Monitoring of Disease Activity With a Smartphone App in Routine Clinical Care in Patients With Axial Spondyloarthritis

Abstract

Objective To investigate the performance of a health app with respect to usability, adherence and equivalence of data in daily care of patients with axial spondyloarthritis (axSpA). Methods Consecutive axSpA patients were asked to export patient-reported outcomes (PRO) electronically with the AxSpA Live App regularly every 2 weeks over a period of 6 months. The first clinical visit was followed by two further personal visits after 3 and 6 months. Patients completed paper-based PRO at every visit, and the Mobile App Rating Scale (MARS) and the System Usability Scale (SUS) after 3 and 6 months, respectively. Results Of 103 axSpA patients 69 agreed to participate (67.0%): age 41.5 (11.3) years, 58.0% male, BASDAI 4.3 (2.0), and 76.8% treated with biologic DMARDS. Patients' adherence to regular app exports was 29.0% and 28.6% after 3 and 6 months, respectively. Significant predictors for good adherence were high disease activity (p = 0.02) and older age (p = 0.04). No systematic differences between digital and paper-based BASDAI scores were found (ICC 0.99 (95%CI 0.98 – 0.99). Performance of the app was rated as good. Conclusion Collection of digital PROs by use of AxSpA Live App may be successfully used in axSpA patients with high disease activity. Our study showed equivalence of digital data but the adherence to the app after 6 months was poor. Higher disease activity and older age resulted in increased adherence to the app. This suggests that the use of health apps like this should concentrate on more severely affected patients.

The Use of Mobile Health Apps in Clinical Practice Remains Challenging

“…9,14,15 In their study, Kempin et al found that older age and higher disease activity were predictors of better app adherence and concluded that health apps such as the AxSpA Live App should concentrate on more severely affected patients. 12 These results contrast in part with findings from a study of rheumatoid arthritis, in which ePROMs were assessed daily with an app. 10 In this study, patients aged 65 years and older were also found to have adhered better to the app; however, the same study found that low instead of high baseline clinical disease activity predicted better adherence.…”

“…8 In this issue of The Journal of Rheumatology, Kempin et al report a proof-of-concept study that investigated the performance of a health app, the AxSpA Live App, with respect to usability, adherence, and equivalence of data in the daily care of patients with axSpA. 12 Every 2 weeks during a 6-month period, patients were asked to complete ePROMs on disease activity and pain, and they subsequently had to export these data via a secure link to the treating rheumatologist. The entries were graphically displayed, so patients could view personal results over time.…”

“…The poor adherence rate in the study by Kempin et al might be explained by the relatively short interval between assessments, as well as the high number of required data transfers. 12 The interval was based on an Assessment of SpondyloArthritis International Society-European Alliance of Associations for Rheumatology recommendation specifically targeted at patients with axSpA with HDA, starting nonsteroidal antiinflammatory drug (NSAID) therapy, for whom biweekly disease activity assessments are advised during a 4-week period (ie, 2 courses of NSAID), after which bDMARD therapy is indicated in case of insufficient response. 2 However, the study design of Kempin et al 12 does not allow for determining whether the AxSpA Live App is fit for use in this specific context.…”

“…The authors acknowledge that this 2-week assessment interval might have been very ambitious. 12 However, other studies have suggested that more frequent use of a health app could actually lead to better adherence, because patients are more likely to integrate this in their daily routine. 9,10 In the study by Kempin et al, patients had to actively export their data and only these exported data were included in the evaluation.…”

“…9,10 In the study by Kempin et al, patients had to actively export their data and only these exported data were included in the evaluation. 12 This action could also have been a barrier for patients to use the app. Perhaps patients had actually entered data, but did not export them; however, this was not studied.…”