Earlier studies revealed that visual feedback has contributed in the management of neuromuscular as well as psychiatric disorders; however, it has not yet been applied in rheumatology. Visual feedback is a relatively new tool that enables the patient to visualize as well as monitor a real-time change of their disease activity parameters as well as the patient's reported outcome measures. Integrating electronic data recording in the standard rheumatology clinical practice made visual feedback possible. To evaluate the feasibility of using the visual feedback in patients with early inflammatory arthritis (EA) and how ubiquitous computing technology can improve the patients' compliance and adherence to therapy, this was a double-blind randomized controlled study, which included 111 patients diagnosed to have EA according to the new ACR/EULAR criteria. All patients received disease-modifying antirheumatic drugs (DMARDs) therapy and monitored regularly over the period of 1 year. By the 6th month of treatment, the patients were randomly allocated to an active group (55 patients) to whom the visual feedback (visualization of charts showing the progression of disease activity parameters) was added to their management protocol, and a control group (56 patients) who continued their standard management protocols. The patients were monitored for another 6-months period. All the patient's disease activity parameters, patient reported outcome measures (PROMs), medications, scores of falls, and cardiovascular risks were recorded electronically. Primary outcome was the change in the patients' adherence to their medications, disease activity score (DAS-28), and PROMs: pain score, patient global assessment, functional disability, and quality of life. Secondary outcome was the answers to a questionnaire completed by every patient in both the active group and control group (using Visual Analogue Scale) by the end of 1 year of management, to rate from the patient's perspective the impact of the management protocol, whether using the standard or visual feedback approach, on them and their disease. The visual feedback provided a significant greater reduction in disease activity parameters as well as improvement of the patients' adherence to antirheumatic therapy (P < 0.01). Also stopping the DMARDs therapy because of intolerance was significantly less in the active group. Concerns about the future was significantly less in the active group whereas inability to coup with daily life and disease stress were significantly more among the control group. The improvement of disease activity parameters was associated with improvement in functional disability and quality of life scores. Mean changes in disease parameters showed no significant differences at 3-6 months of therapy but differences were statistically significant at 12-months follow-up (P < 0.01). Medication compliance was significantly correlated with changes in all measured disease parameters. By recording and monitoring disease activity parameters electronically and incorporating ...

We found ePROM equivalent to standard paper PROM format. Further, it enabled the patients to personally monitor how they are doing regarding their disease activity and helped to optimize their adherence to their treatment.

a b s t r a c tBackground: Early in the development of geriatric medicine, falls were identified as a "geriatric giant", a nonspecific indicator of functional decompensation. This led to the notion of "falls prevention services", and the concept that identification of those patients at high risk of falls is essential to approach this group of elderly people. Objective: This work was carried out aiming to develop a model that predicts falls risk for both in-as well as outpatients using clinical variables that are easily assessed in clinical practice. Study Design: A case-control study to determine the risk factors and the prediction rule of falls risk among older people. Methods: Three hundred and seventy-three outpatients and 186 inpatients, with a minimum age of 65 years, were assessed for falls risk factors. The clinical characteristics with independent predictive value for the development of falls were selected using logistic regression analysis. The diagnostic performance of the prediction rule was evaluated using the area under the curve. Cross-validation controlled for over fitting of the data (internal validation) was also carried out. Results: The prediction rule consisted of five clinical variables: history of falls in the last 12 months, slowing of the walking speed/change in gait, history of loss of balance in the last 12 months, and impaired sight and weak hand grip. The prediction score ranged from 0 to 6.5, and corresponded to the percent chance of sustaining a fall. For several cutoff values, the positive and negative predictive values were determined. The area under the curve values for the prediction rule was 0.89. Conclusion: In elderly people, the risk of sustaining a fall can be predicted, thereby allowing individualized decisions regarding the patient's management. Falls risk assessment score is a new self-reported tool that can be used in standard clinical practice by all health care professionals both in the outpatient and the acute hospital inpatient settings. Assessing for the falls risk would help to minimize the negative impact of falling on the patient's physical, psychological, and social functional abilities.

Background Rheumatology is embarking on a fundamental redesign of rheumatic disease care. It became mandatory not only to recognize disease activity core set data, but also the risks for other co-morbidities associated with the disease. Measurement of patient reported outcomes have become critical in both standard clinical practice and long term observational studies. Objectives to assess validity; reliability and responsiveness to change of a patient self-reported outcome measures (PROMs) questionnaire which can assess construct outcome measures of SLE patients. Methods The PROMs was conceptualized based on frameworks used by the WHO Quality of Life tool, as well as the PRO measurement information system (PROMIS). Cognitive interviews were conducted with 36 SLE patients (diagnosed according to ACR criteria), with a range of severity and disease activity to identify item pool of questions. Item selection and reduction was achieved based on patients as well as an interdisciplinary group of physicians, nurses, and health educators, in addition to clinometric and psychometric methods. The latter included Rasch and internal consistency reliability analyses. The questionnaire includes assessment for functional disability, quality of life, VAS for pain, global status, fatigue, duration of morning stiffness, SLE manifestations, lupus medications as well as review of the systems including the falls and cardiovascular risks, self-helplessness and self-reported joint pain. SLEDAI, SF-36 and Euro QoL 5D were assessed for every patient. Results The questionnaire was reliable as demonstrated by a high-standardized alpha (0.894-0.971). The questionnaire items correlated significantly (P< 0.01) with clinical parameters of disease activity. Patient reported tender joints correlated significantly with the physician’s scores (r= 0.842). Content construct assessment of the PROMs-functional disability and QoL revealed significant correlation (P< 0.01) with both SF-36 and Euro QoL respectively. Changes in parameters of disease activity, SLE systemic manifestations, functional disability, quality of life as well as self-helplessness scores showed significant (P< 0.01) variation with diseases activity status. Mean time to complete the PROMs was 7.01 + 0.92 min. The PROMs questionnaire showed also a high degree of comprehensibility (9.3). Conclusions Integrating patient reported outcome measures into standard clinical practice is feasible and applicable. This version of multidimensional SLE-PROMs questionnaire was found to be valid and reliable. It provides informative quantitative measure for the disease activity core set data, and in the meantime, facilitates assessing the patient’s disease activity, health related quality of life measure, cardiovascular and falls risks on individual basis. Disclosure of Interest: None Declared

Rheumatoid arthritis (RA) has considerable personal impact for sufferers and their families. Those with RA suffer from pain, restricted joint movements, and fatigue, and can have problems with self-esteem and body image. It is also possible that medication causes sexual problems. Research on the subject is limited, and shows a divergent picture. Assessment for sexual dysfunction in clinical practice might be another hurdle, as patients and health professionals are reluctant to discuss this issue face to face. The aim of the work carried out and described in this article was to study the possibility of implementing sexual dysfunction assessment into standard rheumatology clinical practice. Results revealed that the multidimensional patient-reported outcome measures questionnaire offered the opportunity to assess the disease activity parameters, functional disability, quality of life, sexual dysfunction, and self-helplessness in one format. The patients appeared willing to complete questionnaires and this may be an acceptable tool for assessment. Improving patient education, as well as nurse-patient communication, through discussions about available options may minimize patients' feelings of isolation in addressing the problem and could help compensate for negative effects resulting from the disease.