Background In standard clinical practice, patient-reported outcome measures (PROMs), has gained recognition as a primary end point. Electronic-PROMs (e-PROMs) has the potential to enhance clinical care by closer monitoring of the disease activity and flagging important symptoms in between clinic visits. Also it offers the possibility of setting up a standardized assessment and management service.
Objectives To assess: 1) the facility of using e-PROMs in standard clinical practice for the management of early inflammatory arthritis patients. 2) the ability ePROMs to enhance clinical care by flagging activity peaks (predictive of additional structural damage), recording disease activity and saving clinicians time; 3) the existence of user-friendly platforms for electronic patient self-reporting and how ubiquitous computing technology can improve the patients' compliance and adherence to therapy.
Methods This was a double-blinded randomized controlled study. All patients diagnosed to have early inflammatory arthritis (EA) according to the ACR/EULAR criteria (2010) completed a PROMs paper format in their first visit to the rheumatology clinic. Patients were randomized to: Group 1: download an e-PROMs questionnaire, complete and save it online as well as print a copy of the completed questionnaire on monthly bases. Group 2: continue the standard clinical practice with monthly visits to the clinic and completing the standard PROMs paper format. Patients in both groups were taught how to calculate RAPID 3. For a total period of 1-year, Group 1 patients were assessed every 3 months in the clinic, whereas group 2 patients were assessed on monthly basis in the first 6 months, then every 3 months. Both groups were treated following the same protocol (NICE guidelines). Primary end point: no inferiority of outcomes and management of the patients (RAPID 3 and DAS-28 scores) in both groups. Secondary end point: the patients' adherence to their medications by the end of 1-year assessment period.
Results By the end of 3 months, 27% of group I and 26% of group II achieved remission (DAS-28<2.6) or low disease activity (DAS-28 <3.2). Mean RAPID 3 score in group I was 3.85+1.66 whereas in Group II it was 3.43 + 1.57. At 6-months, 56% of group I and 57% of group II achieved remission or low disease activity. At 12-months 22% of group I and 24% of group II have started already biologic therapy. There was a trend toward lower patient reported tender joints count and functional disability score in group I versus group II, though no significant difference. The patients' adherence to anti-rheumatic therapy was significantly (p<0.1) higher in group I whereas stopping DMARDs for intolerability was significantly (p<0.01) higher in group II at both 6- and 12-months of treatment.
Conclusions By recording and monitoring disease activity electronically and giving the patients the ability to personally record their disease activity, a new experience can be created. e-PROMs, was not inferior to standard paper PROMs format. Furthermore, it enabled the patients to personally monitor how they are doing regarding their disease activity and helped to optimize their adherence to their treatment. e-PROMs might have a potential disease modifying role.
Disclosure of Interest None declared
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