POS1444 ADOPTION OF DIGITAL MANIKINS TO SELF-REPORT PAIN: A SYSTEMATIC REVIEW

Background:

Chronic pain is common in rheumatic and musculoskeletal conditions, and a major driver of disability worldwide. Knowledge gaps exist with respect to correct estimates of chronic pain [1], what causes it and how best to manage it [2]. To address this, researchers need validated methods to measure pain in large, representative populations. Though many authors have recognised the potential benefits of paper-based and digital pain manikins [3]–[5], it is unknown to what extent studies have adopted digital manikins as a data collection tool.

Objectives:

The objective of our review was to identify and characterise published studies that have used digital pain manikins as a data collection tool.

Methods:

We systematically searched six electronic databases, including Medline, CINAHL, Embase, Scopus, IEEE Xplore digital library, ACM Digital Library, on 3-4 of November 2020 by using a pre-defined search strategy. We included a study in our review if it used a digital manikin for self-reporting any pain aspect (e.g., intensity, type) by people suffering from pain, and if its full text was published in English. We conducted this review by following the PRISMA reporting guidelines and conducted a descriptive synthesis of findings, including manikin-derived outcome measures.

Results:

Our search yielded 4,685 unique studies. After full text screening of 705 articles, we included 14 studies in our review. Most articles were excluded because they used either paper-based manikins or didn’t include enough details to determine that the manikin was digital (n=386). The majority of included studies were published in Europe (n=11). Most studies collected data on a manikin once (n=11); from people with pain conditions (n=9); and in clinical settings (n=9). There was only one study that collected digital pain manikin data in a large sized (i.e., ~20,000) population-based survey.

In most studies participants shaded any painful area on manikin (n=9) and did not enable participants to record location-specific pain aspects (n=11). None of the manikins enabled participants to record location-specific pain intensity. Pain distribution (i.e. number or percentage of pre-defined body areas or locations experiencing pain) and pain extent (i.e. number or percentage of shaded pixels) were commonly used manikin-derived outcome measures. In six studies, a heat map was used to summarise the extent of pain across the population.

Conclusion:

Digital pain manikins have been available since the 1990s but their adoption in research has been slow. Few manikins enabled location-specific pain recording suggesting that the digital nature of the manikin is not yet fully utilised. Future development of a validated digital pain manikin supporting self-reporting of the location and intensity of pain, usable across any device and screen size, may increase uptake and value.

References:

[1]S. E. E. Mills, K. P. Nicolson, and B. H. Smith, “Chronic pain: a review of its epidemiology and associated factors in population-based studies,” Br. J. Anaesth., vol. 123, no. 2, pp. e273–e283, Aug. 2019.

[2]D. B. Reuben et al., “National Institutes of Health Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain,” Ann. Intern. Med., vol. 162, no. 4, p. 295, Feb. 2015.

[3]R. Waller, P. Manuel, and L. Williamson, “The Swindon Foot and Ankle Questionnaire: Is a Picture Worth a Thousand Words?,” ISRN Rheumatol., vol. 2012, pp. 1–8, 2012.

[4]M. Barbero et al., “Clinical Significance and Diagnostic Value of Pain Extent Extracted from Pain Drawings: A Scoping Review,” Diagnostics, vol. 10, no. 8, p. 604, Aug. 2020.

[5]S. M. Ali, W. J. Lau, J. McBeth, W. G. Dixon, and S. N. van der Veer, “Digital manikins to self-report pain on a smartphone: A systematic review of mobile apps,” Eur. J. Pain, vol. 25, no. 2, pp. 327–338, Feb. 2021.

Disclosure of Interests:

None declared

AB1154 EHR-INTEGRATED PATIENT-GENERATED HEALTH DATA FOR SYMPTOM MONITORING IN LONG-TERM CONDITIONS: A SYSTEMATIC REVIEW

Background:

Patients with long-term conditions (LTCs), including many RMDs, often require continuous management of care. Patient-generated health data (PGHD) collected between visits could inform ongoing care management and provide important insights into patient health and well-being. There is increasing interest in integrating PGHD in electronic health records (EHRs). However, integration is still largely aspirational with limited evidence of successful systems.

Objectives:

To map the landscape of EHR-integrated remote symptom monitoring systems in the field of LTCs. The objectives were to 1) characterise state of the art systems, 2) describe their clinical use, and 3) outline anticipated and realized benefits for clinical practice.

Methods:

A systematic search was conducted in three electronic databases up until November 2019. Titles and abstracts were independently screened by two reviewers. One reviewer screened full-text articles, identified those relevant for review and extracted data. Inclusion criteria included 1) symptom reporting systems in adult patients suffering a LTC, 2) integration of data into the EHR, 3) symptom data collected remotely, 4) evidence of use in clinical care. We did not exclude studies based on study design, quality, or sample size. Synthesis focused on describing system specifications and their use. For objective three we adopted a list of outcome indicators [1], which each of the studies were assessed against.

Results:

The initial search yielded 2040 articles. Only 12 studies reporting on ten unique systems were identified. Two systems were used in rheumatology, but the majority were used in oncology. Systems were highly heterogeneous in terms of technical and functional specifications. Nine systems were fully integrated (data viewable in the EHR) while the remaining system represented a partial integration (data viewable via link in the EHR). Five systems allowed repeated data collection at pre-defined intervals between visits with frequencies varying from daily to monthly. The remaining five made a single request before a scheduled clinic visit. The number of items requested from patients ranged from 9-48 per session. We identified three different clinical workflows: Simple (data only used during consultation, n=5), moderate (real-time alerts for providers when severe symptoms were reported, n=4) and on-demand (patient-initiated visits, n=1). Benefits of symptom reporting from each of the studies were categorised as anticipated, realized quantitative, and realized qualitative. We present summarised counts of these benefits in Figure 1. The most common anticipated benefits were better communication, changes to patient management and improved health outcomes. Most common realized benefits were detecting unrecognised problems and changes to patient management.

Figure 1.

Summarized counts of benefits from each included study assessed against Chen et al.’s 10 outcome indicators. Categorized in anticipated (orange), realized quantitative (light purple), and realized qualitative benefits (dark purple).

Conclusion:

There is growing interest and urge for integrating symptom data in the EHR and clinical care. Yet, this review has illustrated that there are limited published efforts to learn from. The heterogeneity in approaches underpins the need for a common framework. There is growing evidence from qualitative work in support of remote symptom-reporting in enabling better and patient-centred care in LTCs. The next step will be for robust, quantitative studies to provide evidence of benefits.

References:

[1]Chen J, Ou L, Hollis SJ. A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting. BMC Health Serv Res. 2013 Jun 11;13:211.

Disclosure of Interests:

Julie de Fonss Gandrup: None declared, Syed Mustafa Ali: None declared, Sabine van der Veer: None declared, John McBeth: None declared, William Dixon Consultant of: Bayer and Google

Systematic review of outcome measures following chemoradiotherapy for the treatment of anal cancer (CORMAC)

AIM

Six Phase III randomized trials have determined the effectiveness of chemoradiotherapy as primary treatment for anal squamous cell carcinoma (ASCC), but outcomes reported in these trials varied widely, hindering evidence synthesis. To improve reporting in all future trials, we aim to develop a core outcomes set (COS). As the first stage of COS development, we undertook a systematic review to summarize the outcomes reported in studies evaluating chemoradiotherapy for ASCC.

METHOD

Systematic literature searches identified studies evaluating radiotherapy or chemoradiotherapy for ASCC. Outcomes and accompanying definitions were extracted verbatim and categorized into domains.

RESULTS

From 5170 abstracts, we identified 95 eligible studies, reporting 1192 outcomes and 533 unique terms. We collapsed these terms into 86 standardized outcomes and five domains: survival; disease activity; life impact [including quality of life (QoL)]; delivery of care; and toxicity. The most commonly reported domains were survival and disease activity, reported in 74 (86%) and 54 (62%) studies, respectively. No outcome was reported in every publication. Over half (43/86) of the standardized outcome terms were reported in fewer than five studies, and 21 (25%) were reported in a single study only. There was wide variation in definitions of disease-free survival, colostomy-free survival and progression-free survival (PFS). Anal continence was reported in only 35 (41%) studies.

CONCLUSION

Outcomes reported in studies evaluating chemoradiotherapy for ASCC were heterogenous and definitions varied widely. Outcomes likely to be important to patients, such as ano-rectal function, toxicity and QoL, have been neglected. A COS for future trials will address these issues.