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Smartphone-Assisted Patient-Initiated Care Versus Usual Care in Patients With Rheumatoid Arthritis and Low Disease Activity: A Randomized Controlled Trial.
Seppen, Bart; Wiegel, Jimmy; Ter Wee, Marieke M; van Schaardenburg, Dirkjan; Roorda, Leo D; Nurmohamed, Michael T; Boers, Maarten; Bos, Wouter H.
  • Seppen B; Reade Rheumatology, and the Department of Rheumatology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.
  • Wiegel J; Reade Rheumatology, and the Department of Rheumatology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.
  • Ter Wee MM; Department of Epidemiology and Data Science, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.
  • van Schaardenburg D; Reade Rheumatology, and the Department of Rheumatology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.
  • Roorda LD; Reade Rehabilitation, Amsterdam, The Netherlands.
  • Nurmohamed MT; Reade Rheumatology, and the Department of Rheumatology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.
  • Boers M; Reade Rheumatology, and the Department of Epidemiology and Data Science, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.
  • Bos WH; Reade Rheumatology, Amsterdam, The Netherlands.
Arthritis Rheumatol ; 74(11): 1737-1745, 2022 11.
Article in English | MEDLINE | ID: covidwho-2127571
ABSTRACT

OBJECTIVE:

We developed a smartphone application for patients with rheumatoid arthritis (RA) that allows them to self-monitor their disease activity in between clinic visits by answering a weekly Routine Assessment of Patient Index Data 3. This study was undertaken to assess the safety (noninferiority in the Disease Activity Score in 28 joints using the erythrocyte sedimentation rate [DAS28-ESR]) and efficacy (reduction in number of visits) of patient-initiated care assisted using a smartphone app, compared to usual care.

METHODS:

A 12-month, randomized, noninferiority clinical trial was conducted in RA patients with low disease activity and without treatment changes in the past 6 months. Patients were randomized 11 to either app-supported patient-initiated care with a scheduled follow-up consultation after a year (app intervention group) or usual care. The coprimary outcome measures were noninferiority in terms of change in DAS28-ESR score after 12 months and the ratio of the mean number of consultations with rheumatologists between the groups. The noninferiority limit was 0.5 difference in DAS28-ESR between the groups.

RESULTS:

Of the 103 randomized patients, 102 completed the study. After a year, noninferiority in terms of the DAS28-ESR score was established, as the 95% confidence interval (95% CI) of the mean ΔDAS28-ESR between the groups was within the noninferiority limit -0.04 in favor of the app intervention group (95% CI -0.39, 0.30). The number of rheumatologist consultations was significantly lower in the app intervention group compared to the usual care group (mean ± SD 1.7 ± 1.8 versus 2.8 ± 1.4; visit ratio 0.62 [95% CI 0.47, 0.81]).

CONCLUSION:

Patient-initiated care supported by smartphone self-monitoring was noninferior to usual care in terms of the ΔDAS28-ESR and led to a 38% reduction in rheumatologist consultations in RA patients with stable low disease activity.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Arthritis, Rheumatoid / Antirheumatic Agents Type of study: Cohort study / Experimental Studies / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Arthritis Rheumatol Year: 2022 Document Type: Article Affiliation country: Art.42292

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Arthritis, Rheumatoid / Antirheumatic Agents Type of study: Cohort study / Experimental Studies / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Arthritis Rheumatol Year: 2022 Document Type: Article Affiliation country: Art.42292