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Labinsky H, May S, Boy K, von Rohr S, Grahammer M, Kuhn S, Rojas-Restrepo J, Vogt E, Heinze M, Schett G, Muehlensiepen F, Knitza J. Evaluation of a hybrid telehealth care pathway for patients with axial spondyloarthritis including self-sampling at home: results of a longitudinal proof-of-concept mixed-methods study (TeleSpactive). Rheumatol Int 2024; 44:1133-1142. [PMID: 38602534 PMCID: PMC11108867 DOI: 10.1007/s00296-024-05581-w] [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: 02/19/2024] [Accepted: 03/12/2024] [Indexed: 04/12/2024]
Abstract
Patients with axial spondyloarthritis (axSpA) require close monitoring to achieve the goal of sustained disease remission. Telehealth can facilitate continuous care while relieving scarce healthcare resources. In a mixed-methods proof-of-concept study, we investigated a hybrid telehealth care axSpA pathway in patients with stable disease over 6 months. Patients used a medical app to document disease activity (BASDAI and PtGA bi-weekly, flare questionnaire weekly). To enable a remote ASDAS-CRP (TELE-ASDAS-CRP), patients used a capillary self-sampling device at home. Monitoring results were discussed and a decision was reached via shared decision-making whether a pre-planned 3-month on-site appointment (T3) was necessary. Ten patients completed the study, and eight patients also completed additional telephone interviews. Questionnaire adherence was high; BASDAI (82.3%), flares (74.8%) and all patients successfully completed the TELE-ASDAS-CRP for the T3 evaluation. At T3, 9/10 patients were in remission or low disease activity and all patients declined the offer of an optional T3 on-site appointment. Patient acceptance of all study components was high with a net promoter score (NPS) of +50% (mean NPS 8.8 ± 1.5) for self-sampling, +70% (mean NPS 9.0 ± 1.6) for the electronic questionnaires and +90% for the T3 teleconsultation (mean NPS 9.7 ± 0.6). In interviews, patients reported benefits such as a better overview of their condition, ease of use of telehealth tools, greater autonomy, and, most importantly, travel time savings. To our knowledge, this is the first study to investigate a hybrid approach to follow-up axSpA patients including self-sampling. The positive results observed in this scalable proof-of-concept study warrant a larger confirmatory study.
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Affiliation(s)
- Hannah Labinsky
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
- Department of Internal Medicine 2, Rheumatology/Clinical Immunology, University Hospital Würzburg, Oberdürrbacher Straße 6, Würzburg, Germany.
| | - Susann May
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | - Katharina Boy
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | - Sophie von Rohr
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Manuel Grahammer
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Abaton GmbH, Berlin, Germany
| | - Sebastian Kuhn
- Institute for Digital Medicine, University Hospital of Giessen and Marburg, Marburg, Germany
| | | | | | - Martin Heinze
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Hospital Rüdersdorf, Rüdersdorf, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Internal Medicine 2, Rheumatology/Clinical Immunology, University Hospital Würzburg, Oberdürrbacher Straße 6, Würzburg, Germany
| | - Felix Muehlensiepen
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- AGEIS, Université Grenoble Alpes, Grenoble, France
| | - Johannes Knitza
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Internal Medicine 2, Rheumatology/Clinical Immunology, University Hospital Würzburg, Oberdürrbacher Straße 6, Würzburg, Germany
- AGEIS, Université Grenoble Alpes, Grenoble, France
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Oliveira TL, Silva FD, Filho AGO, Nico MAC, Fernandes ARC, Ramiro S, Pinheiro MM. Relationship between spinal structural damage and sagittal balance in axial spondyloarthritis: Is the thoracic spine the starting point? Semin Arthritis Rheum 2024; 65:152415. [PMID: 38340611 DOI: 10.1016/j.semarthrit.2024.152415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES To assess the relationship between spinal structural damage, sagittal balance parameters and spine curvatures in patients with axial spondyloarthritis (axSpA). MATERIAL AND METHODS In this cross-sectional study, the pelvic and sagittal balance parameters were obtained through EOS® (Biospace, Paris, France). Patients were divided into three groups according to the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) tertiles (G1 ≤6, n = 36; G2: 6.1-31, n = 36; G3 >31, n = 35) and pelvic and sagittal parameters were compared across them. Multivariable regression analysis was performed to analyze the impact of spinal structural damage and of other factors on sagittal vertical axis (SVA), an important sagittal balance parameter. RESULTS A total of 107 patients was included. G2 and 3 exhibited higher mean values of thoracic kyphosis T1-T12 when compared to G1 (10.5°(12.3) vs. 22.3°(17.3) vs. 35.2°(14.6), p < 0.001), and G3 demonstrated lumbar L1-S1 straightening compared to the other groups (55.7°(9) and 50.7°(19.8), G1 and G2, respectively, vs. 35.7°(13.2), p < 0.001). Mean SVA values showed an increasing gradient from G1 to G3 (21.6(25.1) vs. 41(44.3) vs. 84.3(47.2)mm, p < 0.001). In the multivariable regression, a one-unit increase in total mSASSS was associated with an average 0.8 mm higher SVA. CONCLUSIONS Our data showed that more spinal structural damage is associated with a higher SVA, reflecting poorer sagittal balance. Patients with increasing spinal damage have an important increase in thoracic kyphosis suggesting that postural modifications in patients with axSpA might have their origin in the thoracic spine.
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Affiliation(s)
- Thauana L Oliveira
- Rheumatology Division, Federal University of São Paulo/ Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Flávio D Silva
- Diagnostic Imaging Department, Federal University of São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil; Diagnostic Imaging Department, Fleury Medicina e Saúde, São Paulo, Brazil
| | - Alípio G O Filho
- Diagnostic Imaging Department, Fleury Medicina e Saúde, São Paulo, Brazil
| | - Marcelo A C Nico
- Diagnostic Imaging Department, Fleury Medicina e Saúde, São Paulo, Brazil
| | - Artur R C Fernandes
- Diagnostic Imaging Department, Federal University of São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Sofia Ramiro
- Department of Rheumatology, The Netherlands and Zuyderland Medical Center, Leiden University Medical Center, Heerlen, the Netherlands
| | - Marcelo M Pinheiro
- Rheumatology Division, Head of Spondyloarthritis Section, Federal University of São Paulo/ Escola Paulista de Medicina (UNIFESP/EPM), Rua Borges Lagoa, 913/ 53, Vila Clementino, São Paulo, SP CEP 04038-034, Brazil.
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Kiefer D, Schneider L, Braun J, Kiltz U, Kolle N, Andreica I, Tsiami S, Buehring B, Sewerin P, Herbold S, Baraliakos X. Impact of daily physical therapy over 2 weeks on spinal mobility including objective electronic measurements and function in patients with axial spondyloarthritis. Ther Adv Musculoskelet Dis 2024; 16:1759720X231224212. [PMID: 38404654 PMCID: PMC10894534 DOI: 10.1177/1759720x231224212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/11/2023] [Indexed: 02/27/2024] Open
Abstract
Background Patients with axial spondyloarthritis (axSpA) are often compromised by impaired function and mobility. The standardized 2-week inpatient program 'multimodal rheumatologic complex treatment' (MRCT) was designed for patients with axSpA. The Epionics SPINE (ES) is an objective tool validated to assess mobility. Objective To investigate the impact of MRCT on physical function and mobility including range of motion (RoM) and kinematics (RoK). Design Single-center interventional, observational trial. Methods Patients with axSpA presenting with high disease activity and impaired physical function were consecutively recruited to undergo MRCT. Assessments performed before (V1) and after (V2) the intervention included Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis functional index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), the ankylosing spondylitis physical performance index (ASPI), the Short Physical Performance Battery (SPPB), and ES measurements. Results At baseline, the 80 patients included had: BASDAI 5.5 ± 1.5, BASFI 5.6 ± 2.0, BASMI 4.2 ± 1.8, SPPB 13.8 ± 1.8, and ASPI 37.3 ± 18.1 s. Clinically relevant improvements between V1 versus V2 were noted for BASFI, BASMI, and all other assessments (p < 0.001), and also for ES measures of RoK (all p < 0.003) and RoM (all p < 0.04), while a positive trend was seen for flexion and extension (RoM). There was no significant effect of changes in medication (all p > 0.05). Conclusion The 2-weeks MRCT was associated with definite improvements of function and mobility. Importantly, the effect of this extensive physical activity was confirmed by using the ES as an objective tool to assess spinal mobility. The ES demonstrated for the first time that the RoK of spinal mobility can significantly improve related to an exercise intervention. Trial registration Ethical Committee: Ruhr-Universität (reference-number: 19-6735-BR).
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Affiliation(s)
- David Kiefer
- Ruhr-University Bochum, Bochum, Rheumazentrum Ruhrgebiet, Claudiusstrasse 45, Herne 44649, Germany
| | - Lucia Schneider
- Ruhr-Universität Bochum, Herne, Rheumazentrum Ruhrgebiet, Germany
| | - Juergen Braun
- Ruhr-Universität Bochum, Herne, Rheumazentrum Ruhrgebiet, Germany
| | - Uta Kiltz
- Ruhr-Universität Bochum, Herne, Rheumazentrum Ruhrgebiet, Germany
| | - Niklas Kolle
- Ruhr-Universität Bochum, Herne, Rheumazentrum Ruhrgebiet, Germany
| | - Ioana Andreica
- Ruhr-Universität Bochum, Herne, Rheumazentrum Ruhrgebiet, Germany
| | - Styliani Tsiami
- Ruhr-Universität Bochum, Herne, Rheumazentrum Ruhrgebiet, Germany
| | - Bjoern Buehring
- Bergisches Rheuma-Zentrum Wuppertal, Ruhr-Universität Bochum, Herne, Nordrhein-Westfalen, Germany
| | - Philipp Sewerin
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Germany Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Germany
| | - Susanne Herbold
- Ruhr-Universität Bochum, Herne, Rheumazentrum Ruhrgebiet, Germany
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Kiefer D, Schneider L, Braun J, Kiltz U, Kolle N, Andreica I, Tsiami S, Buehring B, Sewerin P, Herbold S, Baraliakos X. Clinically relevant differences in spinal mobility related to daytime performance in patients with axial spondyloarthritis. RMD Open 2024; 10:e003733. [PMID: 38191214 PMCID: PMC10806495 DOI: 10.1136/rmdopen-2023-003733] [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: 09/18/2023] [Accepted: 11/30/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVE Patients with axial spondyloarthritis (axSpA) suffer from clinical symptoms like morning stiffness and back pain. Mobility of patients with axSpA is often impaired. The aim of this study is to compare the performance of patients with axSpA regarding mobility measures including performance-based tests and objective electronic assessments with the Epionics SPINE device (ES) at different times of the day compared with healthy controls (HC). METHODS Observational trial, consecutive inpatients with axSpA (n=100) and 20 HCs were examined in the morning (V1: before 10:00 am) and in the afternoon (V2: after 02:00 pm) by the Bath Ankylosing Spondylitis Metrology Index (BASMI), the AS physical performance index (ASPI), the Short Physical Performance Battery (SPPB) and ES measurements, including range of motion (RoM) and range of kinematics (RoK). RESULTS The assessments of patients with axSpA performed in the morning clearly differed from those in the afternoon, especially regarding performance-based tests. Significant improvements were seen for BASMI (4.0±3.8 to 3.8±1.9; p<0.001), ASPI (36.2±18.3 to 28.8±11.9 s; p<0.001), SPPB (10.1±1.5 to 10.7±1.4 points; p<0.001) and for ES measures of speed (RoK; p<0.018) but not for RoM, except for lateral flexion (13.3±7.4 to 14.7±8.2°; p=0.002). This time of assessment-related variability was not observed in HC. CONCLUSION The spinal mobility of patients with axSpA was worse in the morning but significantly improved in the afternoon. This was captured best by performance-based measures and was not seen in HC. The diurnal variation of mobility has implications for clinical studies, suggesting that the time of assessments needs to be standardised.
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Affiliation(s)
- David Kiefer
- Rheumatologie, Ruhr-Universitat Bochum, Bochum, Germany
- Rheumatologie, Rheumazentrum Ruhrgebiet, Herne, NRW, Germany
| | - Lucia Schneider
- Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Jürgen Braun
- Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Uta Kiltz
- Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
- Rheumazentrum Ruhrgebiet, Herne, Nordrhein-Westfalen, Germany
| | - Niklas Kolle
- Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Ioana Andreica
- Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
- Rheumazentrum Ruhrgebiet, Herne, Nordrhein-Westfalen, Germany
| | - Styliani Tsiami
- Rheumazentrum Ruhrgebiet, Herne, Nordrhein-Westfalen, Germany
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
| | | | - Philipp Sewerin
- Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Susanne Herbold
- Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
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Kiefer D, Braun J, Chatzistefanidi V, Kiltz U, Adolf D, Schwarze I, Kabelitz M, Lange U, Brandt-Jürgens J, Stemmler E, Sartingen S, Baraliakos X. Clinical Relevance of Axial Radiographic Damage in Axial Spondyloarthritis: Evaluation of Functional Consequences by an Objective Electronic Device. J Rheumatol 2023; 50:1422-1429. [PMID: 37061230 DOI: 10.3899/jrheum.2022-1240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVE Axial spondyloarthritis (axSpA) is associated with decreased function and mobility of patients as a result of inflammation and radiographic damage. The Epionics SPINE device (ES), an electronic device that objectively measures spinal mobility, including range of motion (RoM) and speed (ie, range of kinematics [RoK]) of movement, has been clinically validated in axSpA. We investigated the performance of the ES relative to radiographic damage in the axial skeleton of patients with axSpA. METHODS A total of 103 patients with axSpA, 31 with nonradiographic axSpA (nr-axSpA) and 72 with radiographic axSpA (r-axSpA), were consecutively examined. Conventional radiographs of the spine (including presence, number, and location of syndesmophytes) and the sacroiliac joints (SIJs; rated by the modified New York criteria) were analyzed with the ES. Function and mobility were assessed using analyses of covariance and Spearman correlation. RESULTS The number of syndesmophytes correlated positively with Bath Ankylosing Spondylitis Metrology Index scores (r 0.38, P = 0.02) and correlated negatively with chest expansion (r -0.39, P = 0.02) and ES measurements (-0.53 ≤ r ≤ -0.34, all P < 0.03), except for RoM and RoK regarding rotation and RoK for extension of the lumbar and thoracic spines. In the radiographic evaluation of the SIJs, the extent of damage correlated negatively with ES scores and metric measurements (-0.49 ≤ r ≤ -0.33, all P < 0.001). Patients with r-axSpA, as compared to those with nr-axSpA, showed significantly worse ES scores for RoM, RoK, and chest expansion. CONCLUSION The ES scores, in accordance with mobility measurements, correlated well with the presence and extent of radiographic damage in the spine and the SIJs. As expected, patients with r-axSpA had more severe impairments than those with nr-axSpA.
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Affiliation(s)
- David Kiefer
- D. Kiefer, MD, J. Braun, MD, V. Chatzistefanidi, MD, U. Kiltz, MD, X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum;
| | - Jürgen Braun
- D. Kiefer, MD, J. Braun, MD, V. Chatzistefanidi, MD, U. Kiltz, MD, X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum
| | - Varvara Chatzistefanidi
- D. Kiefer, MD, J. Braun, MD, V. Chatzistefanidi, MD, U. Kiltz, MD, X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum
| | - Uta Kiltz
- D. Kiefer, MD, J. Braun, MD, V. Chatzistefanidi, MD, U. Kiltz, MD, X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum
| | - Daniela Adolf
- D. Adolf, PhD, M. Kabelitz, StatConsult, Gesellschaft für klinische und Versorgungsforschung mbH, Magdeburg
| | | | - Maria Kabelitz
- D. Adolf, PhD, M. Kabelitz, StatConsult, Gesellschaft für klinische und Versorgungsforschung mbH, Magdeburg
| | - Uwe Lange
- U. Lange, MD, Rheumatologie und klinische Immunologie Campus Kerckhoff, Bad Nauheim, Universität Gießen, Gießen
| | | | - Edgar Stemmler
- E. Stemmler, PhD, S. Sartingen, PhD, Medical Immunology, AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | - Sabine Sartingen
- E. Stemmler, PhD, S. Sartingen, PhD, Medical Immunology, AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | - Xenofon Baraliakos
- D. Kiefer, MD, J. Braun, MD, V. Chatzistefanidi, MD, U. Kiltz, MD, X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum
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Ermann J. A Move Toward Precision: Innovations in Measuring Spinal Mobility in Axial Spondyloarthritis. J Rheumatol 2023; 50:1362-1363. [PMID: 37778767 DOI: 10.3899/jrheum.2023-0852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Affiliation(s)
- Joerg Ermann
- J. Ermann, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA.
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