Background Rheumatoid arthritis (RA) and other rheumatic diseases (RD) are associated with depression, fatigue, and disturbed sleep, symptoms that often impact behavior. Recent advances in reality mining technology combined with the growing use of smartphones have shown measurable changes in phone behavior due to health issues like depression, stress, and influenza. It is unclear if this technology could provide results that could be adopted for improved management of RD patient care.
Objectives To determine the feasibility of a smartphone app for longitudinal collection of RD patient reported outcomes (PROs).
Methods In Sep 2013 we invited 700 randomly-selected participants from the Arthritis Internet Registry and the National Data Bank for Rheumatic Diseases, large US observational registries of RD patients who complete semiannual comprehensive questionnaires, who indicated owning a smartphone and being interested in this study. After providing consent, patients were asked to download our app and to complete daily two visual analog scale (VAS) questions on pain and global disease assessment and weekly 12 questions from the Patient Activity Scale-II (PAS-II). After two months, the daily questions ceased while the weekly PAS-II questions continued for 4 more months. We examined the impact of baseline socioeconomics, diagnosis, and clinical status on participation through multivariable logistic regressions. Passive data collected by the app included distance traveled, number of unique calls and text messages, call durations, call counts, and number of missed calls.
Results Of the 9183 patients surveyed in 2013, only 3204 (35%) reported owning a smartphone. While lower than the national average (∼60%), this was significantly associated with age and income. Of the 700 patients invited, 189 (27%) successfully downloaded the app and submitted PRO data. See Table for socioeconomic and diagnosis breakdown by participation status. Only age was significantly associated with participation. From followup (N=117), 90% thought the daily survey was not burdensome and 62% thought sharing this data with their doctor would improve management of their RD. As of 2014, 7.7K daily and 2.2K weekly surveys were completed with a median (IQR) pain VAS of 3 (1.5, 4.5). Early results show high pain is associated with missed calls, shorter call length, and greater phone mobility. Final results will be available in spring 2014.
Conclusions We showed that RD patients using a smartphone survey app differed primarily by age. While preliminary results associate smartphone behavior with disease activity, future clinical use may be limited by patient access.
Disclosure of Interest None declared
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