Monitoring chronic inflammatory musculoskeletal diseases mixing virtual and face-to-face assessments—Results of the digireuma study

Abstract

Mobile health technology holds great promise for the clinical management of patients with chronic disease. However, evidence on the implementation of projects involving digital health solutions in rheumatology is scarce. We aimed to study the feasibility of a hybrid (virtual and face-to-face) monitoring strategy for personalized care in rheumatoid arthritis (RA) and spondyloarthritis (SpA). This project included the development of a remote monitoring model and its assessment. After a focus group with patients and rheumatologists, relevant concerns regarding the management of RA and SpA were raised, leading to the development of the Mixed Attention Model (MAM), which combined hybrid (virtual and face-to-face) monitoring. Then, a prospective study using the mobile solution Adhera for Rheumatology was conducted. Over a 3-month follow-up period, patients were given the opportunity to complete disease-specific electronic patient reported outcomes (ePROs) for RA and SpA with a pre-established frequency, as well as flares and changes in medication at any time. Number of interactions and alerts were assessed. The usability of the mobile solution was measured by the Net-Promoter Score (NPS) and through a 5-star Likert scale. Following the MAM development, forty-six patients were recruited to utilize the mobile solution, of whom 22 had RA and 24 SpA. There were 4,019 total interactions in the RA group, and 3,160 in the SpA group. Fifteen patients generated a total of 26 alerts, of which 24 were flares and 2 were medication-related problems; most (69%) were managed remotely. Regarding patient satisfaction, 65% of the respondents were considered to have endorsed Adhera for Rheumatology, yielding a NPS of 57 and an overall rating was 4.3 out of 5 stars. We concluded that the use of the digital health solution is feasible in clinical practice to monitor ePROs for RA and SpA. Next steps involve the implementation of this telemonitoring method in a multicentric setting. Author summary There has been an exponential growth in the use of communication technologies to support diagnosis, monitoring or treatment in recent years. In rheumatology, the use of mobile applications, provides an opportunity to improve disease management through the collection of large amounts of data. This can be done using electronic patient-reported-outcomes (ePROs). Here, we present the development and implementation of a mobile solution and a hybrid care model. We found the use of ePROs feasible to monitor disease activity, flares and problems with the medication in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA). Our study provides new insights into the use of digital health technology in rheumatology, highlighting the importance of the involvement of both healthcare professionals and patients the implementation of mobile health in clinical practice