A Smartphone App for Self-Monitoring of Rheumatoid Arthritis Disease Activity to Assist Patient-Initiated Care: Protocol for a Randomized Controlled Trial

Seppen, Bart F; l’Ami, M.; Rico, Sharon Duarte dos Santos; Wee, Marieke M. ter; Turkstra, Franktien; Roorda, Leo D.; Catarinella, Fabio S.; Schaardenburg, Dirkjan van; Nurmohamed, Michael T.; Boers, Maarten; Bos, Wouter H

doi:10.2196/15105

Cited by 19 publications

(24 citation statements)

References 25 publications

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“…Fewer consultations, however, may also delay biological tapering or treatment when necessary. The safety and cost-effectiveness of this form of monitoring mHealth is currently investigated in two RCTs [ 20 , 39 ]. We anticipate that the use of monitoring mHealth interventions (telemonitoring) will increase based on the increasing number of studies performed with mHealth and the increasing use of smartphones in the population.…”

Section: Discussionmentioning

confidence: 99%

Asynchronous mHealth Interventions in Rheumatoid Arthritis: Systematic Scoping Review

Seppen¹,

Boer²,

Wiegel³

et al. 2020

JMIR Mhealth Uhealth

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Background Mobile devices such as smartphones and tablets have surged in popularity in recent years, generating numerous possibilities for their use in health care as mobile health (mHealth) tools. One advantage of mHealth is that it can be provided asynchronously, signifying that health care providers and patients are not communicating in real time. The integration of asynchronous mHealth into daily clinical practice might therefore help to make health care more efficient for patients with rheumatoid arthritis (RA). The benefits have been reviewed in various medical conditions, such as diabetes and asthma, with promising results. However, to date, it is unclear what evidence exists for the use of asynchronous mHealth in the field of RA. Objective The objective of this study was to map the different asynchronous mHealth interventions tested in clinical trials in patients with RA and to summarize the effects of the interventions. Methods A systematic search of Pubmed, Scopus, Cochrane, and PsycINFO was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were initially screened and later assessed by two independent researchers. Disagreements on inclusion or exclusion of studies were resolved by discussion. Results The literature search yielded 1752 abstracts. After deduplication and screening, 10 controlled intervention studies were included. All studies were assessed to be at risk for bias in at least one domain of the Cochrane risk-of-bias tool. In the 10 selected studies, 4 different types of mHealth interventions were used: SMS reminders (to increase medication adherence or physical activity; n=3), web apps (for disease monitoring and/or to provide medical information; n=5), smartphone apps (for disease monitoring; n=1), and pedometers (to increase and track steps; n=1). Measured outcomes varied widely between studies; improvements were seen in terms of medication compliance (SMS reminders), reaching rapid remission (web app), various domains of physical activity (pedometer, SMS reminders, and web apps), patient-physician interaction (web apps), and self-efficacy (smartphone app). Conclusions SMS reminders, web apps, smartphone apps, and pedometers have been evaluated in intervention studies in patients with RA. These interventions have been used to monitor patients or to support them in their health behavior. The use of asynchronous mHealth led to desirable outcomes in nearly all studies. However, since all studies were at risk of bias and methods used were very heterogeneous, high-quality research is warranted to corroborate these promising results.

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Section: Discussionmentioning

confidence: 99%

Asynchronous mHealth Interventions in Rheumatoid Arthritis: Systematic Scoping Review

Seppen¹,

Boer²,

Wiegel³

et al. 2020

JMIR Mhealth Uhealth

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“…The 3 phases were as follows: (1) setting design requirements, building the prototype, and the first evaluation, (2) improvement of the prototype and re-evaluation, (3) further improvement of the app and a randomized controlled trial. Phase 3 has been described previously [ 6 ].…”

Section: Methodsmentioning

confidence: 99%

“…mHealth promises to provide medical support for patients through mobile devices such as smartphones or tablets [ 2 ]. In rheumatology, we can use mHealth to enable patients to self-monitor their own conditions with patient-reported outcomes (PROs) [ 3 - 5 ], which in turn could support self-initiated care [ 6 ]. Most patients visit their rheumatologist every 3-6 months to evaluate disease activity [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Self-Monitoring Rheumatoid Arthritis With a Smartphone App: Results of Two Mixed-Methods Pilot Studies

Seppen¹,

Wiegel²,

l’Ami³

et al. 2020

JMIR Form Res

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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.

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“…Therefore, this digital tool has the potential to generate a twofold positive impact on healthcare systems. First, it may help to reduce direct costs by lowering face-to-face consultations and by preventing unnecessary control visits [51], patient travel, and work leaves [52]. Second, it may improve the quality of the public health service offered to patients.…”

Section: Discussionmentioning

confidence: 99%

“…Second, it may improve the quality of the public health service offered to patients. In this sense, there is an urgent need to enhance the management provided in primary care for individuals with hand rheumatic conditions [53], because most of the interventions used in the clinical setting are not based on current evidence and clinical guidelines [52]. This gap between evidence-based and reported practice may lead to a large dissatisfaction in patients with RA [54], preventing some of them to attend to primary care even if they are severely affected and show functional difficulties [55,56].…”

Section: Discussionmentioning

confidence: 99%

A mobile app using therapeutic exercise and education for self-management in patients with hand rheumatoid arthritis: a randomized controlled trial protocol

Sánchez-Laulhé

Romero

Blanquero

et al. 2020

Trials

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Background Therapeutic exercise is a safe and cost-effective approach to alleviate hand rheumatoid arthritis (RA)-related symptoms. This study aims to investigate the differences in self-management between a smartphone app (CareHand), using hand exercises and educational advices, compared with a standard approach, on hand overall function, pain intensity, stiffness, and grip and pinch strength in patients with hand RA. Methods The project is a prospective, longitudinal, superiority, randomized controlled trial. Fifty-eight participants with hand RA will be randomly assigned into an experimental group (CareHand app) or a control group (conventional treatment). Control intervention involves a paper sheet with exercises and recommendations, and the experimental group includes the use of a smartphone app, which provides individualized exercise programs, self-management, and educational strategies to promote adherence to treatment. Both intervention protocols will last for 3 months. The principal investigator will conduct an educational session at baseline for all participants. Primary outcome comprises the overall hand function, assessed with the Michigan Hand Outcome Questionnaire (MHQ). Secondary outcomes include self-reported functional ability with the Quick DASH questionnaire, self-reported pain intensity and morning stiffness using a Visual Analogue Scale (VAS), and hand grip and pinch strength (dynamometer). Outcome measures will be collected at baseline, and at 1 month and 3-month follow-up. Discussion This study will evaluate the effectiveness of a tele-rehabilitation tool, which uses exercise and self-management strategies, compared to a conventional approach, in patients with hand RA. The smartphone app will allow to monitor the patient’s status and to enhance patient-therapist communication. Some limitations may be related to the short follow-up duration and the lack of evaluation of psychosocial factors. Overall, this new way of promoting long-term effects in patients with a chronic rheumatic disease could be feasible and easy to implement in daily life clinical practice and current musculoskeletal care. Trial registration ClinicalTrials.gov NCT04263974. Registered on 7 March 2020. Date of last update 15 April 2020. Ethics committee code: PI_RH_2018.

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A Smartphone App for Self-Monitoring of Rheumatoid Arthritis Disease Activity to Assist Patient-Initiated Care: Protocol for a Randomized Controlled Trial

Cited by 19 publications

References 25 publications

Asynchronous mHealth Interventions in Rheumatoid Arthritis: Systematic Scoping Review

Asynchronous mHealth Interventions in Rheumatoid Arthritis: Systematic Scoping Review

Feasibility of Self-Monitoring Rheumatoid Arthritis With a Smartphone App: Results of Two Mixed-Methods Pilot Studies

A mobile app using therapeutic exercise and education for self-management in patients with hand rheumatoid arthritis: a randomized controlled trial protocol

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