scholarly journals Impact of assessing patient-reported outcomes with mobile apps on patient–provider interaction

RMD Open ◽  
2021 ◽  
Vol 7 (1) ◽  
pp. e001566
Author(s):  
Yomei Shaw ◽  
Delphine S Courvoisier ◽  
Almut Scherer ◽  
Adrian Ciurea ◽  
Thomas Lehmann ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Rheumatic Diseases ◽  
Patient Reported Outcomes ◽  
Activity Index ◽  
Mobile Apps ◽  
Disease Activity Index ◽  
Discussion Group ◽  
Patient Reported ◽  
Physician Awareness

ObjectiveTo explore the effect of apps measuring patient-reported outcomes (PROs) on patient–provider interaction in the rheumatic diseases in an observational setting.MethodsPatients in the Swiss Clinical Quality Management in Rheumatic Diseases Registry were offered mobile apps (iDialog and COmPASS) to track disease status between rheumatology visits using validated PROs (Rheumatoid Arthritis Disease Activity Index-5 score, Bath Ankylosing Spondylitis Disease Activity Index score, Routine Assessment of Patient Index Data-3 score and Visual Analogue Scale score for pain, disease activity and skin symptoms). We assessed two aspects of patient–provider interaction: shared decision making (SDM) and physician awareness of disease fluctuations. We used logistic regressions to compare outcomes among patients who (1) used an app and discussed app data with their physician (app+discussion group), (2) used an app without discussing the data (app-only group) or (3) did not use any app (non-app users).Results2111 patients were analysed, including 1799 non-app users, 150 app-only users and 162 app+discussion users (43% male; with 902 patients with rheumatoid arthritis, 766 patients with axial spondyloarthritis and 443 patients with psoriatic arthritis). App users were younger than non-app users (mean age of 47 vs 51 years, p<0.001). Compared with non-app users, the app+discussion group rated their rheumatologist more highly in SDM (OR 1.7, 95% CI 1.1 to 2.4) and physician awareness of disease fluctuations (OR 2.0, 95% CI 1.3 to 3.1). This improvement was absent in the app-only group.ConclusionApp users who discussed app data with their rheumatologist reported more favourably on patient–provider interactions than app users who did not and non-app users. Apps measuring PROs may contribute little to patient–provider interactions without integration of app data into care processes.

scholarly journals “From Where I Stand”: Using Multiple Anchors Yields Different Benchmarks for Meaningful Improvement and Worsening in the Rheumatoid Arthritis Flare Questionnaire (RA-FQ)

2021 ◽  
Author(s):  
Susan J. Bartlett ◽  
Vivian P. Bykerk ◽  
Orit Schieir ◽  
Marie-France Valois ◽  
Janet E Pope ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Global Assessment ◽  
Activity Index ◽  
Disease Activity Index ◽  
Early Arthritis ◽  
Meaningful Change ◽  
Meaningful Improvement ◽  
Patient Reported ◽  
New Evidence

Abstract Purpose The Rheumatoid Arthritis Flare Questionnaire (RA-FQ) is a patient-reported measure of disease activity in RA. We estimated minimal and meaningful change from the perspective of RA patients, physicians, and using a disease activity index. Methods Data were from 3- and 6-month visits of adults with early RA enrolled in the Canadian Early Arthritis Cohort. Participants completed the RA-FQ, the Patient Global Assessment of RA, and Patient Global Change Impression at consecutive visits. Rheumatologists recorded joint counts and MD Global. Clinical Disease Activity Index (CDAI) scores were computed. We compared mean RA-FQ change across categories using patients, physicians, and CDAI anchors. Results The 808 adults were mostly white (84%) women (71%) with a mean age of 55 and moderate-high disease activity (85%) at enrollment. At V2, 79% of patients classified their RA as changed; 59% were better and 20% were worse. Patients reporting they were a lot worse had a mean RA-FQ increase of 8.9 points whereas those who were a lot better had a -6.0 decrease. Minimal worsening and improvement were associated with a mean 4.7 and -1.8 change in RA-FQ, respectively, while patients rating their RA unchanged had stable scores. Physician and CDAI classified more patients as worse than patients, and minimal and meaningful RA-FQ thresholds differed by group. Conclusion Thresholds to identify meaningful change vary by anchor used. These data offer new evidence demonstrating robust psychometric properties of the RA-FQ and offer guidance about improvement or worsening, supporting its use in RA care, research and decision-making.

Performance of the Rheumatoid Arthritis Impact of Disease (RAID) score in relation to other patient-reported outcomes in a register of patients with rheumatoid arthritis

2011 ◽  
Vol 70 (6) ◽  
pp. 1080-1082 ◽  
Author(s):  
Turid Heiberg ◽  
Cathrine Austad ◽  
Tore K Kvien ◽  
Till Uhlig
Keyword(s):  
Rheumatoid Arthritis ◽  
Patient Reported Outcomes ◽  
Activity Index ◽  
Short Form ◽  
Pearson Correlation ◽  
Disease Activity Index ◽  
Postal Survey ◽  
Floor Effect ◽  
Rheumatoid Arthritis Disease ◽  
Patient Reported

ObjectiveDelegates at the Outcome Measures in Rheumatology (OMERACT) 10 conference (Borneo, 4–8 May 2010) questioned how the new seven-domain Rheumatoid Arthritis Impact of Disease (RAID) score performs as a global measure. Score distributions and associations between the RAID score and patient-reported outcomes (PROs) and demographic variables were examined in a large sample of rheumatoid arthritis (RA) patients.Methods1086 patients in the Oslo RA Register responded to a postal survey with commonly used PROs. Bivariate associations between the RAID score and other measures are reported as Pearson correlation coefficients.ResultsThe mean RAID was 3.37±2.17. The distribution of the RAID score showed a slight floor effect: 17.5% had a score between 0 and 1, and 14.4% between 1 and 2, whereas only 1.0% and 0.3% had scores between 8 and 9, and 9 and 10, respectively. Correlations between the RAID score and the patient global assessment, Rheumatoid Arthritis Disease Activity Index, Short-Form (SF)-6D and EQ-5D were 0.82, 0.82, −0.77 and −0.73, respectively. Strong correlation was also seen between RAID and pain, the domain with highest weight, whereas correlations to measures of other RAID domains were moderate. The RAID score was higher in women than men (3.49 vs 2.95, p=0.001).ConclusionThe RAID score was correlated more strongly to other global measures than to PROs, reflecting single health domains.

scholarly journals Is Tightly Controlled Disease Activity Possible with Online Patient-reported Outcomes?

2014 ◽  
Vol 41 (4) ◽  
pp. 640-647 ◽  
Author(s):  
Margot J. Walter ◽  
S.H. Mohd Din ◽  
Johanna M. Hazes ◽  
E. Lesaffre ◽  
P.J. Barendregt ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Patient Reported Outcomes ◽  
Cross Validation ◽  
Activity Index ◽  
Joint Modeling ◽  
Joint Disease ◽  
Rheumatoid Arthritis Disease ◽  
Patient Reported ◽  
Over Time

Objective.To evaluate the performance of patient-reported outcomes (PRO) as primary indices for identification and prediction of a 28-joint Disease Activity Score (DAS28) > 3.2 among patients with rheumatoid arthritis (RA).Methods.Patients with RA completed monthly online PRO [Health Assessment Questionnaire (HAQ), Rheumatoid Arthritis Disease Activity Index (RADAI), visual analog scale (VAS) fatigue] and were clinically assessed every 3 months using the DAS28. Simple descriptive statistics, logistic regression, and the Bayesian joint modeling approach were used to analyze the data. The Bayesian joint model combines the scores and changes in the scores of 3 PRO to predict a DAS28 > 3.2 at the subsequent timepoint.Results.A group of 159 patients with RA participated. Stratified summaries of the PRO by DAS28 categories at baseline provided incremental values of the PRO for more active disease. However, on an individual level, the DAS28 and the PRO fluctuated over time. The prediction of subsequent DAS score by a single instrument at single timepoints resulted in moderate sensitivity and specificity. Using the intercept and slope of the combined PRO of the first 3 measurements to predict the DAS28 state at 3 months resulted in a sensitivity of 0.81 and a specificity of 0.92. After 10-fold cross validation, the model had a sensitivity of 0.61 and specificity of 0.75 to identify patients with a DAS28 > 3.2.Conclusion.PRO showed fluctuating levels of disease activity over time, while on a group level disease activity stayed the same. Using the changes in RADAI, HAQ, and VAS fatigue over time to predict future DAS28 > 3.2 resulted in moderate performance after the internal cross-validation of the model (sensitivity 0.61, specificity 0.75).

scholarly journals POS1460-HPR MYRA TOUCH FOR DISEASE ACTIVITY EVALUATION IN RHEUMATOID ARTHRITIS: A COMPARISON OF PATIENT-REPORTED OUTCOMES WITH PHYSICIAN’S ASSESSMENT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1015.1-1015
Author(s):  
L. H. Eow ◽  
J. Yew ◽  
K. H. Lee ◽  
S. Selvadurai ◽  
S. M. Liau ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Inflammatory Markers ◽  
Patient Reported Outcomes ◽  
Activity Index ◽  
Disease Assessment ◽  
Activity Measurement ◽  
Patient Reported ◽  
Rheumatology Unit ◽  
High Level

Background:Patient-reported outcomes (PROs) have become an essential component of patients’ assessment in the management of Rheumatoid Arthritis(RA).They have been reported to be at least as informative if not more than physician assessed outcomes.MyRA Touch was pioneered by the Rheumatology Unit of Hospital Tuanku Jaa’far in Seremban Malaysia in March 2018,to engage and empower all RA patients on their own disease activity monitoring. It is an electronic platform, designed to enhanced the application of electronic patient reported outcomes (ePROs) among RA patients where they examine and record their own painful and/or swollen joints for DAS28 calculation and report their health assessment through Routine Assessment of Patient Index Data with 3 Measures (RAPID 3).MyRA Touch is an applications (App) that is user friendly and available in four major spoken languages (English, Chinese, Malay and Tamil) with an animated version for patients who are illiterate.Objectives:The objectives of this study are to determine the correlation between:I)Patient-reported and physician reported DAS28 ESR/CRPII)RAPID3 and Clinical Disease activity Index (CDAI)III)RAPID3 and DAS28 ESR/CRP assessed by physician and patientIV)RAPID3 and inflammatory markers ESR/CRP.Methods:This was a cross-sectional study carried out in the Rheumatology Unit of Hospital Tuanku Jaa’far. All data entered through MyRA Touch App from April 2018 till April 2020 was analysed.Results:There were a total of 562 patients who entered the data in the App, 87.9% were women. The ethnic compositions of the study subjects comprised of Indians (36.7%) followed by the Malays (34.7%),Chinese (26.3%) and other ethnics (2.3%). About half of patients (59.8%) were in the 51-70 age group whereas 22.9%,1.8% and 15.5% were in the 31-50,18-30 and above 70 age groups respectively. The majority of our patients (96%) were literate. A total of 54.3% of them received secondary education, 27% primary, 12.2% tertiary and 6.6% did not receive any formal education.There was a high level of correlation between DAS28 ESR/CRP performed by patient and DAS28 ESR/CRP assessed by physician, (r=0.808 for DAS28 ESR and r=0.804 for DAS28 CRP). RAPID3 also showed high level of correlation with CDAI and DAS28 CRP assessed by patient (r=0.700 and r=0.718 respectively). There was a moderate correlation between DAS28 ESR/CRP done by physician with RAPID3 (r=0.656 and r=0.696 respectively).RAPID3 demonstrated little correlation with inflammatory markers ESR and CRP (r=0.141 and r=0.171 respectively).Conclusion:PROs via DAS 28 (ESR/CRP) and RAPID3 showed moderate to high correlation with disease activity assessed by physician. We can empower patients to perform their own disease assessment by using the MyRA Touch App before seeing their physician and the information provided in the App, can help to reduced consultation time. During the COVID-19 pandemic, telemedicine is very much encouraged. By using the MyRA Touch, patients can assess their own tender and swollen joint count on a homunculus, evaluate their own physical function, health and pain using the RAPID3 parameters. The information obtained from the PROs in the MyRA touch App enables the physician to make a more comprehensive virtual assessment of the patient’s condition which helps in treatment decision making. In conclusion, MyRA Touch is an useful tool for disease activity measurement by patient.References:[1]Jenny AA, Diana BC, Omar JC, et al. Usefulness of Patients-Reported Outcomes in Rheumatoid Arthritis Focus Group. Hindawi Publishing Corporation Arthritis, vol 2012,Article ID935187.[2]Ana MO, Clifton OB. Patient Reported Outcomes in Rheumatoid Arthritis Clinical Trials. Curr Rheumato Rep.2015 April;17(4):501.Disclosure of Interests:None declared

Patient adherence with a smartphone app for patient-reported outcomes in rheumatoid arthritis

Rheumatology ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 108-112 ◽  
Author(s):  
Josh Colls ◽  
Yvonne C Lee ◽  
Chang Xu ◽  
Cassandra Corrigan ◽  
Fengxin Lu ◽  
...  
Keyword(s):  
Disease Activity ◽  
Patient Reported Outcomes ◽  
Patient Adherence ◽  
Activity Index ◽  
Disease Activity Index ◽  
Clinical Disease Activity Index ◽  
Clinical Disease ◽  
Clinical Disease Activity ◽  
Patient Reported ◽  
To Receive

Abstract Objectives Electronic patient-reported outcomes (ePROs) transmitted digitally allow patients to communicate with their clinicians and track the activity of chronic diseases, such as RA. Several ePRO smartphone apps have been developed in rheumatology, yet few data have been reported regarding patient adherence. We developed a PRO app for RA and assessed adherence over 6 months. Methods We developed an app to deliver daily assessments to participants (RA App v.1.0). The app was tested as part of a randomized controlled trial examining potential clinical benefits. The current analyses focus on the adherence to the ePRO app for patients randomized to receive the app. We recruited RA patients from an academic rheumatology practice in the USA. Patients randomized to receive the app received daily notifications regarding ePROs. We examined adherence to the PRO questionnaires over the 6-month study and examined factors related to adherence. Results Seventy-eight patients received the app and have data included in these analyses: 63 (80.7%) were female, mean age was 55.2 years, 71% had attended college or beyond, and the mean Clinical Disease Activity Index at baseline was 9.7 (low disease activity). Median adherence to the daily questions was 79% (interquartile range 48–90%). Significant predictors of increased adherence were age ≥65 (P = 0.03) and low baseline Clinical Disease Activity Index (P = 0.02). Conclusion We developed and tested an ePRO app for RA over a 6-month study. Adherence to the app was strong. There was correlation between older age and better disease control and increased adherence. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov/, NCT02822521.

scholarly journals Safety and efficacy of switching from adalimumab to sarilumab in patients with rheumatoid arthritis in the ongoing MONARCH open-label extension

RMD Open ◽  
2019 ◽  
Vol 5 (2) ◽  
pp. e001017 ◽  
Author(s):  
Gerd R Burmester ◽  
Vibeke Strand ◽  
Andrea Rubbert-Roth ◽  
Howard Amital ◽  
Tatiana Raskina ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Activity Index ◽  
Disease Activity Index ◽  
Normative Values ◽  
Open Label ◽  
Double Blind ◽  
Safety And Efficacy ◽  
Patient Reported ◽  
Open Label Extension

ObjectiveEvaluate open-label sarilumab monotherapy in patients with rheumatoid arthritis switching from adalimumab monotherapy in MONARCH (NCT02332590); assess long-term safety and efficacy in patients continuing sarilumab during open-label extension (OLE).MethodsDuring the 48-week OLE, patients received sarilumab 200 mg subcutaneously once every 2 weeks. Safety (March 2017 cut-off) and efficacy, including patient-reported outcomes, were evaluated.ResultsIn the double-blind phase, patients receiving sarilumab or adalimumab monotherapy showed meaningful improvements in disease activity; sarilumab was superior to adalimumab for improving signs, symptoms and physical function. Overall, 320/369 patients completing the 24-week double-blind phase entered OLE (155 switched from adalimumab; 165 continued sarilumab). Sarilumab safety profile was consistent with previous reports. Treatment-emergent adverse events were similar between groups; no unexpected safety signals emerged in the first 10 weeks postswitch. Among switch patients, improvement in disease activity was evident at OLE week 12: 47.1%/34.8% had changes ≥1.2 in Disease Activity Score (28 joints) (DAS28)-erythrocyte sedimentation rate/DAS28-C-reactive protein. In switch patients achieving low disease activity (LDA: Clinical Disease Activity Index (CDAI) ≤10; Simplified Disease Activity Index (SDAI) ≤11) by OLE week 24, 70.7%/69.5% sustained CDAI/SDAI LDA at both OLE weeks 36 and 48. Proportions of switch patients achieving CDAI ≤2.8 and SDAI ≤3.3 by OLE week 24 increased through OLE week 48. Improvements postswitch approached continuation-group values, including scores ≥normative values.ConclusionsDuring this OLE, there were no unexpected safety issues in patients switching from adalimumab to sarilumab monotherapy, and disease activity improved in many patients. Patients continuing sarilumab reported safety consistent with prolonged use and had sustained benefit.

scholarly journals Impact of the COVID-19 pandemic on the disease course of patients with inflammatory rheumatic diseases: results from the Swiss Clinical Quality Management cohort

2020 ◽  
pp. annrheumdis-2020-218705 ◽  
Author(s):  
Adrian Ciurea ◽  
Eleftherios Papagiannoulis ◽  
Kristina Bürki ◽  
Isabell von Loga ◽  
Raphael Micheroli ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Quality Management ◽  
Disease Activity ◽  
Activity Index ◽  
Statistical Significance ◽  
Disease Activity Index ◽  
Inflammatory Rheumatic Diseases ◽  
Disease Course ◽  
Clinical Quality ◽  
Patient Reported

ObjectivesTo investigate whether the transient reduction in rheumatology services imposed by virus containment measures during the COVID-19 pandemic was associated with disease worsening in axial spondyloarthritis (axSpA), rheumatoid arthritis (RA) or psoriatic arthritis (PsA).MethodsPatient-reported disease activity assessed during face-to-face visits and/or via a smartphone application were compared between three periods of each 2 months duration (before, during and after the COVID-19-wave) from January to June 2020 in 666 patients with axSpA, RA and PsA in the Swiss Clinical Quality Management cohort.ResultsThe number of consultations dropped by 52%, whereas the number of remote assessments increased by 129%. The proportion of patients with drug non-compliance slightly increased during the pandemic, the difference reaching statistical significance in axSpA (19.9% vs 13.2% before the pandemic, p=0.003). The proportion of patients with disease flares remained stable (<15%). There was no increase in mean values of the Bath Ankylosing Disease Activity Index, the Rheumatoid Arthritis Disease Activity Index-5 and the Patient Global Assessment in patients with axSpA, RA and PsA, respectively.ConclusionA short interruption of in-person patient–rheumatologist interactions had no major detrimental impact on the disease course of axSpA, RA and PsA as assessed by patient-reported outcomes.

Patient Reported Outcomes (PROs) im rheumatologischen Praxisalltag – App hat sich bewährt

2018 ◽  
Vol 58 (01) ◽  
pp. 52-56
Author(s):  
Sarah Ohrndorf ◽  
Marie-Christin Weber ◽  
Sandra Hermann ◽  
Karlfried Aupperle ◽  
Beate Follendorf ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Rheumatoide Arthritis ◽  
Patient Reported Outcomes ◽  
Activity Index ◽  
Disease Activity Index ◽  
Functional Index ◽  
Patient Reported ◽  
Medizinische Fachangestellte

Zusammenfassung Hintergrund Patient-reported-outcomes (PROs) haben einen zunehmenden Einfluss auf die unmittelbare Therapieentscheidung des Arztes in der klinischen Praxis. Zielstellung Überprüfung der Integration und des Nutzens von elektronisch erhobenen PROs per ScoreCheck Rheuma®-App (SCR App) im klinischen Praxisalltag der rheumatologischen Fachambulanz (Dispensaire) der Charité - Universitätsmedizin Berlin in Hinblick auf Praxistauglich, Patientenakzeptanz und medizinischen Mehrwert. Patienten und Methoden N=190 Patienten (63% weiblich, mittleres Alter: 55 Jahre, min 23-max 82; Diagnosen: 52,9% Rheumatoide Arthritis, 28,6% Spondyloarthritis, 9,3% Kollagenosen, 3,6% Vaskulitis, 5,6% sonstiges) sowie 3 medizinische Fachangestellte (MFA) und 3 Ärzte (Rheumatologen) haben an diesem Pilotprojekt teilgenommen. Die folgenden PROs wurden elektronisch mittels SCR App von den eingeschlossenen Patienten ausgefüllt: FFbH (Funktionsfragebogen Hannover), BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) und BASFI (Bath Ankylosing Spondylitis Functional Index) sowie ein Fragebogen zur Selbsteinschätzung. Zusätzlich wurde für jeden eingeschlossenen Patienten je ein Beurteilungs-Protokoll vom Patienten selbst, von der zuständigen MFA und vom betreuenden Arzt ausgefüllt. Ergebnisse Von den 190 teilnehmenden Patienten gaben 147 (77%) an, Vorerfahrungen mit Touchpad-Geräten zu haben. 96% der Patienten fühlten sich außerdem gut bis sehr gut in die Bedienung des iPADs und der SCR App durch die MFAs eingewiesen und fanden das Ausfüllen der Fragebögen auf dem iPAD einfach; Schwierigkeiten, wie z. B. mit der Schriftgröße, der Handhabung, usw. wurden nur von 10% der Patienten angegeben. Immerhin 74% der Patienten wünschten sich den vermehrten Einsatz elektronischer Hilfsmittel beim Arztbesuch und 75% bevorzugten den Einsatz des iPADs gegenüber dem Ausfüllen der Fragebögen auf Papier. Die MFAs gaben in über 80% der Fälle an, dass die Patienten die Fragebögen zu den PROs ohne oder mit nur wenig Hilfe selbstständig ausfüllen konnten. In ca. 2/3 der Fälle sahen die MFAs Vorteile durch die Anwendung der SCR App sowohl bezüglich der Qualität der Patientenbetreuung als auch bezüglich der Erfassung der Funktionsscores. Die Ärzte sahen in 2/3 der Fälle eher keine Zeitersparnis durch den Einsatz des iPADs. In 78% der Fälle konnte der Patientenscore in das Arzt-Patienten-Gespräch eingebracht werden, jedoch sparte die Anwendung der SCR App nur in 50% der Fälle Zeit im Praxisalltag. Die Ärzte sahen v. a. Vorteile bezüglich der Anamneseerhebung und der Therapieempfehlungen. Schlussfolgerung Insgesamt zeigt das vorgestellte Pilotprojekt zur Anwendung und Integration der SCR App eine gute Resonanz bei den Patienten, MFAs und Ärzten. Die Arztbewertung ergibt, dass durch die SCR App bei jedem zweiten Patienten ein Vorteil bei der Therapieempfehlung gesehen wurde.

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