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

Abstract

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.

Mobile App-based documentation of patient-reported outcomes — 3-months results from a proof-of-concept study on modern rheumatology patient management

“…Our data showed that App use for self-reporting of symptoms is feasible longitudinally, and retention rate after 3 months was still high in MiDEAR. Thus, as reported from other ePROM studies, the App use might contribute to optimized patient–doctor interactions and care [ 31 , 32 ].…”

“…Walker et al rated web-based patient assessments as useful for cost-effective monitoring between outpatient visits [ 28 ]. Further positive results and benefits from mHealth interventions have recently been summarized by Seppen et al [ 31 ]. In line with those findings our rheumatologists, who e.g., valued the App data for permitting broader views on the course of the disease, reported some positive effect on the patient-physician interaction and on therapy adherence, and recommended its further use.…”

Development, implementation and real-life use assessment of HIBOOT: a smartphone application for safety, self-assessment and medication adherence for patients with inflammatory arthritis. A user-centred step-by-step approach.

“…HIBOOT app does not contain monitoring of patient-related outcomes as described in other apps [7]. Although studies have shown that patients favour self-monitoring health or disease activity [39][40][41] and many people with IA would agree to share their mobile app data for research purposes or regularly enter data [40], self-monitoring was suggested by only 10 patients in our quantitative study and thus was not retained.…”

“…This observation may indicate that an important proportion of French people with IA was interested in installing HIBOOT, probably close to the whole population who already used mhealth apps (i.e, 5%). The HIBOOT app life is longer than most published apps: some have shown a rapid decrease in use over a 4-week period [7], 75% people had stopped using them after 3 months [39] and only 5% of apps for rheumatic and musculoskeletal diseases were still available 2 years after their launch [4].…”

“…Mobile health applications (mhealth apps) have undergone signi cant development in recent years and are of increasing interest and usefulness to help patients manage their chronic in ammatory arthritis (IA), that is, rheumatoid arthritis (RA) and spondyloarthritis (SpA) including psoriatic arthritis [1][2][3]. Most mhealth apps for IA described in the English literature have addressed symptom tracking, including disease activity, pain and fatigue [4][5][6][7]. Other outcomes pursued included physical activity [8.9].…”