medical notes with documented absence of disease activity. Conclusions: In the clinical context of RA, the quality-of-care provided by telephone consultations is below the standard of care and impacts the treatment.
Collapse
Affiliation(s)
- Guillermo A Guaracha-Basáñez
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Irazú Contreras-Yáñez
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Vivian A Estrada-González
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Vivian A Estrada-González
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Salvador S Valverde-Hernández
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Gabriela Hernández-Molina
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| |
Collapse
|
9
|
Seppen B, Wiegel J, ter Wee MM, van Schaardenburg D, Roorda LD, Nurmohamed MT, Boers M, Bos WH. Smartphone-Assisted Patient-Initiated Care Versus Usual Care in Patients With Rheumatoid Arthritis and Low Disease Activity: A Randomized Controlled Trial. Arthritis Rheumatol 2022; 74:1737-1745. [PMID: 35818342 PMCID: PMC9826407 DOI: 10.1002/art.42292] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/14/2022] [Accepted: 06/02/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We developed a smartphone application for patients with rheumatoid arthritis (RA) that allows them to self-monitor their disease activity in between clinic visits by answering a weekly Routine Assessment of Patient Index Data 3. This study was undertaken to assess the safety (noninferiority in the Disease Activity Score in 28 joints using the erythrocyte sedimentation rate [DAS28-ESR]) and efficacy (reduction in number of visits) of patient-initiated care assisted using a smartphone app, compared to usual care. METHODS A 12-month, randomized, noninferiority clinical trial was conducted in RA patients with low disease activity and without treatment changes in the past 6 months. Patients were randomized 1:1 to either app-supported patient-initiated care with a scheduled follow-up consultation after a year (app intervention group) or usual care. The coprimary outcome measures were noninferiority in terms of change in DAS28-ESR score after 12 months and the ratio of the mean number of consultations with rheumatologists between the groups. The noninferiority limit was 0.5 difference in DAS28-ESR between the groups. RESULTS Of the 103 randomized patients, 102 completed the study. After a year, noninferiority in terms of the DAS28-ESR score was established, as the 95% confidence interval (95% CI) of the mean ΔDAS28-ESR between the groups was within the noninferiority limit: -0.04 in favor of the app intervention group (95% CI -0.39, 0.30). The number of rheumatologist consultations was significantly lower in the app intervention group compared to the usual care group (mean ± SD 1.7 ± 1.8 versus 2.8 ± 1.4; visit ratio 0.62 [95% CI 0.47, 0.81]). CONCLUSION Patient-initiated care supported by smartphone self-monitoring was noninferior to usual care in terms of the ΔDAS28-ESR and led to a 38% reduction in rheumatologist consultations in RA patients with stable low disease activity.
Collapse
Affiliation(s)
- Bart Seppen
- Reade Rheumatology, and the Department of RheumatologyAmsterdam UMC, VU University Medical CenterAmsterdamThe Netherlands
| | - Jimmy Wiegel
- Reade Rheumatology, and the Department of RheumatologyAmsterdam UMC, VU University Medical CenterAmsterdamThe Netherlands
| | - Marieke M. ter Wee
- Department of Epidemiology and Data ScienceAmsterdam UMC, VU University Medical CenterAmsterdamThe Netherlands
| | - Dirkjan van Schaardenburg
- Reade Rheumatology, and the Department of RheumatologyAmsterdam UMC, Academic Medical CenterAmsterdamThe Netherlands
| | | | - Michael T. Nurmohamed
- Reade Rheumatology, and the Department of RheumatologyAmsterdam UMC, VU University Medical CenterAmsterdamThe Netherlands
| | - Maarten Boers
- Reade Rheumatology, and the Department of Epidemiology and Data ScienceAmsterdam UMC, VU University Medical CenterAmsterdamThe Netherlands
| | | |
Collapse
|
10
|
E-Health and its therapeutic applications in rheumatology. Joint Bone Spine 2022; 89:105405. [DOI: 10.1016/j.jbspin.2022.105405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/31/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022]
|
11
|
MacBrayne A, Marsh W, Humby F. Review: Remote disease monitoring in rheumatoid arthritis. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_142_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
12
|
Doumen M, Westhovens R, Pazmino S, Bertrand D, Stouten V, Neys C, Creten N, Van Laeken E, Verschueren P, De Cock D. The ideal mHealth-application for rheumatoid arthritis: qualitative findings from stakeholder focus groups. BMC Musculoskelet Disord 2021; 22:746. [PMID: 34461875 PMCID: PMC8406841 DOI: 10.1186/s12891-021-04624-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Shifts in treatment strategies for rheumatoid arthritis (RA) have made ambulatory care more labour-intensive. These developments have prompted innovative care models, including mobile health (mHealth) applications. This study aimed to explore the perceptions of mHealth-inexperienced stakeholders concerning these applications in RA care. Methods We performed a qualitative study by focus group interviews of stakeholders including RA patients, nurses specialised in RA care and rheumatologists. The qualitative analysis guide of Leuven (QUAGOL), which is based on grounded theory principles, was used to thematically analyse the data. In addition, the Persuasive Systems Design (PSD) model was used to structure recommended app-features. Results In total, 2 focus groups with nurses (total n = 16), 2 with patients (n = 17) and 2 with rheumatologists (n = 25) took place. Six overarching themes emerged from the analysis. Efficiency of care and enabling patient empowerment were the two themes considered as expected benefits of mHealth-use in practice by the stakeholders. In contrast, 4 themes emerged as possible barriers of mHealth-use: the burden of chronic app-use, motivational aspects, target group aspects, and legal and organisational requirements. Additionally, recommendations for an ideal mHealth-app could be structured into 4 domains (Primary Task Support, Dialogue Support, Social Support and System Credibility) according to the PSD-framework. Most recommended features were related to improving ease of use (Task Support) and System Credibility. Conclusions Although mHealth-apps were expected to improve care efficiency and stimulate patient empowerment, stakeholders were concerned that mHealth-app use could reinforce negative illness behaviour. For mHealth-apps to be successful in practice, challenges according to stakeholders were avoiding long-term poor compliance, finding the target audience and tailoring a legal and organisational framework. Finally, the ideal mHealth-application should above all be trustworthy and easy to use. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04624-8.
Collapse
Affiliation(s)
- Michaël Doumen
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium. .,Rheumatology, University Hospitals Leuven, Leuven, Belgium.
| | - René Westhovens
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium.,Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Sofia Pazmino
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Delphine Bertrand
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Veerle Stouten
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Claudia Neys
- Patient Experts Rheumatology, ReumaNet, Leuven, Belgium
| | - Nelly Creten
- Patient Experts Rheumatology, ReumaNet, Leuven, Belgium
| | | | - Patrick Verschueren
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium.,Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Diederik De Cock
- Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| |
Collapse
|
13
|
Lambrecht A, Vuillerme N, Raab C, Simon D, Messner EM, Hagen M, Bayat S, Kleyer A, Aubourg T, Schett G, Hueber A, Knitza J. Quality of a Supporting Mobile App for Rheumatic Patients: Patient-Based Assessment Using the User Version of the Mobile Application Scale (uMARS). Front Med (Lausanne) 2021; 8:715345. [PMID: 34368202 PMCID: PMC8339429 DOI: 10.3389/fmed.2021.715345] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/28/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction: Mobile applications promise to improve current health care. However, current mobile app quality ratings are mostly physician-based. The aim of this study was (1) to assess the quality of the self-management app Rheuma Auszeit using the validated uMARS (User Version of the Mobile App Rating Scale) app quality assessment tool and (2) to evaluate the association between uMARS scores and patients' characteristics. Materials and Methods: Consecutive patients with rheumatoid arthritis, psoriatic arthritis and spondyloarthritis were seen at the rheumatology clinic at university hospital Erlangen, Germany. They were asked to test Rheuma Auszeit, evaluate its quality using uMARS and complete a paper-based survey evaluating the individual preferences, attitudes and ehealth literacy. The association between uMARS scores and patients' characteristics was further explored. Results: Between December 2018 and January 2019, a total of 126 patients evaluated Rheuma Auszeit using uMARS and filled out the paper-based survey. The median uMARS score was 3.9, IQR 0.7. Functionality was the domain with the highest rating (median 4.8, IQR 0.8), followed by aesthetics (median 4.0, IQR 0.7), information (median 3.5, IQR 0.8), and engagement (median 3.2, IQR 1.0). Subjective quality was average (median 3.0, IQR 1.0). The lowest scoring individual item was customization with a median of 2.5/5. Lower functionality scores were reported among older female rheumatic patients (P < 0.004). Older male rheumatic patients reported a higher subjective quality score (P < 0.024). Perceived disease activity and disease duration did not significantly correlate with any uMARS subdomain scores. eHealth literacy significantly correlated with functionality uMARS subdomain ratings (Rho = 0.18; P < 0.042). Preferred time of app usage significantly correlated with engagement (Rho = 0.20; P < 0.024), functionality (Rho = 0.19; P < 0.029), total uMARS score (Rho = 0.21; P < 0.017) and subjective quality score (Rho = 0.21; P < 0.017). The vast majority of rheumatic patients would consider recommending Rheuma Auszeit to other patients (117/126; 92.9%). Conclusion: Rheuma Auszeit was well-accepted by German patients suffering from rheumatoid arthritis, psoriatic arthritis and ankylosing spondyloarthritis. Lacking customization could lead to low app compliance and should be improved. Lower functionality scores among older female rheumatic patients highlight the need for patient education. The study underlines the potential and feasibility of therapeutic complementary digital solutions in rheumatology.
Collapse
Affiliation(s)
- Antonia Lambrecht
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Nicolas Vuillerme
- Université Grenoble Alpes, AGEIS, Grenoble, France
- LabCom Telecom4Health, Univ. Grenoble Alpes & Orange Labs, Grenoble, France
- Institut Universitaire de France, Paris, France
| | - Christina Raab
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Eva-Maria Messner
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Melanie Hagen
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Sara Bayat
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Timothée Aubourg
- Université Grenoble Alpes, AGEIS, Grenoble, France
- LabCom Telecom4Health, Univ. Grenoble Alpes & Orange Labs, Grenoble, France
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Axel Hueber
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Université Grenoble Alpes, AGEIS, Grenoble, France
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| |
Collapse
|
14
|
Mair J, Woolley M, Grainger R. Abrupt change to telephone follow-up clinics in a regional rheumatology service during COVID-19: analysis of treatment decisions. Intern Med J 2021; 51:960-964. [PMID: 34155761 PMCID: PMC8447013 DOI: 10.1111/imj.15336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/24/2021] [Accepted: 04/13/2021] [Indexed: 01/21/2023]
Abstract
During the 2020 COVID‐19 lockdown our rheumatology service provided follow up by phone. We reviewed clinic documents to compare patients serviced, and patient assessment and treatment outcomes. More patients received care during the lockdown but patient rheumatic disease was deemed active less frequently, more patients had no change to disease‐modifying anti‐rheumatic drugs and patients were less likely to have an intervention arranged. This suggests careful patient selection and appropriate infrastructure should be part of future rheumatology telemedicine.
Collapse
Affiliation(s)
- Jonathan Mair
- Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Michelle Woolley
- Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Rebecca Grainger
- Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand.,Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| |
Collapse
|
15
|
Cavagna L, Zanframundo G, Codullo V, Pisu MG, Caporali R, Montecucco C. Telemedicine in rheumatology: a reliable approach beyond the pandemic. Rheumatology (Oxford) 2021; 60:366-370. [PMID: 32893293 PMCID: PMC7499691 DOI: 10.1093/rheumatology/keaa554] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/28/2020] [Indexed: 12/13/2022] Open
Abstract
Objectives The SARS-CoV-2 outbreak has imposed considerable restrictions on people’s mobility, which affects the referral of chronically ill patients to health care structures. The emerging need for alternative ways to follow these patients up is leading to a wide adoption of telemedicine. We aimed to evaluate the feasibility of this approach for our cohort of patients with CTDs, investigating their attitude to adopting telemedicine, even after the pandemic. Methods We conducted a telephonic survey among consecutive patients referred to our CTD outpatients’ clinic, evaluating their capability and propensity for adopting telemedicine and whether they would prefer it over face-to-face evaluation. Demographical and occupational factors were also collected, and their influence on the answers has been evaluated by a multivariate analysis. Results A total of 175 patients answered our survey (M/F = 28/147), with a median age of 62.5 years [interquartile range (IQR) 53–73]. About 80% of patients owned a device allowing video-calls, and 86% would be able to perform a tele-visit, either alone (50%) or with the help of a relative (36%). Telemedicine was considered acceptable by 78% of patients and 61% would prefer it. Distance from the hospital and patient’s educational level were the strongest predictive factors for the acceptance of telemedicine (P < 0.05), whereas age only affected the mastering of required skills (P < 0.001). Conclusion Telemedicine is a viable approach to be considered for routine follow-up of chronic patients, even beyond the pandemic. Our data showed that older patients would be willing to use this approach, although a proper guide for them would be required.
Collapse
Affiliation(s)
- Lorenzo Cavagna
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo, Pavia
| | | | - Veronica Codullo
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo, Pavia
| | - Maria Grazia Pisu
- Associazione Lombarda Malati Reumatici, ALOMAR, c/o Hospital G. Pini-CTO
| | - Roberto Caporali
- Rheumatology Division, Hospital G. Pini-CTO, University of Milan, Milan, Italy
| | | |
Collapse
|
16
|
Self-Management of Rheumatoid Arthritis: Mobile Applications. Curr Rheumatol Rep 2020; 23:2. [DOI: 10.1007/s11926-020-00968-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 02/07/2023]
|
17
|
Grainger R, Townsley HR, Stebbings S, Harrison AA, Taylor WJ, Stamp LK. Codevelopment of Patient Self-Examination Methods and Joint Count Reporting for Rheumatoid Arthritis. ACR Open Rheumatol 2020; 2:705-709. [PMID: 33200883 PMCID: PMC7738803 DOI: 10.1002/acr2.11197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/09/2020] [Indexed: 12/15/2022] Open
Abstract
Objective To determine whether training increases accuracy of self‐reported joint counts in people with rheumatoid arthritis (RA) and describe the knowledge and techniques for self‐examination of joints for reporting of RA disease activity. Methods This mixed‐methods study included 10 patients with RA and four rheumatologists. A rheumatologist presented about joint inflammation and disease monitoring in RA. Patients then self‐examined and reported 28‐tender joint count (28‐TJC) and 28‐swollen joint count (28‐SJC). Next, two paired rheumatologists examined patients and reported 28‐TJC and 28‐SJC. After watching a joint examination video for training physicians, patients discussed their training needs for self‐examination, with discussion analyzed using thematic analysis. Self‐examination techniques were determined by consensus. Finally, patients self‐examined and reported 28‐TJC and 28‐SJC. Reliability between the first and second patient‐reported 28‐TJCs and 28‐SJCs and rheumatologist pair‐reported 28‐TJC and 28‐SJC was determined with the intraclass coefficient. Results The reliability for patient self‐reported joint counts was higher for the 28‐TJC than for the 28‐SJC. Reliability improved following rheumatologist examination and training. Patients identified a preference for practical information rather than detailed information on joint anatomy and pathophysiology. Clear definitions of “swollen” and “tender” were important; patients found the concept of “tenderness” difficult. Techniques for self‐examination and reporting of joint counts were agreed on and demonstrated in an instructional video. Conclusion Training increased reliability of patient‐reported joint counts. Patients with RA identified important aspects of training for self‐examination and reporting of joint counts. An 8‐minute instructional video was codeveloped; the next step is the evaluation of the video’s impact on patient‐reported joint counts.
Collapse
Affiliation(s)
- Rebecca Grainger
- University of Otago, Wellington, New Zealand.,Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | | | - Simon Stebbings
- University of Otago, Dunedin School of Medicine, New Zealand.,Dunedin Hospital, Dunedin, New Zealand
| | - Andrew A Harrison
- University of Otago, Wellington, New Zealand.,Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - William J Taylor
- University of Otago, Wellington, New Zealand.,Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Lisa K Stamp
- University of Otago, Christchurch, New Zealand.,Christchurch Hospital, Christchurch, New Zealand
| |
Collapse
|
18
|
Seppen BF, Wiegel J, L'ami MJ, Duarte Dos Santos Rico S, Catarinella FS, Turkstra F, Boers M, Bos WH. Feasibility of Self-Monitoring Rheumatoid Arthritis With a Smartphone App: Results of Two Mixed-Methods Pilot Studies. JMIR Form Res 2020; 4:e20165. [PMID: 32955447 PMCID: PMC7536594 DOI: 10.2196/20165] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 01/16/2023] Open
Abstract
Background Several mobile apps that monitor symptoms of rheumatoid arthritis (RA) exist, but a recent systematic review indicated that high-quality apps are lacking. When patients self-monitor their own disease with patient-reported outcomes (PROs) and self-initiate care at the right moment, it may be possible to reduce the frequency of their clinic visits, which would reduce health care burden and costs. We developed an app, that is, the MijnReuma Reade app, for this purpose and performed 2 pilot tests with weekly self-monitoring. Objective The primary objective of this study was to design, develop, and evaluate the usability, satisfaction, and usage of the MijnReuma Reade app—an app that allows patients with RA to monitor their own disease. The secondary objective was to review the patients’ perspectives on app usage and its intended purpose. Methods This app was designed in collaboration with patients with RA, rheumatologists, and information technology experts. Two 1-month pilot studies were performed, after which satisfaction (0-10 scale), usability (system usability scale, 0-100), and usage (proportion of completed questionnaires) of this app were assessed. After the second pilot study, semistructured interviews were performed to determine patients’ perspectives and the promoters and barriers of app usage. Results In the first and second pilot study, 42 and 27 patients were included, respectively. Overall, the patients were satisfied (medians, 8 and 7) and found the app usable (mean system usability scores, 76 and 71) in pilot studies 1 and 2, respectively. App usage declined over time in both the pilot studies; 61% (17/28) and 37% (10/27) of the patients who disclosed their usage statistics completed the final weekly questionnaire in pilot study 1 and pilot study 2, respectively. Approximately 81% (25/31) of the patients indicated they would like to skip hospital visits if the self-monitored disease activity is low. In the semistructured interviews, technical problems, internal resistance (respondent fatigue, the app reminded them of their disease), and a lack of symptoms were identified as barriers for usage. Patients reported that “experiencing more grip on their disease” and “improved communication with their physician” were promoters for usage. Patients reported that pain positively mediated usage, that is, more pain promoted and less pain discouraged app usage. Conclusions This study illustrates the feasibility of the MijnReuma Reade app that enables self-monitoring of the disease activity in patients with RA with the overarching aim to allocate clinical consultations according to need. Satisfaction with the app and usability of the app were found to be high; however, app usage declined over time. Patients acknowledged the potential of the app to self-monitor their own disease and would like to be able to skip clinic visits if the monitored disease activity is low. To evaluate this strategy, a randomized controlled trial is underway.
Collapse
Affiliation(s)
- Bart F Seppen
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands.,Department of Rheumatology, VU Medical Center, Amsterdam UMC, Amsterdam, Netherlands
| | - Jimmy Wiegel
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands.,Department of Rheumatology, VU Medical Center, Amsterdam UMC, Amsterdam, Netherlands
| | - Merel J L'ami
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | | | | | - Franktien Turkstra
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Maarten Boers
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands.,Department of Epidemiology & Biostatistics, Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Wouter H Bos
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| |
Collapse
|
19
|
Ingegnoli F, Schioppo T, Ubiali T, Bollati V, Ostuzzi S, Buoli M, Caporali R. Relevant non-pharmacologic topics for clinical research in rheumatic musculoskeletal diseases: The patient perspective. Int J Rheum Dis 2020; 23:1305-1310. [PMID: 32757261 DOI: 10.1111/1756-185x.13932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/03/2020] [Accepted: 07/13/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The research approach on rheumatic musculoskeletal diseases (RMDs) is challenging and patient involvement is an emerging issue to obtain relevant information to research. Despite growing interest in non-pharmacologic aspects of clinical research in RMDs, the patients' perspectives are currently poorly explored. METHODS A cross-sectional no-profit online survey was devised to identify and rank the priorities for clinical research in RMDs according to patients' perspectives. Patients were asked to rate the following topics: food/nutrition, air pollution, smoking, work activity, social participation, physical activity, emotional well-being/stress, alternative medicine, and patient-physician relationship. The survey was disseminated by ALOMAR (Lombard Association for Rheumatic Diseases) between June and October 2019. RESULTS Two hundred RMD patients completed the survey. The topic most rated 188 (94%) was the doctor-patient relationship, considered very or extremely important. Other topics rated as follows: psychological well-being 185 (92.5%), physical activity 155 (77.5%), nutrition, eating habits 150 (75%), alternative therapies 144 (72%), work activity 144 (72%), environmental pollution 134 (67%), social life 121 (60.5%) and cigarette smoke 119 (59.5%). The topics considered relevant were perceived to be able to influence disease symptoms. Environmental pollution and smoking were considered the most important for RMD prevention in 43.3% and 48.7% respectively. CONCLUSIONS This survey highlights the relevance of several unmet needs and indicates that active patient involvement is essential to design successful translational studies and improve clinical outcomes.
Collapse
Affiliation(s)
- Francesca Ingegnoli
- Division of Clinical Rheumatology, ASST Pini-CTO, Milano, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
| | - Tommaso Schioppo
- Division of Clinical Rheumatology, ASST Pini-CTO, Milano, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
| | - Tania Ubiali
- Division of Clinical Rheumatology, ASST Pini-CTO, Milano, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
| | - Valentina Bollati
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy.,EPIGET - Epidemiology, Epigenetics and Toxicology Lab, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Silvia Ostuzzi
- ALOMAR Lombard Association for Rheumatic Diseases, Milan, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, ASST Pini-CTO, Milano, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
| |
Collapse
|